|
PLATE PROFYLE LOCK 2.3 3D 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 PROFYLE LOCK 2.3 STR 16H
|
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 LOCK 2.3 STR 16H
|
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 LOCK 2.3 STR 4H
|
Facility
|
OP
|
$4,230.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.90 |
| Max. Negotiated Rate |
$4,060.80 |
| Rate for Payer: Aetna Commercial |
$3,257.10
|
| Rate for Payer: Anthem Medicaid |
$1,454.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,299.40
|
| Rate for Payer: Cash Price |
$2,115.00
|
| Rate for Payer: Cigna Commercial |
$3,510.90
|
| Rate for Payer: First Health Commercial |
$4,018.50
|
| Rate for Payer: Humana Commercial |
$3,595.50
|
| Rate for Payer: Humana KY Medicaid |
$1,454.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,469.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,468.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,121.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,269.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,483.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,722.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$846.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$549.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.30
|
| Rate for Payer: PHCS Commercial |
$4,060.80
|
| Rate for Payer: United Healthcare All Payer |
$3,722.40
|
|
|
PLATE PROFYLE LOCK 2.3 STR 4H
|
Facility
|
IP
|
$4,230.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.90 |
| Max. Negotiated Rate |
$4,060.80 |
| Rate for Payer: Aetna Commercial |
$3,257.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,299.40
|
| Rate for Payer: Cash Price |
$2,115.00
|
| Rate for Payer: Cigna Commercial |
$3,510.90
|
| Rate for Payer: First Health Commercial |
$4,018.50
|
| Rate for Payer: Humana Commercial |
$3,595.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,468.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,121.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,269.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,722.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$846.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$549.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.30
|
| Rate for Payer: PHCS Commercial |
$4,060.80
|
| Rate for Payer: United Healthcare All Payer |
$3,722.40
|
|
|
PLATE PROFYLE LOCK STR 1.7 16H
|
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 STR 1.7 16H
|
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 STR 1.7 4H
|
Facility
|
OP
|
$4,230.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.90 |
| Max. Negotiated Rate |
$4,060.80 |
| Rate for Payer: Aetna Commercial |
$3,257.10
|
| Rate for Payer: Anthem Medicaid |
$1,454.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,299.40
|
| Rate for Payer: Cash Price |
$2,115.00
|
| Rate for Payer: Cigna Commercial |
$3,510.90
|
| Rate for Payer: First Health Commercial |
$4,018.50
|
| Rate for Payer: Humana Commercial |
$3,595.50
|
| Rate for Payer: Humana KY Medicaid |
$1,454.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,469.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,468.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,121.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,269.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,483.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,722.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$846.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$549.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.30
|
| Rate for Payer: PHCS Commercial |
$4,060.80
|
| Rate for Payer: United Healthcare All Payer |
$3,722.40
|
|
|
PLATE PROFYLE LOCK STR 1.7 4H
|
Facility
|
IP
|
$4,230.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.90 |
| Max. Negotiated Rate |
$4,060.80 |
| Rate for Payer: Aetna Commercial |
$3,257.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,299.40
|
| Rate for Payer: Cash Price |
$2,115.00
|
| Rate for Payer: Cigna Commercial |
$3,510.90
|
| Rate for Payer: First Health Commercial |
$4,018.50
|
| Rate for Payer: Humana Commercial |
$3,595.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,468.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,121.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,269.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,722.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$846.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$549.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.30
|
| Rate for Payer: PHCS Commercial |
$4,060.80
|
| Rate for Payer: United Healthcare All Payer |
$3,722.40
|
|
|
PLATE PROFYLE M COMP STR 6H
|
Facility
|
OP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem Medicaid |
$1,363.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Humana KY Medicaid |
$1,363.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,377.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,390.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE PROFYLE M COMP STR 6H
|
Facility
|
IP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE PROFYLE M COND 2.3 5H L
|
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 M COND 2.3 5H L
|
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 PROFYLE M COND 2.3 5H R
|
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 M COND 2.3 5H R
|
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 PROFYLE M COND 2.3 6H L
|
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 PROFYLE M COND 2.3 6H L
|
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 PROFYLE M COND 2.3 6H R
|
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 PROFYLE M COND 2.3 6H R
|
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 OBL 90D 2.3 6H L
|
Facility
|
IP
|
$3,084.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$401.02 |
| Max. Negotiated Rate |
$2,961.41 |
| Rate for Payer: Aetna Commercial |
$2,375.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,406.14
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cigna Commercial |
$2,560.38
|
| Rate for Payer: First Health Commercial |
$2,930.56
|
| Rate for Payer: Humana Commercial |
$2,622.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,529.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,276.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$925.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,714.62
|
| Rate for Payer: Ohio Health Group HMO |
$2,313.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$616.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$401.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$956.29
|
| Rate for Payer: PHCS Commercial |
$2,961.41
|
| Rate for Payer: United Healthcare All Payer |
$2,714.62
|
|
|
PLATE PROFYLE OBL 90D 2.3 6H L
|
Facility
|
OP
|
$3,084.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$401.02 |
| Max. Negotiated Rate |
$2,961.41 |
| Rate for Payer: Aetna Commercial |
$2,375.30
|
| Rate for Payer: Anthem Medicaid |
$1,060.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,406.14
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cigna Commercial |
$2,560.38
|
| Rate for Payer: First Health Commercial |
$2,930.56
|
| Rate for Payer: Humana Commercial |
$2,622.08
|
| Rate for Payer: Humana KY Medicaid |
$1,060.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,071.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,529.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,276.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$925.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,082.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,714.62
|
| Rate for Payer: Ohio Health Group HMO |
$2,313.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$616.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$401.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$956.29
|
| Rate for Payer: PHCS Commercial |
$2,961.41
|
| Rate for Payer: United Healthcare All Payer |
$2,714.62
|
|
|
PLATE PROFYLE OBL 90D 2.3 6H R
|
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 OBL 90D 2.3 6H R
|
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 OBLI L 1.7 6H LT
|
Facility
|
IP
|
$3,084.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$401.02 |
| Max. Negotiated Rate |
$2,961.41 |
| Rate for Payer: Aetna Commercial |
$2,375.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,406.14
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cigna Commercial |
$2,560.38
|
| Rate for Payer: First Health Commercial |
$2,930.56
|
| Rate for Payer: Humana Commercial |
$2,622.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,529.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,276.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$925.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,714.62
|
| Rate for Payer: Ohio Health Group HMO |
$2,313.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$616.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$401.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$956.29
|
| Rate for Payer: PHCS Commercial |
$2,961.41
|
| Rate for Payer: United Healthcare All Payer |
$2,714.62
|
|
|
PLATE PROFYLE OBLI L 1.7 6H LT
|
Facility
|
OP
|
$3,084.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$401.02 |
| Max. Negotiated Rate |
$2,961.41 |
| Rate for Payer: Aetna Commercial |
$2,375.30
|
| Rate for Payer: Anthem Medicaid |
$1,060.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,406.14
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cigna Commercial |
$2,560.38
|
| Rate for Payer: First Health Commercial |
$2,930.56
|
| Rate for Payer: Humana Commercial |
$2,622.08
|
| Rate for Payer: Humana KY Medicaid |
$1,060.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,071.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,529.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,276.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$925.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,082.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,714.62
|
| Rate for Payer: Ohio Health Group HMO |
$2,313.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$616.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$401.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$956.29
|
| Rate for Payer: PHCS Commercial |
$2,961.41
|
| Rate for Payer: United Healthcare All Payer |
$2,714.62
|
|
