|
PLATE PROFYLE CONDYLAR 1H
|
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 CONDYLAR 1H
|
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 CONDYLAR 5H LT
|
Facility
|
IP
|
$1,820.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.64 |
| Max. Negotiated Rate |
$1,747.52 |
| Rate for Payer: Aetna Commercial |
$1,401.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,419.86
|
| Rate for Payer: Cash Price |
$910.16
|
| Rate for Payer: Cigna Commercial |
$1,510.87
|
| Rate for Payer: First Health Commercial |
$1,729.31
|
| Rate for Payer: Humana Commercial |
$1,547.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,601.89
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.30
|
| Rate for Payer: PHCS Commercial |
$1,747.52
|
| Rate for Payer: United Healthcare All Payer |
$1,601.89
|
|
|
PLATE PROFYLE CONDYLAR 5H LT
|
Facility
|
OP
|
$1,820.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.64 |
| Max. Negotiated Rate |
$1,747.52 |
| Rate for Payer: Aetna Commercial |
$1,401.65
|
| Rate for Payer: Anthem Medicaid |
$626.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,419.86
|
| Rate for Payer: Cash Price |
$910.16
|
| Rate for Payer: Cigna Commercial |
$1,510.87
|
| Rate for Payer: First Health Commercial |
$1,729.31
|
| Rate for Payer: Humana Commercial |
$1,547.28
|
| Rate for Payer: Humana KY Medicaid |
$626.01
|
| Rate for Payer: Kentucky WC Medicaid |
$632.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$638.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,601.89
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.30
|
| Rate for Payer: PHCS Commercial |
$1,747.52
|
| Rate for Payer: United Healthcare All Payer |
$1,601.89
|
|
|
PLATE PROFYLE CONDYLAR 5H RT
|
Facility
|
IP
|
$1,820.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.64 |
| Max. Negotiated Rate |
$1,747.52 |
| Rate for Payer: Aetna Commercial |
$1,401.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,419.86
|
| Rate for Payer: Cash Price |
$910.16
|
| Rate for Payer: Cigna Commercial |
$1,510.87
|
| Rate for Payer: First Health Commercial |
$1,729.31
|
| Rate for Payer: Humana Commercial |
$1,547.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,601.89
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.30
|
| Rate for Payer: PHCS Commercial |
$1,747.52
|
| Rate for Payer: United Healthcare All Payer |
$1,601.89
|
|
|
PLATE PROFYLE CONDYLAR 5H RT
|
Facility
|
OP
|
$1,820.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.64 |
| Max. Negotiated Rate |
$1,747.52 |
| Rate for Payer: Aetna Commercial |
$1,401.65
|
| Rate for Payer: Anthem Medicaid |
$626.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,419.86
|
| Rate for Payer: Cash Price |
$910.16
|
| Rate for Payer: Cigna Commercial |
$1,510.87
|
| Rate for Payer: First Health Commercial |
$1,729.31
|
| Rate for Payer: Humana Commercial |
$1,547.28
|
| Rate for Payer: Humana KY Medicaid |
$626.01
|
| Rate for Payer: Kentucky WC Medicaid |
$632.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$638.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,601.89
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.30
|
| Rate for Payer: PHCS Commercial |
$1,747.52
|
| Rate for Payer: United Healthcare All Payer |
$1,601.89
|
|
|
PLATE PROFYLE CONDYLAR W/B 5H
|
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 CONDYLAR W/B 5H
|
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 L 90D 6H LT
|
Facility
|
OP
|
$3,378.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.24 |
| Max. Negotiated Rate |
$3,243.65 |
| Rate for Payer: Aetna Commercial |
$2,601.68
|
| Rate for Payer: Anthem Medicaid |
$1,161.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,635.46
|
| Rate for Payer: Cash Price |
$1,689.40
|
| Rate for Payer: Cigna Commercial |
$2,804.40
|
| Rate for Payer: First Health Commercial |
$3,209.86
|
| Rate for Payer: Humana Commercial |
$2,871.98
|
| Rate for Payer: Humana KY Medicaid |
$1,161.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,173.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,770.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,493.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,013.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,185.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,973.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,534.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$675.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,047.43
|
| Rate for Payer: PHCS Commercial |
$3,243.65
|
| Rate for Payer: United Healthcare All Payer |
$2,973.34
|
|
|
PLATE PROFYLE L 90D 6H LT
|
Facility
|
IP
|
$3,378.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.24 |
| Max. Negotiated Rate |
$3,243.65 |
| Rate for Payer: Aetna Commercial |
$2,601.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,635.46
|
| Rate for Payer: Cash Price |
$1,689.40
|
| Rate for Payer: Cigna Commercial |
$2,804.40
|
| Rate for Payer: First Health Commercial |
$3,209.86
|
| Rate for Payer: Humana Commercial |
$2,871.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,770.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,493.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,013.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,973.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,534.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$675.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,047.43
|
| Rate for Payer: PHCS Commercial |
$3,243.65
|
| Rate for Payer: United Healthcare All Payer |
$2,973.34
|
|
|
PLATE PROFYLE L 90D 6H RT
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.70 |
| Max. Negotiated Rate |
$2,102.40 |
| Rate for Payer: Aetna Commercial |
$1,686.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,708.20
|
| Rate for Payer: Cash Price |
$1,095.00
|
| Rate for Payer: Cigna Commercial |
$1,817.70
|
| Rate for Payer: First Health Commercial |
$2,080.50
|
| Rate for Payer: Humana Commercial |
$1,861.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,795.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,616.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$657.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,927.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,642.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.90
|
| Rate for Payer: PHCS Commercial |
$2,102.40
|
| Rate for Payer: United Healthcare All Payer |
$1,927.20
|
|
|
PLATE PROFYLE L 90D 6H RT
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.70 |
| Max. Negotiated Rate |
$2,102.40 |
| Rate for Payer: Anthem Medicaid |
$753.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,708.20
|
| Rate for Payer: Cash Price |
$1,095.00
|
| Rate for Payer: Cigna Commercial |
$1,817.70
|
| Rate for Payer: First Health Commercial |
$2,080.50
|
| Rate for Payer: Humana Commercial |
$1,861.50
|
| Rate for Payer: Humana KY Medicaid |
$753.14
|
| Rate for Payer: Kentucky WC Medicaid |
$760.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,795.80
|
| Rate for Payer: Aetna Commercial |
$1,686.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,616.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$657.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$768.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,927.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,642.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.90
|
| Rate for Payer: PHCS Commercial |
$2,102.40
|
| Rate for Payer: United Healthcare All Payer |
$1,927.20
|
|
|
PLATE PROFYLE LCK 2.3 ROT 5H
|
Facility
|
OP
|
$3,663.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$476.22 |
| Max. Negotiated Rate |
$3,516.71 |
| Rate for Payer: Aetna Commercial |
$2,820.69
|
| Rate for Payer: Anthem Medicaid |
$1,259.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,857.33
|
| Rate for Payer: Cash Price |
$1,831.62
|
| Rate for Payer: Cigna Commercial |
$3,040.49
|
| Rate for Payer: First Health Commercial |
$3,480.08
|
| Rate for Payer: Humana Commercial |
$3,113.75
|
| Rate for Payer: Humana KY Medicaid |
$1,259.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,272.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,003.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,703.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,098.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,285.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,223.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,747.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$732.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,135.60
|
| Rate for Payer: PHCS Commercial |
$3,516.71
|
| Rate for Payer: United Healthcare All Payer |
$3,223.65
|
|
|
PLATE PROFYLE LCK 2.3 ROT 5H
|
Facility
|
IP
|
$3,663.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$476.22 |
| Max. Negotiated Rate |
$3,516.71 |
| Rate for Payer: Aetna Commercial |
$2,820.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,857.33
|
| Rate for Payer: Cash Price |
$1,831.62
|
| Rate for Payer: Cigna Commercial |
$3,040.49
|
| Rate for Payer: First Health Commercial |
$3,480.08
|
| Rate for Payer: Humana Commercial |
$3,113.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,003.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,703.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,098.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,223.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,747.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$732.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,135.60
|
| Rate for Payer: PHCS Commercial |
$3,516.71
|
| Rate for Payer: United Healthcare All Payer |
$3,223.65
|
|
|
PLATE PROFYLE LCK ROT 1.7 5H
|
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 PROFYLE LCK ROT 1.7 5H
|
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 PROFYLE L CMP 2.3 7H
|
Facility
|
OP
|
$3,174.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.67 |
| Max. Negotiated Rate |
$3,047.42 |
| Rate for Payer: Aetna Commercial |
$2,444.29
|
| Rate for Payer: Anthem Medicaid |
$1,091.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,476.03
|
| Rate for Payer: Cash Price |
$1,587.20
|
| Rate for Payer: Cigna Commercial |
$2,634.75
|
| Rate for Payer: First Health Commercial |
$3,015.68
|
| Rate for Payer: Humana Commercial |
$2,698.24
|
| Rate for Payer: Humana KY Medicaid |
$1,091.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,102.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,603.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,342.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$952.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,113.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,793.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,380.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$634.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$412.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$984.06
|
| Rate for Payer: PHCS Commercial |
$3,047.42
|
| Rate for Payer: United Healthcare All Payer |
$2,793.47
|
|
|
PLATE PROFYLE L CMP 2.3 7H
|
Facility
|
IP
|
$3,174.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.67 |
| Max. Negotiated Rate |
$3,047.42 |
| Rate for Payer: Aetna Commercial |
$2,444.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,476.03
|
| Rate for Payer: Cash Price |
$1,587.20
|
| Rate for Payer: Cigna Commercial |
$2,634.75
|
| Rate for Payer: First Health Commercial |
$3,015.68
|
| Rate for Payer: Humana Commercial |
$2,698.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,603.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,342.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$952.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,793.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,380.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$634.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$412.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$984.06
|
| Rate for Payer: PHCS Commercial |
$3,047.42
|
| Rate for Payer: United Healthcare All Payer |
$2,793.47
|
|
|
PLATE PROFYLE L CMP 2.3 8H
|
Facility
|
OP
|
$1,918.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.34 |
| Max. Negotiated Rate |
$1,841.30 |
| Rate for Payer: Aetna Commercial |
$1,476.88
|
| Rate for Payer: Anthem Medicaid |
$659.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,496.06
|
| Rate for Payer: Cash Price |
$959.01
|
| Rate for Payer: Cigna Commercial |
$1,591.96
|
| Rate for Payer: First Health Commercial |
$1,822.12
|
| Rate for Payer: Humana Commercial |
$1,630.32
|
| Rate for Payer: Humana KY Medicaid |
$659.61
|
| Rate for Payer: Kentucky WC Medicaid |
$666.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,572.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,415.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$672.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,687.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,438.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$594.59
|
| Rate for Payer: PHCS Commercial |
$1,841.30
|
| Rate for Payer: United Healthcare All Payer |
$1,687.86
|
|
|
PLATE PROFYLE L CMP 2.3 8H
|
Facility
|
IP
|
$1,918.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.34 |
| Max. Negotiated Rate |
$1,841.30 |
| Rate for Payer: Aetna Commercial |
$1,476.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,496.06
|
| Rate for Payer: Cash Price |
$959.01
|
| Rate for Payer: Cigna Commercial |
$1,591.96
|
| Rate for Payer: First Health Commercial |
$1,822.12
|
| Rate for Payer: Humana Commercial |
$1,630.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,572.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,415.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,687.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,438.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$594.59
|
| Rate for Payer: PHCS Commercial |
$1,841.30
|
| Rate for Payer: United Healthcare All Payer |
$1,687.86
|
|
|
PLATE PROFYLE LOCK 2.3 3D 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 PROFYLE LOCK 2.3 3D 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 PROFYLE LOCK 2.3 3D 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 PROFYLE LOCK 2.3 3D 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 PROFYLE LOCK 2.3 3D 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
|
|
