|
PLATE COMPRESSION 2.0MM 4H
|
Facility
|
OP
|
$3,147.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.14 |
| Max. Negotiated Rate |
$3,021.24 |
| Rate for Payer: Aetna Commercial |
$2,423.28
|
| Rate for Payer: Anthem Medicaid |
$1,082.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,454.75
|
| Rate for Payer: Cash Price |
$1,573.56
|
| Rate for Payer: Cigna Commercial |
$2,612.11
|
| Rate for Payer: First Health Commercial |
$2,989.76
|
| Rate for Payer: Humana Commercial |
$2,675.05
|
| Rate for Payer: Humana KY Medicaid |
$1,082.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,093.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,580.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,322.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,104.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,769.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,360.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,517.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,737.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.51
|
| Rate for Payer: PHCS Commercial |
$3,021.24
|
| Rate for Payer: United Healthcare All Payer |
$2,769.47
|
|
|
PLATE COMPRESSION 2.0MM 6H
|
Facility
|
OP
|
$3,669.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,100.87 |
| Max. Negotiated Rate |
$3,522.79 |
| Rate for Payer: Aetna Commercial |
$2,825.57
|
| Rate for Payer: Anthem Medicaid |
$1,261.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,862.26
|
| Rate for Payer: Cash Price |
$1,834.79
|
| Rate for Payer: Cigna Commercial |
$3,045.74
|
| Rate for Payer: First Health Commercial |
$3,486.09
|
| Rate for Payer: Humana Commercial |
$3,119.13
|
| Rate for Payer: Humana KY Medicaid |
$1,261.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,274.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,009.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,708.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,100.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,287.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,229.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,752.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,935.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,192.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,532.00
|
| Rate for Payer: PHCS Commercial |
$3,522.79
|
| Rate for Payer: United Healthcare All Payer |
$3,229.22
|
|
|
PLATE COMPRESSION 2.0MM 6H
|
Facility
|
IP
|
$3,669.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,100.87 |
| Max. Negotiated Rate |
$3,522.79 |
| Rate for Payer: Aetna Commercial |
$2,825.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,862.26
|
| Rate for Payer: Cash Price |
$1,834.79
|
| Rate for Payer: Cigna Commercial |
$3,045.74
|
| Rate for Payer: First Health Commercial |
$3,486.09
|
| Rate for Payer: Humana Commercial |
$3,119.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,009.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,708.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,100.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,229.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,752.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,935.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,192.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,532.00
|
| Rate for Payer: PHCS Commercial |
$3,522.79
|
| Rate for Payer: United Healthcare All Payer |
$3,229.22
|
|
|
PLATE COMPRESSION 2.3MM 4H
|
Facility
|
IP
|
$3,144.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$943.45 |
| Max. Negotiated Rate |
$3,019.05 |
| Rate for Payer: Aetna Commercial |
$2,421.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,452.98
|
| Rate for Payer: Cash Price |
$1,572.42
|
| Rate for Payer: Cigna Commercial |
$2,610.22
|
| Rate for Payer: First Health Commercial |
$2,987.60
|
| Rate for Payer: Humana Commercial |
$2,673.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,578.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,320.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$943.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,767.46
|
| Rate for Payer: Ohio Health Group HMO |
$2,358.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,515.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,736.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.94
|
| Rate for Payer: PHCS Commercial |
$3,019.05
|
| Rate for Payer: United Healthcare All Payer |
$2,767.46
|
|
|
PLATE COMPRESSION 2.3MM 4H
|
Facility
|
OP
|
$3,144.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$943.45 |
| Max. Negotiated Rate |
$3,019.05 |
| Rate for Payer: Aetna Commercial |
$2,421.53
|
| Rate for Payer: Anthem Medicaid |
$1,081.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,452.98
|
| Rate for Payer: Cash Price |
$1,572.42
|
| Rate for Payer: Cigna Commercial |
$2,610.22
|
| Rate for Payer: First Health Commercial |
$2,987.60
|
| Rate for Payer: Humana Commercial |
$2,673.11
|
| Rate for Payer: Humana KY Medicaid |
$1,081.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,092.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,578.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,320.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$943.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,103.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,767.46
|
| Rate for Payer: Ohio Health Group HMO |
$2,358.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,515.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,736.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.94
|
| Rate for Payer: PHCS Commercial |
$3,019.05
|
| Rate for Payer: United Healthcare All Payer |
$2,767.46
|
|
|
PLATE COMPRESSION 2.3MM 6H
|
Facility
|
IP
|
$3,669.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,100.87 |
| Max. Negotiated Rate |
$3,522.79 |
| Rate for Payer: Aetna Commercial |
$2,825.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,862.26
|
| Rate for Payer: Cash Price |
$1,834.79
|
| Rate for Payer: Cigna Commercial |
$3,045.74
|
| Rate for Payer: First Health Commercial |
$3,486.09
|
| Rate for Payer: Humana Commercial |
$3,119.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,009.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,708.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,100.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,229.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,752.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,935.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,192.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,532.00
|
| Rate for Payer: PHCS Commercial |
$3,522.79
|
| Rate for Payer: United Healthcare All Payer |
$3,229.22
|
|
|
PLATE COMPRESSION 2.3MM 6H
|
Facility
|
OP
|
$3,669.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,100.87 |
| Max. Negotiated Rate |
$3,522.79 |
| Rate for Payer: Aetna Commercial |
$2,825.57
|
| Rate for Payer: Anthem Medicaid |
$1,261.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,862.26
|
| Rate for Payer: Cash Price |
$1,834.79
|
| Rate for Payer: Cigna Commercial |
$3,045.74
|
| Rate for Payer: First Health Commercial |
$3,486.09
|
| Rate for Payer: Humana Commercial |
$3,119.13
|
| Rate for Payer: Humana KY Medicaid |
$1,261.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,274.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,009.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,708.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,100.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,287.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,229.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,752.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,935.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,192.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,532.00
|
| Rate for Payer: PHCS Commercial |
$3,522.79
|
| Rate for Payer: United Healthcare All Payer |
$3,229.22
|
|
|
PLATE COMPRESSION 5H
|
Facility
|
IP
|
$3,963.61
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,189.08 |
| Max. Negotiated Rate |
$3,805.07 |
| Rate for Payer: Aetna Commercial |
$3,051.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.62
|
| Rate for Payer: Cash Price |
$1,981.81
|
| Rate for Payer: Cigna Commercial |
$3,289.80
|
| Rate for Payer: First Health Commercial |
$3,765.43
|
| Rate for Payer: Humana Commercial |
$3,369.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,487.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,972.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,170.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,448.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,734.89
|
| Rate for Payer: PHCS Commercial |
$3,805.07
|
| Rate for Payer: United Healthcare All Payer |
$3,487.98
|
|
|
PLATE COMPRESSION 5H
|
Facility
|
OP
|
$3,963.61
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,189.08 |
| Max. Negotiated Rate |
$3,805.07 |
| Rate for Payer: Aetna Commercial |
$3,051.98
|
| Rate for Payer: Anthem Medicaid |
$1,363.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.62
|
| Rate for Payer: Cash Price |
$1,981.81
|
| Rate for Payer: Cigna Commercial |
$3,289.80
|
| Rate for Payer: First Health Commercial |
$3,765.43
|
| Rate for Payer: Humana Commercial |
$3,369.07
|
| Rate for Payer: Humana KY Medicaid |
$1,363.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,376.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,390.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,487.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,972.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,170.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,448.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,734.89
|
| Rate for Payer: PHCS Commercial |
$3,805.07
|
| Rate for Payer: United Healthcare All Payer |
$3,487.98
|
|
|
PLATE COMPRESSION 7H
|
Facility
|
OP
|
$3,251.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.39 |
| Max. Negotiated Rate |
$3,121.25 |
| Rate for Payer: Aetna Commercial |
$2,503.50
|
| Rate for Payer: Anthem Medicaid |
$1,118.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,536.01
|
| Rate for Payer: Cash Price |
$1,625.65
|
| Rate for Payer: Cigna Commercial |
$2,698.58
|
| Rate for Payer: First Health Commercial |
$3,088.74
|
| Rate for Payer: Humana Commercial |
$2,763.61
|
| Rate for Payer: Humana KY Medicaid |
$1,118.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,666.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,399.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,861.14
|
| Rate for Payer: Ohio Health Group HMO |
$2,438.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,601.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,828.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,243.40
|
| Rate for Payer: PHCS Commercial |
$3,121.25
|
| Rate for Payer: United Healthcare All Payer |
$2,861.14
|
|
|
PLATE COMPRESSION 7H
|
Facility
|
IP
|
$3,251.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.39 |
| Max. Negotiated Rate |
$3,121.25 |
| Rate for Payer: Aetna Commercial |
$2,503.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,536.01
|
| Rate for Payer: Cash Price |
$1,625.65
|
| Rate for Payer: Cigna Commercial |
$2,698.58
|
| Rate for Payer: First Health Commercial |
$3,088.74
|
| Rate for Payer: Humana Commercial |
$2,763.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,666.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,399.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,861.14
|
| Rate for Payer: Ohio Health Group HMO |
$2,438.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,601.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,828.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,243.40
|
| Rate for Payer: PHCS Commercial |
$3,121.25
|
| Rate for Payer: United Healthcare All Payer |
$2,861.14
|
|
|
PLATE CONDYLAR 2.0MM
|
Facility
|
OP
|
$3,091.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.49 |
| Max. Negotiated Rate |
$2,967.96 |
| Rate for Payer: Aetna Commercial |
$2,380.55
|
| Rate for Payer: Anthem Medicaid |
$1,063.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,411.46
|
| Rate for Payer: Cash Price |
$1,545.81
|
| Rate for Payer: Cigna Commercial |
$2,566.04
|
| Rate for Payer: First Health Commercial |
$2,937.04
|
| Rate for Payer: Humana Commercial |
$2,627.88
|
| Rate for Payer: Humana KY Medicaid |
$1,063.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,074.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,535.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,281.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$927.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,084.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,720.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,318.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,473.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,689.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,133.22
|
| Rate for Payer: PHCS Commercial |
$2,967.96
|
| Rate for Payer: United Healthcare All Payer |
$2,720.63
|
|
|
PLATE CONDYLAR 2.0MM
|
Facility
|
IP
|
$3,091.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.49 |
| Max. Negotiated Rate |
$2,967.96 |
| Rate for Payer: Aetna Commercial |
$2,380.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,411.46
|
| Rate for Payer: Cash Price |
$1,545.81
|
| Rate for Payer: Cigna Commercial |
$2,566.04
|
| Rate for Payer: First Health Commercial |
$2,937.04
|
| Rate for Payer: Humana Commercial |
$2,627.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,535.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,281.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$927.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,720.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,318.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,473.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,689.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,133.22
|
| Rate for Payer: PHCS Commercial |
$2,967.96
|
| Rate for Payer: United Healthcare All Payer |
$2,720.63
|
|
|
PLATE CONDYLAR LOCKING L 10H
|
Facility
|
IP
|
$9,513.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.16 |
| Max. Negotiated Rate |
$9,133.31 |
| Rate for Payer: Aetna Commercial |
$7,325.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,420.81
|
| Rate for Payer: Cash Price |
$4,756.93
|
| Rate for Payer: Cigna Commercial |
$7,896.50
|
| Rate for Payer: First Health Commercial |
$9,038.17
|
| Rate for Payer: Humana Commercial |
$8,086.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,801.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,021.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,372.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,135.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,611.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,277.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,564.56
|
| Rate for Payer: PHCS Commercial |
$9,133.31
|
| Rate for Payer: United Healthcare All Payer |
$8,372.20
|
|
|
PLATE CONDYLAR LOCKING L 10H
|
Facility
|
OP
|
$9,513.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.16 |
| Max. Negotiated Rate |
$9,133.31 |
| Rate for Payer: Aetna Commercial |
$7,325.67
|
| Rate for Payer: Anthem Medicaid |
$3,271.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,420.81
|
| Rate for Payer: Cash Price |
$4,756.93
|
| Rate for Payer: Cigna Commercial |
$7,896.50
|
| Rate for Payer: First Health Commercial |
$9,038.17
|
| Rate for Payer: Humana Commercial |
$8,086.78
|
| Rate for Payer: Humana KY Medicaid |
$3,271.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3,305.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,801.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,021.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,337.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,372.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,135.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,611.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,277.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,564.56
|
| Rate for Payer: PHCS Commercial |
$9,133.31
|
| Rate for Payer: United Healthcare All Payer |
$8,372.20
|
|
|
PLATE CONDYLAR LOCKING L 12H
|
Facility
|
OP
|
$9,650.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,895.07 |
| Max. Negotiated Rate |
$9,264.22 |
| Rate for Payer: Aetna Commercial |
$7,430.68
|
| Rate for Payer: Anthem Medicaid |
$3,318.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,527.18
|
| Rate for Payer: Cash Price |
$4,825.11
|
| Rate for Payer: Cigna Commercial |
$8,009.69
|
| Rate for Payer: First Health Commercial |
$9,167.72
|
| Rate for Payer: Humana Commercial |
$8,202.70
|
| Rate for Payer: Humana KY Medicaid |
$3,318.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,352.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,913.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,121.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,895.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,385.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,492.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,237.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,720.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,395.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,658.66
|
| Rate for Payer: PHCS Commercial |
$9,264.22
|
| Rate for Payer: United Healthcare All Payer |
$8,492.20
|
|
|
PLATE CONDYLAR LOCKING L 12H
|
Facility
|
IP
|
$9,650.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,895.07 |
| Max. Negotiated Rate |
$9,264.22 |
| Rate for Payer: Aetna Commercial |
$7,430.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,527.18
|
| Rate for Payer: Cash Price |
$4,825.11
|
| Rate for Payer: Cigna Commercial |
$8,009.69
|
| Rate for Payer: First Health Commercial |
$9,167.72
|
| Rate for Payer: Humana Commercial |
$8,202.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,913.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,121.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,895.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,492.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,237.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,720.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,395.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,658.66
|
| Rate for Payer: PHCS Commercial |
$9,264.22
|
| Rate for Payer: United Healthcare All Payer |
$8,492.20
|
|
|
PLATE CONDYLAR LOCKING L 14H
|
Facility
|
OP
|
$9,786.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,935.97 |
| Max. Negotiated Rate |
$9,395.09 |
| Rate for Payer: Aetna Commercial |
$7,535.64
|
| Rate for Payer: Anthem Medicaid |
$3,365.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,633.51
|
| Rate for Payer: Cash Price |
$4,893.28
|
| Rate for Payer: Cigna Commercial |
$8,122.84
|
| Rate for Payer: First Health Commercial |
$9,297.22
|
| Rate for Payer: Humana Commercial |
$8,318.57
|
| Rate for Payer: Humana KY Medicaid |
$3,365.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,399.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,024.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,222.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,935.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,433.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,612.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,339.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,829.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,514.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,752.72
|
| Rate for Payer: PHCS Commercial |
$9,395.09
|
| Rate for Payer: United Healthcare All Payer |
$8,612.16
|
|
|
PLATE CONDYLAR LOCKING L 14H
|
Facility
|
IP
|
$9,786.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,935.97 |
| Max. Negotiated Rate |
$9,395.09 |
| Rate for Payer: Aetna Commercial |
$7,535.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,633.51
|
| Rate for Payer: Cash Price |
$4,893.28
|
| Rate for Payer: Cigna Commercial |
$8,122.84
|
| Rate for Payer: First Health Commercial |
$9,297.22
|
| Rate for Payer: Humana Commercial |
$8,318.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,024.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,222.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,935.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,612.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,339.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,829.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,514.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,752.72
|
| Rate for Payer: PHCS Commercial |
$9,395.09
|
| Rate for Payer: United Healthcare All Payer |
$8,612.16
|
|
|
PLATE CONDYLAR LOCKING L 16H
|
Facility
|
IP
|
$9,919.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.75 |
| Max. Negotiated Rate |
$9,522.39 |
| Rate for Payer: Aetna Commercial |
$7,637.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,736.94
|
| Rate for Payer: Cash Price |
$4,959.58
|
| Rate for Payer: Cigna Commercial |
$8,232.90
|
| Rate for Payer: First Health Commercial |
$9,423.20
|
| Rate for Payer: Humana Commercial |
$8,431.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,133.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,320.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,728.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,439.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,935.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,629.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,844.22
|
| Rate for Payer: PHCS Commercial |
$9,522.39
|
| Rate for Payer: United Healthcare All Payer |
$8,728.86
|
|
|
PLATE CONDYLAR LOCKING L 16H
|
Facility
|
OP
|
$9,919.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.75 |
| Max. Negotiated Rate |
$9,522.39 |
| Rate for Payer: Aetna Commercial |
$7,637.75
|
| Rate for Payer: Anthem Medicaid |
$3,411.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,736.94
|
| Rate for Payer: Cash Price |
$4,959.58
|
| Rate for Payer: Cigna Commercial |
$8,232.90
|
| Rate for Payer: First Health Commercial |
$9,423.20
|
| Rate for Payer: Humana Commercial |
$8,431.29
|
| Rate for Payer: Humana KY Medicaid |
$3,411.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,133.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,320.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,479.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,728.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,439.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,935.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,629.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,844.22
|
| Rate for Payer: PHCS Commercial |
$9,522.39
|
| Rate for Payer: United Healthcare All Payer |
$8,728.86
|
|
|
PLATE CONDYLAR LOCKING L 18H
|
Facility
|
OP
|
$10,062.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,018.86 |
| Max. Negotiated Rate |
$9,660.35 |
| Rate for Payer: Aetna Commercial |
$7,748.40
|
| Rate for Payer: Anthem Medicaid |
$3,460.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,849.03
|
| Rate for Payer: Cash Price |
$5,031.43
|
| Rate for Payer: Cigna Commercial |
$8,352.17
|
| Rate for Payer: First Health Commercial |
$9,559.72
|
| Rate for Payer: Humana Commercial |
$8,553.43
|
| Rate for Payer: Humana KY Medicaid |
$3,460.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,495.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,251.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,426.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,018.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,530.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,855.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,547.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,050.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,754.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,943.37
|
| Rate for Payer: PHCS Commercial |
$9,660.35
|
| Rate for Payer: United Healthcare All Payer |
$8,855.32
|
|
|
PLATE CONDYLAR LOCKING L 18H
|
Facility
|
IP
|
$10,062.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,018.86 |
| Max. Negotiated Rate |
$9,660.35 |
| Rate for Payer: Aetna Commercial |
$7,748.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,849.03
|
| Rate for Payer: Cash Price |
$5,031.43
|
| Rate for Payer: Cigna Commercial |
$8,352.17
|
| Rate for Payer: First Health Commercial |
$9,559.72
|
| Rate for Payer: Humana Commercial |
$8,553.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,251.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,426.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,018.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,855.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,547.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,050.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,754.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,943.37
|
| Rate for Payer: PHCS Commercial |
$9,660.35
|
| Rate for Payer: United Healthcare All Payer |
$8,855.32
|
|
|
PLATE CONDYLAR LOCKING R 10H
|
Facility
|
IP
|
$9,513.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.16 |
| Max. Negotiated Rate |
$9,133.31 |
| Rate for Payer: Aetna Commercial |
$7,325.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,420.81
|
| Rate for Payer: Cash Price |
$4,756.93
|
| Rate for Payer: Cigna Commercial |
$7,896.50
|
| Rate for Payer: First Health Commercial |
$9,038.17
|
| Rate for Payer: Humana Commercial |
$8,086.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,801.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,021.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,372.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,135.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,611.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,277.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,564.56
|
| Rate for Payer: PHCS Commercial |
$9,133.31
|
| Rate for Payer: United Healthcare All Payer |
$8,372.20
|
|
|
PLATE CONDYLAR LOCKING R 10H
|
Facility
|
OP
|
$9,513.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.16 |
| Max. Negotiated Rate |
$9,133.31 |
| Rate for Payer: Aetna Commercial |
$7,325.67
|
| Rate for Payer: Anthem Medicaid |
$3,271.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,420.81
|
| Rate for Payer: Cash Price |
$4,756.93
|
| Rate for Payer: Cigna Commercial |
$7,896.50
|
| Rate for Payer: First Health Commercial |
$9,038.17
|
| Rate for Payer: Humana Commercial |
$8,086.78
|
| Rate for Payer: Humana KY Medicaid |
$3,271.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3,305.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,801.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,021.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,337.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,372.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,135.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,611.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,277.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,564.56
|
| Rate for Payer: PHCS Commercial |
$9,133.31
|
| Rate for Payer: United Healthcare All Payer |
$8,372.20
|
|
