|
PLATE COMP LK 3.5MM 7H 111MM
|
Facility
|
IP
|
$3,248.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.36 |
| Max. Negotiated Rate |
$3,118.99 |
| Rate for Payer: Aetna Commercial |
$2,501.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,534.18
|
| Rate for Payer: Cash Price |
$1,624.47
|
| Rate for Payer: Cigna Commercial |
$2,696.63
|
| Rate for Payer: First Health Commercial |
$3,086.50
|
| Rate for Payer: Humana Commercial |
$2,761.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,664.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,397.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$974.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,859.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,436.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.17
|
| Rate for Payer: PHCS Commercial |
$3,118.99
|
| Rate for Payer: United Healthcare All Payer |
$2,859.08
|
|
|
PLATE COMP LK 3.5MM 8H 125MM
|
Facility
|
OP
|
$3,404.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.57 |
| Max. Negotiated Rate |
$3,268.18 |
| Rate for Payer: Anthem Medicaid |
$1,170.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,655.39
|
| Rate for Payer: Cash Price |
$1,702.17
|
| Rate for Payer: Cigna Commercial |
$2,825.61
|
| Rate for Payer: First Health Commercial |
$3,234.13
|
| Rate for Payer: Humana Commercial |
$2,893.70
|
| Rate for Payer: Humana KY Medicaid |
$1,170.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,182.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,791.57
|
| Rate for Payer: Aetna Commercial |
$2,621.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,512.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,194.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,995.83
|
| Rate for Payer: Ohio Health Group HMO |
$2,553.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.35
|
| Rate for Payer: PHCS Commercial |
$3,268.18
|
| Rate for Payer: United Healthcare All Payer |
$2,995.83
|
|
|
PLATE COMP LK 3.5MM 8H 125MM
|
Facility
|
IP
|
$3,404.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.57 |
| Max. Negotiated Rate |
$3,268.18 |
| Rate for Payer: Aetna Commercial |
$2,621.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,655.39
|
| Rate for Payer: Cash Price |
$1,702.17
|
| Rate for Payer: Cigna Commercial |
$2,825.61
|
| Rate for Payer: First Health Commercial |
$3,234.13
|
| Rate for Payer: Humana Commercial |
$2,893.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,791.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,512.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,995.83
|
| Rate for Payer: Ohio Health Group HMO |
$2,553.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.35
|
| Rate for Payer: PHCS Commercial |
$3,268.18
|
| Rate for Payer: United Healthcare All Payer |
$2,995.83
|
|
|
PLATE COMP LK 3.5MM 9H 140MM
|
Facility
|
OP
|
$3,326.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.46 |
| Max. Negotiated Rate |
$3,193.58 |
| Rate for Payer: Aetna Commercial |
$2,561.52
|
| Rate for Payer: Anthem Medicaid |
$1,144.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,594.79
|
| Rate for Payer: Cash Price |
$1,663.33
|
| Rate for Payer: Cigna Commercial |
$2,761.12
|
| Rate for Payer: First Health Commercial |
$3,160.32
|
| Rate for Payer: Humana Commercial |
$2,827.65
|
| Rate for Payer: Humana KY Medicaid |
$1,144.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,155.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,727.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,455.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,166.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,927.45
|
| Rate for Payer: Ohio Health Group HMO |
$2,494.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$665.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$432.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.26
|
| Rate for Payer: PHCS Commercial |
$3,193.58
|
| Rate for Payer: United Healthcare All Payer |
$2,927.45
|
|
|
PLATE COMP LK 3.5MM 9H 140MM
|
Facility
|
IP
|
$3,326.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.46 |
| Max. Negotiated Rate |
$3,193.58 |
| Rate for Payer: Aetna Commercial |
$2,561.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,594.79
|
| Rate for Payer: Cash Price |
$1,663.33
|
| Rate for Payer: Cigna Commercial |
$2,761.12
|
| Rate for Payer: First Health Commercial |
$3,160.32
|
| Rate for Payer: Humana Commercial |
$2,827.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,727.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,455.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,927.45
|
| Rate for Payer: Ohio Health Group HMO |
$2,494.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$665.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$432.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.26
|
| Rate for Payer: PHCS Commercial |
$3,193.58
|
| Rate for Payer: United Healthcare All Payer |
$2,927.45
|
|
|
PLATE COMPRESSION 1.3MM 6H
|
Facility
|
OP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem Medicaid |
$1,175.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Humana KY Medicaid |
$1,175.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,187.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,199.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE COMPRESSION 1.3MM 6H
|
Facility
|
IP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE COMPRESSION 2.0MM 4H
|
Facility
|
OP
|
$3,270.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.18 |
| Max. Negotiated Rate |
$3,139.82 |
| Rate for Payer: Aetna Commercial |
$2,518.40
|
| Rate for Payer: Anthem Medicaid |
$1,124.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,551.11
|
| Rate for Payer: Cash Price |
$1,635.33
|
| Rate for Payer: Cigna Commercial |
$2,714.64
|
| Rate for Payer: First Health Commercial |
$3,107.12
|
| Rate for Payer: Humana Commercial |
$2,780.05
|
| Rate for Payer: Humana KY Medicaid |
$1,124.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,136.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,681.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,413.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$981.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,147.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,878.17
|
| Rate for Payer: Ohio Health Group HMO |
$2,452.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,013.90
|
| Rate for Payer: PHCS Commercial |
$3,139.82
|
| Rate for Payer: United Healthcare All Payer |
$2,878.17
|
|
|
PLATE COMPRESSION 2.0MM 4H
|
Facility
|
IP
|
$3,270.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.18 |
| Max. Negotiated Rate |
$3,139.82 |
| Rate for Payer: Aetna Commercial |
$2,518.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,551.11
|
| Rate for Payer: Cash Price |
$1,635.33
|
| Rate for Payer: Cigna Commercial |
$2,714.64
|
| Rate for Payer: First Health Commercial |
$3,107.12
|
| Rate for Payer: Humana Commercial |
$2,780.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,681.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,413.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$981.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,878.17
|
| Rate for Payer: Ohio Health Group HMO |
$2,452.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,013.90
|
| Rate for Payer: PHCS Commercial |
$3,139.82
|
| Rate for Payer: United Healthcare All Payer |
$2,878.17
|
|
|
PLATE COMPRESSION 2.0MM 6H
|
Facility
|
IP
|
$3,758.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.58 |
| Max. Negotiated Rate |
$3,607.94 |
| Rate for Payer: Aetna Commercial |
$2,893.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,931.45
|
| Rate for Payer: Cash Price |
$1,879.13
|
| Rate for Payer: Cigna Commercial |
$3,119.36
|
| Rate for Payer: First Health Commercial |
$3,570.36
|
| Rate for Payer: Humana Commercial |
$3,194.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,081.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,773.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,127.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,307.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,818.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$751.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,165.06
|
| Rate for Payer: PHCS Commercial |
$3,607.94
|
| Rate for Payer: United Healthcare All Payer |
$3,307.28
|
|
|
PLATE COMPRESSION 2.0MM 6H
|
Facility
|
OP
|
$3,758.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.58 |
| Max. Negotiated Rate |
$3,607.94 |
| Rate for Payer: Aetna Commercial |
$2,893.87
|
| Rate for Payer: Anthem Medicaid |
$1,292.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,931.45
|
| Rate for Payer: Cash Price |
$1,879.13
|
| Rate for Payer: Cigna Commercial |
$3,119.36
|
| Rate for Payer: First Health Commercial |
$3,570.36
|
| Rate for Payer: Humana Commercial |
$3,194.53
|
| Rate for Payer: Humana KY Medicaid |
$1,292.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,305.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,081.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,773.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,127.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,318.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,307.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,818.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$751.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,165.06
|
| Rate for Payer: PHCS Commercial |
$3,607.94
|
| Rate for Payer: United Healthcare All Payer |
$3,307.28
|
|
|
PLATE COMPRESSION 2.3MM 4H
|
Facility
|
IP
|
$3,268.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.91 |
| Max. Negotiated Rate |
$3,137.77 |
| Rate for Payer: Aetna Commercial |
$2,516.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,549.44
|
| Rate for Payer: Cash Price |
$1,634.26
|
| Rate for Payer: Cigna Commercial |
$2,712.86
|
| Rate for Payer: First Health Commercial |
$3,105.08
|
| Rate for Payer: Humana Commercial |
$2,778.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,680.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,412.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$980.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,876.29
|
| Rate for Payer: Ohio Health Group HMO |
$2,451.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$653.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$424.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,013.24
|
| Rate for Payer: PHCS Commercial |
$3,137.77
|
| Rate for Payer: United Healthcare All Payer |
$2,876.29
|
|
|
PLATE COMPRESSION 2.3MM 4H
|
Facility
|
OP
|
$3,268.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.91 |
| Max. Negotiated Rate |
$3,137.77 |
| Rate for Payer: Anthem Medicaid |
$1,124.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,549.44
|
| Rate for Payer: Cash Price |
$1,634.26
|
| Rate for Payer: Cigna Commercial |
$2,712.86
|
| Rate for Payer: First Health Commercial |
$3,105.08
|
| Rate for Payer: Humana Commercial |
$2,778.23
|
| Rate for Payer: Humana KY Medicaid |
$1,124.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,135.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,680.18
|
| Rate for Payer: Aetna Commercial |
$2,516.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,412.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$980.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,146.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,876.29
|
| Rate for Payer: Ohio Health Group HMO |
$2,451.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$653.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$424.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,013.24
|
| Rate for Payer: PHCS Commercial |
$3,137.77
|
| Rate for Payer: United Healthcare All Payer |
$2,876.29
|
|
|
PLATE COMPRESSION 2.3MM 6H
|
Facility
|
IP
|
$3,758.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.58 |
| Max. Negotiated Rate |
$3,607.94 |
| Rate for Payer: Aetna Commercial |
$2,893.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,931.45
|
| Rate for Payer: Cash Price |
$1,879.13
|
| Rate for Payer: Cigna Commercial |
$3,119.36
|
| Rate for Payer: First Health Commercial |
$3,570.36
|
| Rate for Payer: Humana Commercial |
$3,194.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,081.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,773.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,127.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,307.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,818.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$751.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,165.06
|
| Rate for Payer: PHCS Commercial |
$3,607.94
|
| Rate for Payer: United Healthcare All Payer |
$3,307.28
|
|
|
PLATE COMPRESSION 2.3MM 6H
|
Facility
|
OP
|
$3,758.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.58 |
| Max. Negotiated Rate |
$3,607.94 |
| Rate for Payer: Aetna Commercial |
$2,893.87
|
| Rate for Payer: Anthem Medicaid |
$1,292.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,931.45
|
| Rate for Payer: Cash Price |
$1,879.13
|
| Rate for Payer: Cigna Commercial |
$3,119.36
|
| Rate for Payer: First Health Commercial |
$3,570.36
|
| Rate for Payer: Humana Commercial |
$3,194.53
|
| Rate for Payer: Humana KY Medicaid |
$1,292.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,305.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,081.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,773.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,127.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,318.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,307.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,818.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$751.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,165.06
|
| Rate for Payer: PHCS Commercial |
$3,607.94
|
| Rate for Payer: United Healthcare All Payer |
$3,307.28
|
|
|
PLATE COMPRESSION 5H
|
Facility
|
IP
|
$4,032.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.25 |
| Max. Negotiated Rate |
$3,871.39 |
| Rate for Payer: Aetna Commercial |
$3,105.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,145.51
|
| Rate for Payer: Cash Price |
$2,016.35
|
| Rate for Payer: Cigna Commercial |
$3,347.14
|
| Rate for Payer: First Health Commercial |
$3,831.06
|
| Rate for Payer: Humana Commercial |
$3,427.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,306.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,976.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,209.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,548.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,024.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$806.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,250.14
|
| Rate for Payer: PHCS Commercial |
$3,871.39
|
| Rate for Payer: United Healthcare All Payer |
$3,548.78
|
|
|
PLATE COMPRESSION 5H
|
Facility
|
OP
|
$4,032.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.25 |
| Max. Negotiated Rate |
$3,871.39 |
| Rate for Payer: Aetna Commercial |
$3,105.18
|
| Rate for Payer: Anthem Medicaid |
$1,386.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,145.51
|
| Rate for Payer: Cash Price |
$2,016.35
|
| Rate for Payer: Cigna Commercial |
$3,347.14
|
| Rate for Payer: First Health Commercial |
$3,831.06
|
| Rate for Payer: Humana Commercial |
$3,427.80
|
| Rate for Payer: Humana KY Medicaid |
$1,386.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,400.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,306.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,976.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,209.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,414.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,548.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,024.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$806.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,250.14
|
| Rate for Payer: PHCS Commercial |
$3,871.39
|
| Rate for Payer: United Healthcare All Payer |
$3,548.78
|
|
|
PLATE COMPRESSION 7H
|
Facility
|
IP
|
$3,367.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.82 |
| Max. Negotiated Rate |
$3,233.16 |
| Rate for Payer: Aetna Commercial |
$2,593.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,626.95
|
| Rate for Payer: Cash Price |
$1,683.94
|
| Rate for Payer: Cigna Commercial |
$2,795.34
|
| Rate for Payer: First Health Commercial |
$3,199.49
|
| Rate for Payer: Humana Commercial |
$2,862.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,761.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,485.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,963.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,525.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$673.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$437.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,044.04
|
| Rate for Payer: PHCS Commercial |
$3,233.16
|
| Rate for Payer: United Healthcare All Payer |
$2,963.73
|
|
|
PLATE COMPRESSION 7H
|
Facility
|
OP
|
$3,367.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.82 |
| Max. Negotiated Rate |
$3,233.16 |
| Rate for Payer: Aetna Commercial |
$2,593.27
|
| Rate for Payer: Anthem Medicaid |
$1,158.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,626.95
|
| Rate for Payer: Cash Price |
$1,683.94
|
| Rate for Payer: Cigna Commercial |
$2,795.34
|
| Rate for Payer: First Health Commercial |
$3,199.49
|
| Rate for Payer: Humana Commercial |
$2,862.70
|
| Rate for Payer: Humana KY Medicaid |
$1,158.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,170.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,761.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,485.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,181.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,963.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,525.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$673.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$437.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,044.04
|
| Rate for Payer: PHCS Commercial |
$3,233.16
|
| Rate for Payer: United Healthcare All Payer |
$2,963.73
|
|
|
PLATE CONDYLAR 2.0MM
|
Facility
|
OP
|
$3,218.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$418.45 |
| Max. Negotiated Rate |
$3,090.10 |
| Rate for Payer: Aetna Commercial |
$2,478.51
|
| Rate for Payer: Anthem Medicaid |
$1,106.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,510.70
|
| Rate for Payer: Cash Price |
$1,609.42
|
| Rate for Payer: Cigna Commercial |
$2,671.65
|
| Rate for Payer: First Health Commercial |
$3,057.91
|
| Rate for Payer: Humana Commercial |
$2,736.02
|
| Rate for Payer: Humana KY Medicaid |
$1,106.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,118.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,639.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,375.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,129.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,832.59
|
| Rate for Payer: Ohio Health Group HMO |
$2,414.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$418.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$997.84
|
| Rate for Payer: PHCS Commercial |
$3,090.10
|
| Rate for Payer: United Healthcare All Payer |
$2,832.59
|
|
|
PLATE CONDYLAR 2.0MM
|
Facility
|
IP
|
$3,218.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$418.45 |
| Max. Negotiated Rate |
$3,090.10 |
| Rate for Payer: Aetna Commercial |
$2,478.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,510.70
|
| Rate for Payer: Cash Price |
$1,609.42
|
| Rate for Payer: Cigna Commercial |
$2,671.65
|
| Rate for Payer: First Health Commercial |
$3,057.91
|
| Rate for Payer: Humana Commercial |
$2,736.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,639.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,375.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,832.59
|
| Rate for Payer: Ohio Health Group HMO |
$2,414.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$418.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$997.84
|
| Rate for Payer: PHCS Commercial |
$3,090.10
|
| Rate for Payer: United Healthcare All Payer |
$2,832.59
|
|
|
PLATE CONDYLAR LOCKING L 10H
|
Facility
|
OP
|
$9,313.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.80 |
| Max. Negotiated Rate |
$8,941.31 |
| Rate for Payer: Anthem Medicaid |
$3,203.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,264.81
|
| Rate for Payer: Cash Price |
$4,656.93
|
| Rate for Payer: Cigna Commercial |
$7,730.50
|
| Rate for Payer: First Health Commercial |
$8,848.17
|
| Rate for Payer: Humana Commercial |
$7,916.78
|
| Rate for Payer: Humana KY Medicaid |
$3,203.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,235.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,637.37
|
| Rate for Payer: Aetna Commercial |
$7,171.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,873.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,267.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,196.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,985.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,862.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.30
|
| Rate for Payer: PHCS Commercial |
$8,941.31
|
| Rate for Payer: United Healthcare All Payer |
$8,196.20
|
|
|
PLATE CONDYLAR LOCKING L 10H
|
Facility
|
IP
|
$9,313.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.80 |
| Max. Negotiated Rate |
$8,941.31 |
| Rate for Payer: Aetna Commercial |
$7,171.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,264.81
|
| Rate for Payer: Cash Price |
$4,656.93
|
| Rate for Payer: Cigna Commercial |
$7,730.50
|
| Rate for Payer: First Health Commercial |
$8,848.17
|
| Rate for Payer: Humana Commercial |
$7,916.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,637.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,873.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,196.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,985.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,862.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.30
|
| Rate for Payer: PHCS Commercial |
$8,941.31
|
| Rate for Payer: United Healthcare All Payer |
$8,196.20
|
|
|
PLATE CONDYLAR LOCKING L 12H
|
Facility
|
OP
|
$9,450.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.53 |
| Max. Negotiated Rate |
$9,072.22 |
| Rate for Payer: Aetna Commercial |
$7,276.68
|
| Rate for Payer: Anthem Medicaid |
$3,249.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,371.18
|
| Rate for Payer: Cash Price |
$4,725.11
|
| Rate for Payer: Cigna Commercial |
$7,843.69
|
| Rate for Payer: First Health Commercial |
$8,977.72
|
| Rate for Payer: Humana Commercial |
$8,032.70
|
| Rate for Payer: Humana KY Medicaid |
$3,249.93
|
| Rate for Payer: Kentucky WC Medicaid |
$3,283.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,749.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,974.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,835.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,315.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,316.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,087.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,890.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,228.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,929.57
|
| Rate for Payer: PHCS Commercial |
$9,072.22
|
| Rate for Payer: United Healthcare All Payer |
$8,316.20
|
|
|
PLATE CONDYLAR LOCKING L 12H
|
Facility
|
IP
|
$9,450.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.53 |
| Max. Negotiated Rate |
$9,072.22 |
| Rate for Payer: Aetna Commercial |
$7,276.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,371.18
|
| Rate for Payer: Cash Price |
$4,725.11
|
| Rate for Payer: Cigna Commercial |
$7,843.69
|
| Rate for Payer: First Health Commercial |
$8,977.72
|
| Rate for Payer: Humana Commercial |
$8,032.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,749.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,974.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,835.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,316.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,087.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,890.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,228.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,929.57
|
| Rate for Payer: PHCS Commercial |
$9,072.22
|
| Rate for Payer: United Healthcare All Payer |
$8,316.20
|
|
