|
PLATE PROFYLE 1.2 3D 4*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: 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: Aetna Commercial |
$2,836.68
|
| 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 4*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 1.7 12H LT
|
Facility
|
OP
|
$1,997.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.71 |
| Max. Negotiated Rate |
$1,917.83 |
| Rate for Payer: Aetna Commercial |
$1,538.26
|
| Rate for Payer: Anthem Medicaid |
$687.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.24
|
| Rate for Payer: Cash Price |
$998.87
|
| Rate for Payer: Cigna Commercial |
$1,658.12
|
| Rate for Payer: First Health Commercial |
$1,897.85
|
| Rate for Payer: Humana Commercial |
$1,698.08
|
| Rate for Payer: Humana KY Medicaid |
$687.02
|
| Rate for Payer: Kentucky WC Medicaid |
$694.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,638.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,758.01
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.30
|
| Rate for Payer: PHCS Commercial |
$1,917.83
|
| Rate for Payer: United Healthcare All Payer |
$1,758.01
|
|
|
PLATE PROFYLE 1.7 12H LT
|
Facility
|
IP
|
$1,997.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.71 |
| Max. Negotiated Rate |
$1,917.83 |
| Rate for Payer: Aetna Commercial |
$1,538.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.24
|
| Rate for Payer: Cash Price |
$998.87
|
| Rate for Payer: Cigna Commercial |
$1,658.12
|
| Rate for Payer: First Health Commercial |
$1,897.85
|
| Rate for Payer: Humana Commercial |
$1,698.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,638.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,758.01
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.30
|
| Rate for Payer: PHCS Commercial |
$1,917.83
|
| Rate for Payer: United Healthcare All Payer |
$1,758.01
|
|
|
PLATE PROFYLE 1.7 12H RT
|
Facility
|
OP
|
$1,997.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.71 |
| Max. Negotiated Rate |
$1,917.83 |
| Rate for Payer: Aetna Commercial |
$1,538.26
|
| Rate for Payer: Anthem Medicaid |
$687.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.24
|
| Rate for Payer: Cash Price |
$998.87
|
| Rate for Payer: Cigna Commercial |
$1,658.12
|
| Rate for Payer: First Health Commercial |
$1,897.85
|
| Rate for Payer: Humana Commercial |
$1,698.08
|
| Rate for Payer: Humana KY Medicaid |
$687.02
|
| Rate for Payer: Kentucky WC Medicaid |
$694.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,638.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,758.01
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.30
|
| Rate for Payer: PHCS Commercial |
$1,917.83
|
| Rate for Payer: United Healthcare All Payer |
$1,758.01
|
|
|
PLATE PROFYLE 1.7 12H RT
|
Facility
|
IP
|
$1,997.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.71 |
| Max. Negotiated Rate |
$1,917.83 |
| Rate for Payer: Aetna Commercial |
$1,538.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.24
|
| Rate for Payer: Cash Price |
$998.87
|
| Rate for Payer: Cigna Commercial |
$1,658.12
|
| Rate for Payer: First Health Commercial |
$1,897.85
|
| Rate for Payer: Humana Commercial |
$1,698.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,638.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,758.01
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.30
|
| Rate for Payer: PHCS Commercial |
$1,917.83
|
| Rate for Payer: United Healthcare All Payer |
$1,758.01
|
|
|
PLATE PROFYLE 3D 1.7 2*2+2H
|
Facility
|
OP
|
$3,440.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.25 |
| Max. Negotiated Rate |
$3,302.78 |
| Rate for Payer: Aetna Commercial |
$2,649.11
|
| Rate for Payer: Anthem Medicaid |
$1,183.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,683.51
|
| Rate for Payer: Cash Price |
$1,720.20
|
| Rate for Payer: Cigna Commercial |
$2,855.53
|
| Rate for Payer: First Health Commercial |
$3,268.38
|
| Rate for Payer: Humana Commercial |
$2,924.34
|
| Rate for Payer: Humana KY Medicaid |
$1,183.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,195.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,821.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,539.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,032.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,206.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,027.55
|
| Rate for Payer: Ohio Health Group HMO |
$2,580.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$688.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.52
|
| Rate for Payer: PHCS Commercial |
$3,302.78
|
| Rate for Payer: United Healthcare All Payer |
$3,027.55
|
|
|
PLATE PROFYLE 3D 1.7 2*2+2H
|
Facility
|
IP
|
$3,440.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.25 |
| Max. Negotiated Rate |
$3,302.78 |
| Rate for Payer: Aetna Commercial |
$2,649.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,683.51
|
| Rate for Payer: Cash Price |
$1,720.20
|
| Rate for Payer: Cigna Commercial |
$2,855.53
|
| Rate for Payer: First Health Commercial |
$3,268.38
|
| Rate for Payer: Humana Commercial |
$2,924.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,821.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,539.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,032.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,027.55
|
| Rate for Payer: Ohio Health Group HMO |
$2,580.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$688.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.52
|
| Rate for Payer: PHCS Commercial |
$3,302.78
|
| Rate for Payer: United Healthcare All Payer |
$3,027.55
|
|
|
PLATE PROFYLE 3D 1.7 2*2H
|
Facility
|
IP
|
$3,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.30 |
| Max. Negotiated Rate |
$2,985.60 |
| Rate for Payer: Aetna Commercial |
$2,394.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,425.80
|
| Rate for Payer: Cash Price |
$1,555.00
|
| Rate for Payer: Cigna Commercial |
$2,581.30
|
| Rate for Payer: First Health Commercial |
$2,954.50
|
| Rate for Payer: Humana Commercial |
$2,643.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,550.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,295.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$933.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,736.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,332.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$964.10
|
| Rate for Payer: PHCS Commercial |
$2,985.60
|
| Rate for Payer: United Healthcare All Payer |
$2,736.80
|
|
|
PLATE PROFYLE 3D 1.7 2*2H
|
Facility
|
OP
|
$3,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.30 |
| Max. Negotiated Rate |
$2,985.60 |
| Rate for Payer: Aetna Commercial |
$2,394.70
|
| Rate for Payer: Anthem Medicaid |
$1,069.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,425.80
|
| Rate for Payer: Cash Price |
$1,555.00
|
| Rate for Payer: Cigna Commercial |
$2,581.30
|
| Rate for Payer: First Health Commercial |
$2,954.50
|
| Rate for Payer: Humana Commercial |
$2,643.50
|
| Rate for Payer: Humana KY Medicaid |
$1,069.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,080.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,550.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,295.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$933.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,090.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,736.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,332.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$964.10
|
| Rate for Payer: PHCS Commercial |
$2,985.60
|
| Rate for Payer: United Healthcare All Payer |
$2,736.80
|
|
|
PLATE PROFYLE 3D 1.7 3*2H
|
Facility
|
OP
|
$4,274.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.72 |
| Max. Negotiated Rate |
$4,103.81 |
| Rate for Payer: Anthem Medicaid |
$1,470.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,334.34
|
| Rate for Payer: Cash Price |
$2,137.40
|
| Rate for Payer: Cigna Commercial |
$3,548.08
|
| Rate for Payer: First Health Commercial |
$4,061.06
|
| Rate for Payer: Humana Commercial |
$3,633.58
|
| Rate for Payer: Humana KY Medicaid |
$1,470.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,485.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,505.34
|
| Rate for Payer: Aetna Commercial |
$3,291.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,154.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,282.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,499.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,761.82
|
| Rate for Payer: Ohio Health Group HMO |
$3,206.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$854.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,325.19
|
| Rate for Payer: PHCS Commercial |
$4,103.81
|
| Rate for Payer: United Healthcare All Payer |
$3,761.82
|
|
|
PLATE PROFYLE 3D 1.7 3*2H
|
Facility
|
IP
|
$4,274.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.72 |
| Max. Negotiated Rate |
$4,103.81 |
| Rate for Payer: Aetna Commercial |
$3,291.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,334.34
|
| Rate for Payer: Cash Price |
$2,137.40
|
| Rate for Payer: Cigna Commercial |
$3,548.08
|
| Rate for Payer: First Health Commercial |
$4,061.06
|
| Rate for Payer: Humana Commercial |
$3,633.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,505.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,154.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,282.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,761.82
|
| Rate for Payer: Ohio Health Group HMO |
$3,206.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$854.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,325.19
|
| Rate for Payer: PHCS Commercial |
$4,103.81
|
| Rate for Payer: United Healthcare All Payer |
$3,761.82
|
|
|
PLATE PROFYLE 3D 1.7 4*2H
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
PLATE PROFYLE 3D 1.7 4*2H
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem Medicaid |
$1,238.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Humana KY Medicaid |
$1,238.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,250.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,262.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
PLATE PROFYLE 3D 2.3
|
Facility
|
OP
|
$3,109.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.27 |
| Max. Negotiated Rate |
$2,985.37 |
| Rate for Payer: Aetna Commercial |
$2,394.52
|
| Rate for Payer: Anthem Medicaid |
$1,069.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,425.61
|
| Rate for Payer: Cash Price |
$1,554.88
|
| Rate for Payer: Cigna Commercial |
$2,581.10
|
| Rate for Payer: First Health Commercial |
$2,954.27
|
| Rate for Payer: Humana Commercial |
$2,643.30
|
| Rate for Payer: Humana KY Medicaid |
$1,069.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,080.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,295.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$932.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,090.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,736.59
|
| Rate for Payer: Ohio Health Group HMO |
$2,332.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$621.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$964.03
|
| Rate for Payer: PHCS Commercial |
$2,985.37
|
| Rate for Payer: United Healthcare All Payer |
$2,736.59
|
|
|
PLATE PROFYLE 3D 2.3
|
Facility
|
IP
|
$3,109.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.27 |
| Max. Negotiated Rate |
$2,985.37 |
| Rate for Payer: Aetna Commercial |
$2,394.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,425.61
|
| Rate for Payer: Cash Price |
$1,554.88
|
| Rate for Payer: Cigna Commercial |
$2,581.10
|
| Rate for Payer: First Health Commercial |
$2,954.27
|
| Rate for Payer: Humana Commercial |
$2,643.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,295.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$932.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,736.59
|
| Rate for Payer: Ohio Health Group HMO |
$2,332.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$621.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$964.03
|
| Rate for Payer: PHCS Commercial |
$2,985.37
|
| Rate for Payer: United Healthcare All Payer |
$2,736.59
|
|
|
PLATE PROFYLE 3D 2.3 2*2+2H
|
Facility
|
OP
|
$4,274.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.72 |
| Max. Negotiated Rate |
$4,103.81 |
| Rate for Payer: Aetna Commercial |
$3,291.60
|
| Rate for Payer: Anthem Medicaid |
$1,470.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,334.34
|
| Rate for Payer: Cash Price |
$2,137.40
|
| Rate for Payer: Cigna Commercial |
$3,548.08
|
| Rate for Payer: First Health Commercial |
$4,061.06
|
| Rate for Payer: Humana Commercial |
$3,633.58
|
| Rate for Payer: Humana KY Medicaid |
$1,470.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,485.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,505.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,154.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,282.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,499.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,761.82
|
| Rate for Payer: Ohio Health Group HMO |
$3,206.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$854.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,325.19
|
| Rate for Payer: PHCS Commercial |
$4,103.81
|
| Rate for Payer: United Healthcare All Payer |
$3,761.82
|
|
|
PLATE PROFYLE 3D 2.3 2*2+2H
|
Facility
|
IP
|
$4,274.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.72 |
| Max. Negotiated Rate |
$4,103.81 |
| Rate for Payer: Aetna Commercial |
$3,291.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,334.34
|
| Rate for Payer: Cash Price |
$2,137.40
|
| Rate for Payer: Cigna Commercial |
$3,548.08
|
| Rate for Payer: First Health Commercial |
$4,061.06
|
| Rate for Payer: Humana Commercial |
$3,633.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,505.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,154.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,282.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,761.82
|
| Rate for Payer: Ohio Health Group HMO |
$3,206.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$854.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,325.19
|
| Rate for Payer: PHCS Commercial |
$4,103.81
|
| Rate for Payer: United Healthcare All Payer |
$3,761.82
|
|
|
PLATE PROFYLE 3D 2.3 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 3D 2.3 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 3D 2.3 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: 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: Aetna Commercial |
$2,836.68
|
| 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 3D 2.3 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
|
|
|
PLATE PROFYLE 3D 2.3 4*2H
|
Facility
|
OP
|
$4,274.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.72 |
| Max. Negotiated Rate |
$4,103.81 |
| Rate for Payer: Aetna Commercial |
$3,291.60
|
| Rate for Payer: Anthem Medicaid |
$1,470.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,334.34
|
| Rate for Payer: Cash Price |
$2,137.40
|
| Rate for Payer: Cigna Commercial |
$3,548.08
|
| Rate for Payer: First Health Commercial |
$4,061.06
|
| Rate for Payer: Humana Commercial |
$3,633.58
|
| Rate for Payer: Humana KY Medicaid |
$1,470.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,485.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,505.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,154.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,282.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,499.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,761.82
|
| Rate for Payer: Ohio Health Group HMO |
$3,206.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$854.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,325.19
|
| Rate for Payer: PHCS Commercial |
$4,103.81
|
| Rate for Payer: United Healthcare All Payer |
$3,761.82
|
|
|
PLATE PROFYLE 3D 2.3 4*2H
|
Facility
|
IP
|
$4,274.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.72 |
| Max. Negotiated Rate |
$4,103.81 |
| Rate for Payer: Aetna Commercial |
$3,291.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,334.34
|
| Rate for Payer: Cash Price |
$2,137.40
|
| Rate for Payer: Cigna Commercial |
$3,548.08
|
| Rate for Payer: First Health Commercial |
$4,061.06
|
| Rate for Payer: Humana Commercial |
$3,633.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,505.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,154.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,282.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,761.82
|
| Rate for Payer: Ohio Health Group HMO |
$3,206.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$854.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,325.19
|
| Rate for Payer: PHCS Commercial |
$4,103.81
|
| Rate for Payer: United Healthcare All Payer |
$3,761.82
|
|
|
PLATE PROFYLE COMP L 2.3 6H L
|
Facility
|
OP
|
$1,768.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.88 |
| Max. Negotiated Rate |
$1,697.56 |
| Rate for Payer: Aetna Commercial |
$1,361.58
|
| Rate for Payer: Anthem Medicaid |
$608.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,379.27
|
| Rate for Payer: Cash Price |
$884.14
|
| Rate for Payer: Cigna Commercial |
$1,467.68
|
| Rate for Payer: First Health Commercial |
$1,679.88
|
| Rate for Payer: Humana Commercial |
$1,503.05
|
| Rate for Payer: Humana KY Medicaid |
$608.11
|
| Rate for Payer: Kentucky WC Medicaid |
$614.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,450.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,305.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$620.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,556.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,326.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.17
|
| Rate for Payer: PHCS Commercial |
$1,697.56
|
| Rate for Payer: United Healthcare All Payer |
$1,556.10
|
|
