|
PLATE CONDYLAR LOCKING L 14H
|
Facility
|
IP
|
$9,586.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.25 |
| Max. Negotiated Rate |
$9,203.09 |
| Rate for Payer: Aetna Commercial |
$7,381.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,477.51
|
| Rate for Payer: Cash Price |
$4,793.28
|
| Rate for Payer: Cigna Commercial |
$7,956.84
|
| Rate for Payer: First Health Commercial |
$9,107.22
|
| Rate for Payer: Humana Commercial |
$8,148.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,860.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,074.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,875.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,436.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,189.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,971.83
|
| Rate for Payer: PHCS Commercial |
$9,203.09
|
| Rate for Payer: United Healthcare All Payer |
$8,436.16
|
|
|
PLATE CONDYLAR LOCKING L 14H
|
Facility
|
OP
|
$9,586.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.25 |
| Max. Negotiated Rate |
$9,203.09 |
| Rate for Payer: Aetna Commercial |
$7,381.64
|
| Rate for Payer: Anthem Medicaid |
$3,296.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,477.51
|
| Rate for Payer: Cash Price |
$4,793.28
|
| Rate for Payer: Cigna Commercial |
$7,956.84
|
| Rate for Payer: First Health Commercial |
$9,107.22
|
| Rate for Payer: Humana Commercial |
$8,148.57
|
| Rate for Payer: Humana KY Medicaid |
$3,296.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,330.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,860.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,074.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,875.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,362.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,436.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,189.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,971.83
|
| Rate for Payer: PHCS Commercial |
$9,203.09
|
| Rate for Payer: United Healthcare All Payer |
$8,436.16
|
|
|
PLATE CONDYLAR LOCKING L 16H
|
Facility
|
IP
|
$9,719.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.49 |
| Max. Negotiated Rate |
$9,330.39 |
| Rate for Payer: Aetna Commercial |
$7,483.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,580.94
|
| Rate for Payer: Cash Price |
$4,859.58
|
| Rate for Payer: Cigna Commercial |
$8,066.90
|
| Rate for Payer: First Health Commercial |
$9,233.20
|
| Rate for Payer: Humana Commercial |
$8,261.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,969.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,172.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,915.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,552.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,289.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,943.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,263.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,012.94
|
| Rate for Payer: PHCS Commercial |
$9,330.39
|
| Rate for Payer: United Healthcare All Payer |
$8,552.86
|
|
|
PLATE CONDYLAR LOCKING L 16H
|
Facility
|
OP
|
$9,719.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.49 |
| Max. Negotiated Rate |
$9,330.39 |
| Rate for Payer: Aetna Commercial |
$7,483.75
|
| Rate for Payer: Anthem Medicaid |
$3,342.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,580.94
|
| Rate for Payer: Cash Price |
$4,859.58
|
| Rate for Payer: Cigna Commercial |
$8,066.90
|
| Rate for Payer: First Health Commercial |
$9,233.20
|
| Rate for Payer: Humana Commercial |
$8,261.29
|
| Rate for Payer: Humana KY Medicaid |
$3,342.42
|
| Rate for Payer: Kentucky WC Medicaid |
$3,376.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,969.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,172.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,915.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,409.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,552.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,289.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,943.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,263.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,012.94
|
| Rate for Payer: PHCS Commercial |
$9,330.39
|
| Rate for Payer: United Healthcare All Payer |
$8,552.86
|
|
|
PLATE CONDYLAR LOCKING L 18H
|
Facility
|
OP
|
$9,862.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,282.17 |
| Max. Negotiated Rate |
$9,468.35 |
| Rate for Payer: Aetna Commercial |
$7,594.40
|
| Rate for Payer: Anthem Medicaid |
$3,391.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,693.03
|
| Rate for Payer: Cash Price |
$4,931.43
|
| Rate for Payer: Cigna Commercial |
$8,186.17
|
| Rate for Payer: First Health Commercial |
$9,369.72
|
| Rate for Payer: Humana Commercial |
$8,383.43
|
| Rate for Payer: Humana KY Medicaid |
$3,391.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3,426.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,087.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,278.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,958.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,459.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,679.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,397.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,972.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,282.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,057.49
|
| Rate for Payer: PHCS Commercial |
$9,468.35
|
| Rate for Payer: United Healthcare All Payer |
$8,679.32
|
|
|
PLATE CONDYLAR LOCKING L 18H
|
Facility
|
IP
|
$9,862.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,282.17 |
| Max. Negotiated Rate |
$9,468.35 |
| Rate for Payer: Aetna Commercial |
$7,594.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,693.03
|
| Rate for Payer: Cash Price |
$4,931.43
|
| Rate for Payer: Cigna Commercial |
$8,186.17
|
| Rate for Payer: First Health Commercial |
$9,369.72
|
| Rate for Payer: Humana Commercial |
$8,383.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,087.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,278.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,958.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,679.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,397.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,972.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,282.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,057.49
|
| Rate for Payer: PHCS Commercial |
$9,468.35
|
| Rate for Payer: United Healthcare All Payer |
$8,679.32
|
|
|
PLATE CONDYLAR LOCKING R 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 R 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 R 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
|
|
|
PLATE CONDYLAR LOCKING R 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 R 14H
|
Facility
|
OP
|
$9,586.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.25 |
| Max. Negotiated Rate |
$9,203.09 |
| Rate for Payer: Aetna Commercial |
$7,381.64
|
| Rate for Payer: Anthem Medicaid |
$3,296.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,477.51
|
| Rate for Payer: Cash Price |
$4,793.28
|
| Rate for Payer: Cigna Commercial |
$7,956.84
|
| Rate for Payer: First Health Commercial |
$9,107.22
|
| Rate for Payer: Humana Commercial |
$8,148.57
|
| Rate for Payer: Humana KY Medicaid |
$3,296.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,330.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,860.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,074.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,875.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,362.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,436.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,189.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,971.83
|
| Rate for Payer: PHCS Commercial |
$9,203.09
|
| Rate for Payer: United Healthcare All Payer |
$8,436.16
|
|
|
PLATE CONDYLAR LOCKING R 14H
|
Facility
|
IP
|
$9,586.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.25 |
| Max. Negotiated Rate |
$9,203.09 |
| Rate for Payer: Aetna Commercial |
$7,381.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,477.51
|
| Rate for Payer: Cash Price |
$4,793.28
|
| Rate for Payer: Cigna Commercial |
$7,956.84
|
| Rate for Payer: First Health Commercial |
$9,107.22
|
| Rate for Payer: Humana Commercial |
$8,148.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,860.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,074.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,875.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,436.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,189.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,971.83
|
| Rate for Payer: PHCS Commercial |
$9,203.09
|
| Rate for Payer: United Healthcare All Payer |
$8,436.16
|
|
|
PLATE CONDYLAR LOCKING R 16H
|
Facility
|
IP
|
$9,719.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.49 |
| Max. Negotiated Rate |
$9,330.39 |
| Rate for Payer: Aetna Commercial |
$7,483.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,580.94
|
| Rate for Payer: Cash Price |
$4,859.58
|
| Rate for Payer: Cigna Commercial |
$8,066.90
|
| Rate for Payer: First Health Commercial |
$9,233.20
|
| Rate for Payer: Humana Commercial |
$8,261.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,969.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,172.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,915.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,552.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,289.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,943.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,263.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,012.94
|
| Rate for Payer: PHCS Commercial |
$9,330.39
|
| Rate for Payer: United Healthcare All Payer |
$8,552.86
|
|
|
PLATE CONDYLAR LOCKING R 16H
|
Facility
|
OP
|
$9,719.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.49 |
| Max. Negotiated Rate |
$9,330.39 |
| Rate for Payer: Aetna Commercial |
$7,483.75
|
| Rate for Payer: Anthem Medicaid |
$3,342.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,580.94
|
| Rate for Payer: Cash Price |
$4,859.58
|
| Rate for Payer: Cigna Commercial |
$8,066.90
|
| Rate for Payer: First Health Commercial |
$9,233.20
|
| Rate for Payer: Humana Commercial |
$8,261.29
|
| Rate for Payer: Humana KY Medicaid |
$3,342.42
|
| Rate for Payer: Kentucky WC Medicaid |
$3,376.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,969.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,172.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,915.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,409.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,552.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,289.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,943.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,263.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,012.94
|
| Rate for Payer: PHCS Commercial |
$9,330.39
|
| Rate for Payer: United Healthcare All Payer |
$8,552.86
|
|
|
PLATE CONDYLAR LOCKING R 18H
|
Facility
|
IP
|
$9,719.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.49 |
| Max. Negotiated Rate |
$9,330.39 |
| Rate for Payer: Aetna Commercial |
$7,483.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,580.94
|
| Rate for Payer: Cash Price |
$4,859.58
|
| Rate for Payer: Cigna Commercial |
$8,066.90
|
| Rate for Payer: First Health Commercial |
$9,233.20
|
| Rate for Payer: Humana Commercial |
$8,261.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,969.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,172.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,915.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,552.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,289.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,943.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,263.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,012.94
|
| Rate for Payer: PHCS Commercial |
$9,330.39
|
| Rate for Payer: United Healthcare All Payer |
$8,552.86
|
|
|
PLATE CONDYLAR LOCKING R 18H
|
Facility
|
OP
|
$9,719.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.49 |
| Max. Negotiated Rate |
$9,330.39 |
| Rate for Payer: Aetna Commercial |
$7,483.75
|
| Rate for Payer: Anthem Medicaid |
$3,342.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,580.94
|
| Rate for Payer: Cash Price |
$4,859.58
|
| Rate for Payer: Cigna Commercial |
$8,066.90
|
| Rate for Payer: First Health Commercial |
$9,233.20
|
| Rate for Payer: Humana Commercial |
$8,261.29
|
| Rate for Payer: Humana KY Medicaid |
$3,342.42
|
| Rate for Payer: Kentucky WC Medicaid |
$3,376.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,969.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,172.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,915.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,409.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,552.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,289.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,943.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,263.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,012.94
|
| Rate for Payer: PHCS Commercial |
$9,330.39
|
| Rate for Payer: United Healthcare All Payer |
$8,552.86
|
|
|
PLATE CONDYLAR LT 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: 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: Aetna Commercial |
$2,478.51
|
| 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 LT 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 LT 2.7MM
|
Facility
|
IP
|
$3,283.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.85 |
| Max. Negotiated Rate |
$3,152.09 |
| Rate for Payer: Aetna Commercial |
$2,528.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.08
|
| Rate for Payer: Cash Price |
$1,641.71
|
| Rate for Payer: Cigna Commercial |
$2,725.25
|
| Rate for Payer: First Health Commercial |
$3,119.26
|
| Rate for Payer: Humana Commercial |
$2,790.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,889.42
|
| Rate for Payer: Ohio Health Group HMO |
$2,462.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.86
|
| Rate for Payer: PHCS Commercial |
$3,152.09
|
| Rate for Payer: United Healthcare All Payer |
$2,889.42
|
|
|
PLATE CONDYLAR LT 2.7MM
|
Facility
|
OP
|
$3,283.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.85 |
| Max. Negotiated Rate |
$3,152.09 |
| Rate for Payer: Aetna Commercial |
$2,528.24
|
| Rate for Payer: Anthem Medicaid |
$1,129.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.08
|
| Rate for Payer: Cash Price |
$1,641.71
|
| Rate for Payer: Cigna Commercial |
$2,725.25
|
| Rate for Payer: First Health Commercial |
$3,119.26
|
| Rate for Payer: Humana Commercial |
$2,790.92
|
| Rate for Payer: Humana KY Medicaid |
$1,129.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,140.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,151.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,889.42
|
| Rate for Payer: Ohio Health Group HMO |
$2,462.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.86
|
| Rate for Payer: PHCS Commercial |
$3,152.09
|
| Rate for Payer: United Healthcare All Payer |
$2,889.42
|
|
|
PLATE CONDYLAR RT 2.7MM
|
Facility
|
OP
|
$3,283.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.85 |
| Max. Negotiated Rate |
$3,152.09 |
| Rate for Payer: Aetna Commercial |
$2,528.24
|
| Rate for Payer: Anthem Medicaid |
$1,129.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.08
|
| Rate for Payer: Cash Price |
$1,641.71
|
| Rate for Payer: Cigna Commercial |
$2,725.25
|
| Rate for Payer: First Health Commercial |
$3,119.26
|
| Rate for Payer: Humana Commercial |
$2,790.92
|
| Rate for Payer: Humana KY Medicaid |
$1,129.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,140.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,151.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,889.42
|
| Rate for Payer: Ohio Health Group HMO |
$2,462.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.86
|
| Rate for Payer: PHCS Commercial |
$3,152.09
|
| Rate for Payer: United Healthcare All Payer |
$2,889.42
|
|
|
PLATE CONDYLAR RT 2.7MM
|
Facility
|
IP
|
$3,283.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.85 |
| Max. Negotiated Rate |
$3,152.09 |
| Rate for Payer: Aetna Commercial |
$2,528.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.08
|
| Rate for Payer: Cash Price |
$1,641.71
|
| Rate for Payer: Cigna Commercial |
$2,725.25
|
| Rate for Payer: First Health Commercial |
$3,119.26
|
| Rate for Payer: Humana Commercial |
$2,790.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,889.42
|
| Rate for Payer: Ohio Health Group HMO |
$2,462.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.86
|
| Rate for Payer: PHCS Commercial |
$3,152.09
|
| Rate for Payer: United Healthcare All Payer |
$2,889.42
|
|
|
PLATE CONDY LCP 4.5 10H 242M L
|
Facility
|
OP
|
$7,382.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.74 |
| Max. Negotiated Rate |
$7,087.28 |
| Rate for Payer: Aetna Commercial |
$5,684.59
|
| Rate for Payer: Anthem Medicaid |
$2,538.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,758.41
|
| Rate for Payer: Cash Price |
$3,691.29
|
| Rate for Payer: Cigna Commercial |
$6,127.54
|
| Rate for Payer: First Health Commercial |
$7,013.45
|
| Rate for Payer: Humana Commercial |
$6,275.19
|
| Rate for Payer: Humana KY Medicaid |
$2,538.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,564.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,053.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,448.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,589.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,496.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,536.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,476.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$959.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,288.60
|
| Rate for Payer: PHCS Commercial |
$7,087.28
|
| Rate for Payer: United Healthcare All Payer |
$6,496.67
|
|
|
PLATE CONDY LCP 4.5 10H 242M L
|
Facility
|
IP
|
$7,382.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.74 |
| Max. Negotiated Rate |
$7,087.28 |
| Rate for Payer: Aetna Commercial |
$5,684.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,758.41
|
| Rate for Payer: Cash Price |
$3,691.29
|
| Rate for Payer: Cigna Commercial |
$6,127.54
|
| Rate for Payer: First Health Commercial |
$7,013.45
|
| Rate for Payer: Humana Commercial |
$6,275.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,053.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,448.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,496.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,536.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,476.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$959.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,288.60
|
| Rate for Payer: PHCS Commercial |
$7,087.28
|
| Rate for Payer: United Healthcare All Payer |
$6,496.67
|
|
|
PLATE CONDY LCP 4.5 10H 242M R
|
Facility
|
IP
|
$7,382.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.74 |
| Max. Negotiated Rate |
$7,087.28 |
| Rate for Payer: Aetna Commercial |
$5,684.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,758.41
|
| Rate for Payer: Cash Price |
$3,691.29
|
| Rate for Payer: Cigna Commercial |
$6,127.54
|
| Rate for Payer: First Health Commercial |
$7,013.45
|
| Rate for Payer: Humana Commercial |
$6,275.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,053.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,448.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,496.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,536.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,476.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$959.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,288.60
|
| Rate for Payer: PHCS Commercial |
$7,087.28
|
| Rate for Payer: United Healthcare All Payer |
$6,496.67
|
|
