|
PLATE PROFL LCK 2.3 STR BAR 4H
|
Facility
|
IP
|
$3,746.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$487.02 |
| Max. Negotiated Rate |
$3,596.49 |
| Rate for Payer: Aetna Commercial |
$2,884.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,922.15
|
| Rate for Payer: Cash Price |
$1,873.17
|
| Rate for Payer: Cigna Commercial |
$3,109.46
|
| Rate for Payer: First Health Commercial |
$3,559.02
|
| Rate for Payer: Humana Commercial |
$3,184.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,072.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,764.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,123.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,296.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,809.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$749.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,161.37
|
| Rate for Payer: PHCS Commercial |
$3,596.49
|
| Rate for Payer: United Healthcare All Payer |
$3,296.78
|
|
|
PLATE PROFL LK 2.3 3D RPL 4X2H
|
Facility
|
IP
|
$4,941.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$642.36 |
| Max. Negotiated Rate |
$4,743.55 |
| Rate for Payer: Aetna Commercial |
$3,804.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,854.14
|
| Rate for Payer: Cash Price |
$2,470.60
|
| Rate for Payer: Cigna Commercial |
$4,101.20
|
| Rate for Payer: First Health Commercial |
$4,694.14
|
| Rate for Payer: Humana Commercial |
$4,200.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,051.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,646.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,482.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,348.26
|
| Rate for Payer: Ohio Health Group HMO |
$3,705.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.77
|
| Rate for Payer: PHCS Commercial |
$4,743.55
|
| Rate for Payer: United Healthcare All Payer |
$4,348.26
|
|
|
PLATE PROFL LK 2.3 3D RPL 4X2H
|
Facility
|
OP
|
$4,941.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$642.36 |
| Max. Negotiated Rate |
$4,743.55 |
| Rate for Payer: Aetna Commercial |
$3,804.72
|
| Rate for Payer: Anthem Medicaid |
$1,699.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,854.14
|
| Rate for Payer: Cash Price |
$2,470.60
|
| Rate for Payer: Cigna Commercial |
$4,101.20
|
| Rate for Payer: First Health Commercial |
$4,694.14
|
| Rate for Payer: Humana Commercial |
$4,200.02
|
| Rate for Payer: Humana KY Medicaid |
$1,699.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,716.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,051.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,646.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,482.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,733.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,348.26
|
| Rate for Payer: Ohio Health Group HMO |
$3,705.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.77
|
| Rate for Payer: PHCS Commercial |
$4,743.55
|
| Rate for Payer: United Healthcare All Payer |
$4,348.26
|
|
|
PLATE PROFL LK 3D 1.7 2X2H+2H
|
Facility
|
IP
|
$4,941.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$642.36 |
| Max. Negotiated Rate |
$4,743.55 |
| Rate for Payer: Aetna Commercial |
$3,804.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,854.14
|
| Rate for Payer: Cash Price |
$2,470.60
|
| Rate for Payer: Cigna Commercial |
$4,101.20
|
| Rate for Payer: First Health Commercial |
$4,694.14
|
| Rate for Payer: Humana Commercial |
$4,200.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,051.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,646.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,482.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,348.26
|
| Rate for Payer: Ohio Health Group HMO |
$3,705.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.77
|
| Rate for Payer: PHCS Commercial |
$4,743.55
|
| Rate for Payer: United Healthcare All Payer |
$4,348.26
|
|
|
PLATE PROFL LK 3D 1.7 2X2H+2H
|
Facility
|
OP
|
$4,941.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$642.36 |
| Max. Negotiated Rate |
$4,743.55 |
| Rate for Payer: Aetna Commercial |
$3,804.72
|
| Rate for Payer: Anthem Medicaid |
$1,699.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,854.14
|
| Rate for Payer: Cash Price |
$2,470.60
|
| Rate for Payer: Cigna Commercial |
$4,101.20
|
| Rate for Payer: First Health Commercial |
$4,694.14
|
| Rate for Payer: Humana Commercial |
$4,200.02
|
| Rate for Payer: Humana KY Medicaid |
$1,699.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,716.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,051.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,646.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,482.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,733.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,348.26
|
| Rate for Payer: Ohio Health Group HMO |
$3,705.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.77
|
| Rate for Payer: PHCS Commercial |
$4,743.55
|
| Rate for Payer: United Healthcare All Payer |
$4,348.26
|
|
|
PLATE PROFL LK 3D NAR 1.7 2X2H
|
Facility
|
OP
|
$4,941.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$642.36 |
| Max. Negotiated Rate |
$4,743.55 |
| Rate for Payer: Anthem Medicaid |
$1,699.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,854.14
|
| Rate for Payer: Cash Price |
$2,470.60
|
| Rate for Payer: Cigna Commercial |
$4,101.20
|
| Rate for Payer: First Health Commercial |
$4,694.14
|
| Rate for Payer: Humana Commercial |
$4,200.02
|
| Rate for Payer: Humana KY Medicaid |
$1,699.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,716.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,051.78
|
| Rate for Payer: Aetna Commercial |
$3,804.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,646.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,482.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,733.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,348.26
|
| Rate for Payer: Ohio Health Group HMO |
$3,705.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.77
|
| Rate for Payer: PHCS Commercial |
$4,743.55
|
| Rate for Payer: United Healthcare All Payer |
$4,348.26
|
|
|
PLATE PROFL LK 3D NAR 1.7 2X2H
|
Facility
|
IP
|
$4,941.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$642.36 |
| Max. Negotiated Rate |
$4,743.55 |
| Rate for Payer: Aetna Commercial |
$3,804.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,854.14
|
| Rate for Payer: Cash Price |
$2,470.60
|
| Rate for Payer: Cigna Commercial |
$4,101.20
|
| Rate for Payer: First Health Commercial |
$4,694.14
|
| Rate for Payer: Humana Commercial |
$4,200.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,051.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,646.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,482.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,348.26
|
| Rate for Payer: Ohio Health Group HMO |
$3,705.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.77
|
| Rate for Payer: PHCS Commercial |
$4,743.55
|
| Rate for Payer: United Healthcare All Payer |
$4,348.26
|
|
|
PLATE PROFL LK 3D NAR 1.7 3X2H
|
Facility
|
OP
|
$4,941.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$642.36 |
| Max. Negotiated Rate |
$4,743.55 |
| Rate for Payer: Aetna Commercial |
$3,804.72
|
| Rate for Payer: Anthem Medicaid |
$1,699.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,854.14
|
| Rate for Payer: Cash Price |
$2,470.60
|
| Rate for Payer: Cigna Commercial |
$4,101.20
|
| Rate for Payer: First Health Commercial |
$4,694.14
|
| Rate for Payer: Humana Commercial |
$4,200.02
|
| Rate for Payer: Humana KY Medicaid |
$1,699.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,716.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,051.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,646.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,482.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,733.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,348.26
|
| Rate for Payer: Ohio Health Group HMO |
$3,705.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.77
|
| Rate for Payer: PHCS Commercial |
$4,743.55
|
| Rate for Payer: United Healthcare All Payer |
$4,348.26
|
|
|
PLATE PROFL LK 3D NAR 1.7 3X2H
|
Facility
|
IP
|
$4,941.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$642.36 |
| Max. Negotiated Rate |
$4,743.55 |
| Rate for Payer: Aetna Commercial |
$3,804.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,854.14
|
| Rate for Payer: Cash Price |
$2,470.60
|
| Rate for Payer: Cigna Commercial |
$4,101.20
|
| Rate for Payer: First Health Commercial |
$4,694.14
|
| Rate for Payer: Humana Commercial |
$4,200.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,051.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,646.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,482.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,348.26
|
| Rate for Payer: Ohio Health Group HMO |
$3,705.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.77
|
| Rate for Payer: PHCS Commercial |
$4,743.55
|
| Rate for Payer: United Healthcare All Payer |
$4,348.26
|
|
|
PLATE PROFL LK 3D NAR 1.7 4X2H
|
Facility
|
OP
|
$4,941.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$642.36 |
| Max. Negotiated Rate |
$4,743.55 |
| Rate for Payer: Aetna Commercial |
$3,804.72
|
| Rate for Payer: Anthem Medicaid |
$1,699.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,854.14
|
| Rate for Payer: Cash Price |
$2,470.60
|
| Rate for Payer: Cigna Commercial |
$4,101.20
|
| Rate for Payer: First Health Commercial |
$4,694.14
|
| Rate for Payer: Humana Commercial |
$4,200.02
|
| Rate for Payer: Humana KY Medicaid |
$1,699.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,716.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,051.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,646.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,482.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,733.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,348.26
|
| Rate for Payer: Ohio Health Group HMO |
$3,705.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.77
|
| Rate for Payer: PHCS Commercial |
$4,743.55
|
| Rate for Payer: United Healthcare All Payer |
$4,348.26
|
|
|
PLATE PROFL LK 3D NAR 1.7 4X2H
|
Facility
|
IP
|
$4,941.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$642.36 |
| Max. Negotiated Rate |
$4,743.55 |
| Rate for Payer: Aetna Commercial |
$3,804.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,854.14
|
| Rate for Payer: Cash Price |
$2,470.60
|
| Rate for Payer: Cigna Commercial |
$4,101.20
|
| Rate for Payer: First Health Commercial |
$4,694.14
|
| Rate for Payer: Humana Commercial |
$4,200.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,051.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,646.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,482.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,348.26
|
| Rate for Payer: Ohio Health Group HMO |
$3,705.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.77
|
| Rate for Payer: PHCS Commercial |
$4,743.55
|
| Rate for Payer: United Healthcare All Payer |
$4,348.26
|
|
|
PLATE PROFY L CMP 2.3 6H L 90^
|
Facility
|
IP
|
$2,159.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.70 |
| Max. Negotiated Rate |
$2,072.83 |
| Rate for Payer: Aetna Commercial |
$1,662.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,684.18
|
| Rate for Payer: Cash Price |
$1,079.60
|
| Rate for Payer: Cigna Commercial |
$1,792.14
|
| Rate for Payer: First Health Commercial |
$2,051.24
|
| Rate for Payer: Humana Commercial |
$1,835.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,770.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,593.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,900.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,619.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.35
|
| Rate for Payer: PHCS Commercial |
$2,072.83
|
| Rate for Payer: United Healthcare All Payer |
$1,900.10
|
|
|
PLATE PROFY L CMP 2.3 6H L 90^
|
Facility
|
OP
|
$2,159.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.70 |
| Max. Negotiated Rate |
$2,072.83 |
| Rate for Payer: Aetna Commercial |
$1,662.58
|
| Rate for Payer: Anthem Medicaid |
$742.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,684.18
|
| Rate for Payer: Cash Price |
$1,079.60
|
| Rate for Payer: Cigna Commercial |
$1,792.14
|
| Rate for Payer: First Health Commercial |
$2,051.24
|
| Rate for Payer: Humana Commercial |
$1,835.32
|
| Rate for Payer: Humana KY Medicaid |
$742.55
|
| Rate for Payer: Kentucky WC Medicaid |
$750.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,770.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,593.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$757.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,900.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,619.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.35
|
| Rate for Payer: PHCS Commercial |
$2,072.83
|
| Rate for Payer: United Healthcare All Payer |
$1,900.10
|
|
|
PLATE PROFY L CMP 2.3 6H R 90^
|
Facility
|
OP
|
$2,159.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.70 |
| Max. Negotiated Rate |
$2,072.83 |
| Rate for Payer: Aetna Commercial |
$1,662.58
|
| Rate for Payer: Anthem Medicaid |
$742.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,684.18
|
| Rate for Payer: Cash Price |
$1,079.60
|
| Rate for Payer: Cigna Commercial |
$1,792.14
|
| Rate for Payer: First Health Commercial |
$2,051.24
|
| Rate for Payer: Humana Commercial |
$1,835.32
|
| Rate for Payer: Humana KY Medicaid |
$742.55
|
| Rate for Payer: Kentucky WC Medicaid |
$750.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,770.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,593.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$757.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,900.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,619.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.35
|
| Rate for Payer: PHCS Commercial |
$2,072.83
|
| Rate for Payer: United Healthcare All Payer |
$1,900.10
|
|
|
PLATE PROFY L CMP 2.3 6H R 90^
|
Facility
|
IP
|
$2,159.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.70 |
| Max. Negotiated Rate |
$2,072.83 |
| Rate for Payer: Aetna Commercial |
$1,662.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,684.18
|
| Rate for Payer: Cash Price |
$1,079.60
|
| Rate for Payer: Cigna Commercial |
$1,792.14
|
| Rate for Payer: First Health Commercial |
$2,051.24
|
| Rate for Payer: Humana Commercial |
$1,835.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,770.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,593.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,900.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,619.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.35
|
| Rate for Payer: PHCS Commercial |
$2,072.83
|
| Rate for Payer: United Healthcare All Payer |
$1,900.10
|
|
|
PLATE PROFYL COMP T 2.3 6H 90^
|
Facility
|
OP
|
$1,802.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.32 |
| Max. Negotiated Rate |
$1,730.34 |
| Rate for Payer: Anthem Medicaid |
$619.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,405.90
|
| Rate for Payer: Cash Price |
$901.22
|
| Rate for Payer: Cigna Commercial |
$1,496.03
|
| Rate for Payer: First Health Commercial |
$1,712.32
|
| Rate for Payer: Humana Commercial |
$1,532.07
|
| Rate for Payer: Humana KY Medicaid |
$619.86
|
| Rate for Payer: Kentucky WC Medicaid |
$626.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,478.00
|
| Rate for Payer: Aetna Commercial |
$1,387.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,330.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$632.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,586.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,351.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.76
|
| Rate for Payer: PHCS Commercial |
$1,730.34
|
| Rate for Payer: United Healthcare All Payer |
$1,586.15
|
|
|
PLATE PROFYL COMP T 2.3 6H 90^
|
Facility
|
IP
|
$1,802.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.32 |
| Max. Negotiated Rate |
$1,730.34 |
| Rate for Payer: Aetna Commercial |
$1,387.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,405.90
|
| Rate for Payer: Cash Price |
$901.22
|
| Rate for Payer: Cigna Commercial |
$1,496.03
|
| Rate for Payer: First Health Commercial |
$1,712.32
|
| Rate for Payer: Humana Commercial |
$1,532.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,478.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,330.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,586.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,351.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.76
|
| Rate for Payer: PHCS Commercial |
$1,730.34
|
| Rate for Payer: United Healthcare All Payer |
$1,586.15
|
|
|
PLATE PROFYL COMP T 2.3 7H 90^
|
Facility
|
IP
|
$1,802.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.32 |
| Max. Negotiated Rate |
$1,730.34 |
| Rate for Payer: Aetna Commercial |
$1,387.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,405.90
|
| Rate for Payer: Cash Price |
$901.22
|
| Rate for Payer: Cigna Commercial |
$1,496.03
|
| Rate for Payer: First Health Commercial |
$1,712.32
|
| Rate for Payer: Humana Commercial |
$1,532.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,478.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,330.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,586.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,351.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.76
|
| Rate for Payer: PHCS Commercial |
$1,730.34
|
| Rate for Payer: United Healthcare All Payer |
$1,586.15
|
|
|
PLATE PROFYL COMP T 2.3 7H 90^
|
Facility
|
OP
|
$1,802.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.32 |
| Max. Negotiated Rate |
$1,730.34 |
| Rate for Payer: Aetna Commercial |
$1,387.88
|
| Rate for Payer: Anthem Medicaid |
$619.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,405.90
|
| Rate for Payer: Cash Price |
$901.22
|
| Rate for Payer: Cigna Commercial |
$1,496.03
|
| Rate for Payer: First Health Commercial |
$1,712.32
|
| Rate for Payer: Humana Commercial |
$1,532.07
|
| Rate for Payer: Humana KY Medicaid |
$619.86
|
| Rate for Payer: Kentucky WC Medicaid |
$626.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,478.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,330.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$632.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,586.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,351.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.76
|
| Rate for Payer: PHCS Commercial |
$1,730.34
|
| Rate for Payer: United Healthcare All Payer |
$1,586.15
|
|
|
PLATE PROFYLE 1.2 3D 2*2+2H
|
Facility
|
IP
|
$3,684.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.92 |
| Max. Negotiated Rate |
$3,536.64 |
| Rate for Payer: Aetna Commercial |
$2,836.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,873.52
|
| Rate for Payer: Cash Price |
$1,842.00
|
| Rate for Payer: Cigna Commercial |
$3,057.72
|
| Rate for Payer: First Health Commercial |
$3,499.80
|
| Rate for Payer: Humana Commercial |
$3,131.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,020.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,718.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,105.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,241.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,763.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,142.04
|
| Rate for Payer: PHCS Commercial |
$3,536.64
|
| Rate for Payer: United Healthcare All Payer |
$3,241.92
|
|
|
PLATE PROFYLE 1.2 3D 2*2+2H
|
Facility
|
OP
|
$3,684.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.92 |
| Max. Negotiated Rate |
$3,536.64 |
| Rate for Payer: Aetna Commercial |
$2,836.68
|
| Rate for Payer: Anthem Medicaid |
$1,266.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,873.52
|
| Rate for Payer: Cash Price |
$1,842.00
|
| Rate for Payer: Cigna Commercial |
$3,057.72
|
| Rate for Payer: First Health Commercial |
$3,499.80
|
| Rate for Payer: Humana Commercial |
$3,131.40
|
| Rate for Payer: Humana KY Medicaid |
$1,266.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,279.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,020.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,718.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,105.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,292.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,241.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,763.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,142.04
|
| Rate for Payer: PHCS Commercial |
$3,536.64
|
| Rate for Payer: United Healthcare All Payer |
$3,241.92
|
|
|
PLATE PROFYLE 1.2 3D 2*2H
|
Facility
|
IP
|
$3,684.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.92 |
| Max. Negotiated Rate |
$3,536.64 |
| Rate for Payer: Aetna Commercial |
$2,836.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,873.52
|
| Rate for Payer: Cash Price |
$1,842.00
|
| Rate for Payer: Cigna Commercial |
$3,057.72
|
| Rate for Payer: First Health Commercial |
$3,499.80
|
| Rate for Payer: Humana Commercial |
$3,131.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,020.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,718.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,105.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,241.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,763.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,142.04
|
| Rate for Payer: PHCS Commercial |
$3,536.64
|
| Rate for Payer: United Healthcare All Payer |
$3,241.92
|
|
|
PLATE PROFYLE 1.2 3D 2*2H
|
Facility
|
OP
|
$3,684.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.92 |
| Max. Negotiated Rate |
$3,536.64 |
| Rate for Payer: Aetna Commercial |
$2,836.68
|
| Rate for Payer: Anthem Medicaid |
$1,266.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,873.52
|
| Rate for Payer: Cash Price |
$1,842.00
|
| Rate for Payer: Cigna Commercial |
$3,057.72
|
| Rate for Payer: First Health Commercial |
$3,499.80
|
| Rate for Payer: Humana Commercial |
$3,131.40
|
| Rate for Payer: Humana KY Medicaid |
$1,266.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,279.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,020.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,718.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,105.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,292.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,241.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,763.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,142.04
|
| Rate for Payer: PHCS Commercial |
$3,536.64
|
| Rate for Payer: United Healthcare All Payer |
$3,241.92
|
|
|
PLATE PROFYLE 1.2 3D 3*2H
|
Facility
|
OP
|
$3,684.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.92 |
| Max. Negotiated Rate |
$3,536.64 |
| Rate for Payer: Aetna Commercial |
$2,836.68
|
| Rate for Payer: Anthem Medicaid |
$1,266.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,873.52
|
| Rate for Payer: Cash Price |
$1,842.00
|
| Rate for Payer: Cigna Commercial |
$3,057.72
|
| Rate for Payer: First Health Commercial |
$3,499.80
|
| Rate for Payer: Humana Commercial |
$3,131.40
|
| Rate for Payer: Humana KY Medicaid |
$1,266.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,279.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,020.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,718.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,105.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,292.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,241.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,763.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,142.04
|
| Rate for Payer: PHCS Commercial |
$3,536.64
|
| Rate for Payer: United Healthcare All Payer |
$3,241.92
|
|
|
PLATE PROFYLE 1.2 3D 3*2H
|
Facility
|
IP
|
$3,684.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.92 |
| Max. Negotiated Rate |
$3,536.64 |
| Rate for Payer: Aetna Commercial |
$2,836.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,873.52
|
| Rate for Payer: Cash Price |
$1,842.00
|
| Rate for Payer: Cigna Commercial |
$3,057.72
|
| Rate for Payer: First Health Commercial |
$3,499.80
|
| Rate for Payer: Humana Commercial |
$3,131.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,020.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,718.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,105.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,241.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,763.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,142.04
|
| Rate for Payer: PHCS Commercial |
$3,536.64
|
| Rate for Payer: United Healthcare All Payer |
$3,241.92
|
|
