|
PLATE PROFYLE OBLI L 1.7 6H RT
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
PLATE PROFYLE OBLI L 1.7 6H RT
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
PLATE PROFYLE OBL T CMP 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 T CMP 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 T CMP 6H R
|
Facility
|
IP
|
$1,851.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.67 |
| Max. Negotiated Rate |
$1,777.22 |
| Rate for Payer: Aetna Commercial |
$1,425.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.99
|
| Rate for Payer: Cash Price |
$925.64
|
| Rate for Payer: Cigna Commercial |
$1,536.55
|
| Rate for Payer: First Health Commercial |
$1,758.71
|
| Rate for Payer: Humana Commercial |
$1,573.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,518.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,629.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.89
|
| Rate for Payer: PHCS Commercial |
$1,777.22
|
| Rate for Payer: United Healthcare All Payer |
$1,629.12
|
|
|
PLATE PROFYLE OBL T CMP 6H R
|
Facility
|
OP
|
$1,851.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.67 |
| Max. Negotiated Rate |
$1,777.22 |
| Rate for Payer: Aetna Commercial |
$1,425.48
|
| Rate for Payer: Anthem Medicaid |
$636.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.99
|
| Rate for Payer: Cash Price |
$925.64
|
| Rate for Payer: Cigna Commercial |
$1,536.55
|
| Rate for Payer: First Health Commercial |
$1,758.71
|
| Rate for Payer: Humana Commercial |
$1,573.58
|
| Rate for Payer: Humana KY Medicaid |
$636.65
|
| Rate for Payer: Kentucky WC Medicaid |
$643.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,518.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$649.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,629.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.89
|
| Rate for Payer: PHCS Commercial |
$1,777.22
|
| Rate for Payer: United Healthcare All Payer |
$1,629.12
|
|
|
PLATE PROFYLE REPLANT 1.7 4*2H
|
Facility
|
OP
|
$4,239.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.17 |
| Max. Negotiated Rate |
$4,070.21 |
| Rate for Payer: Aetna Commercial |
$3,264.65
|
| Rate for Payer: Anthem Medicaid |
$1,458.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,307.04
|
| Rate for Payer: Cash Price |
$2,119.90
|
| Rate for Payer: Cigna Commercial |
$3,519.03
|
| Rate for Payer: First Health Commercial |
$4,027.81
|
| Rate for Payer: Humana Commercial |
$3,603.83
|
| Rate for Payer: Humana KY Medicaid |
$1,458.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,472.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,476.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,128.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,271.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,487.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,731.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,179.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$847.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$551.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,314.34
|
| Rate for Payer: PHCS Commercial |
$4,070.21
|
| Rate for Payer: United Healthcare All Payer |
$3,731.02
|
|
|
PLATE PROFYLE REPLANT 1.7 4*2H
|
Facility
|
IP
|
$4,239.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.17 |
| Max. Negotiated Rate |
$4,070.21 |
| Rate for Payer: Aetna Commercial |
$3,264.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,307.04
|
| Rate for Payer: Cash Price |
$2,119.90
|
| Rate for Payer: Cigna Commercial |
$3,519.03
|
| Rate for Payer: First Health Commercial |
$4,027.81
|
| Rate for Payer: Humana Commercial |
$3,603.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,476.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,128.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,271.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,731.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,179.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$847.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$551.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,314.34
|
| Rate for Payer: PHCS Commercial |
$4,070.21
|
| Rate for Payer: United Healthcare All Payer |
$3,731.02
|
|
|
PLATE PROFYLE REPLANT 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 REPLANT 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: 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 ROT 2.3 5H
|
Facility
|
OP
|
$4,843.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.62 |
| Max. Negotiated Rate |
$4,649.47 |
| Rate for Payer: Anthem Medicaid |
$1,665.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,777.70
|
| Rate for Payer: Cash Price |
$2,421.60
|
| Rate for Payer: Cigna Commercial |
$4,019.86
|
| Rate for Payer: First Health Commercial |
$4,601.04
|
| Rate for Payer: Humana Commercial |
$4,116.72
|
| Rate for Payer: Humana KY Medicaid |
$1,665.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,682.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,971.42
|
| Rate for Payer: Aetna Commercial |
$3,729.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,574.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,452.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,698.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,262.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,632.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$968.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$629.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,501.39
|
| Rate for Payer: PHCS Commercial |
$4,649.47
|
| Rate for Payer: United Healthcare All Payer |
$4,262.02
|
|
|
PLATE PROFYLE ROT 2.3 5H
|
Facility
|
IP
|
$4,843.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.62 |
| Max. Negotiated Rate |
$4,649.47 |
| Rate for Payer: Aetna Commercial |
$3,729.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,777.70
|
| Rate for Payer: Cash Price |
$2,421.60
|
| Rate for Payer: Cigna Commercial |
$4,019.86
|
| Rate for Payer: First Health Commercial |
$4,601.04
|
| Rate for Payer: Humana Commercial |
$4,116.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,971.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,574.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,452.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,262.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,632.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$968.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$629.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,501.39
|
| Rate for Payer: PHCS Commercial |
$4,649.47
|
| Rate for Payer: United Healthcare All Payer |
$4,262.02
|
|
|
PLATE PROFYLE STRAIGHT 1.7 16H
|
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 STRAIGHT 1.7 16H
|
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 STRAIGHT 1.7 4H
|
Facility
|
OP
|
$1,559.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.70 |
| Max. Negotiated Rate |
$1,496.85 |
| Rate for Payer: Aetna Commercial |
$1,200.60
|
| Rate for Payer: Anthem Medicaid |
$536.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,216.19
|
| Rate for Payer: Cash Price |
$779.61
|
| Rate for Payer: Cigna Commercial |
$1,294.15
|
| Rate for Payer: First Health Commercial |
$1,481.26
|
| Rate for Payer: Humana Commercial |
$1,325.34
|
| Rate for Payer: Humana KY Medicaid |
$536.22
|
| Rate for Payer: Kentucky WC Medicaid |
$541.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,278.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,150.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$546.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,372.11
|
| Rate for Payer: Ohio Health Group HMO |
$1,169.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$311.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$202.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.36
|
| Rate for Payer: PHCS Commercial |
$1,496.85
|
| Rate for Payer: United Healthcare All Payer |
$1,372.11
|
|
|
PLATE PROFYLE STRAIGHT 1.7 4H
|
Facility
|
IP
|
$1,559.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.70 |
| Max. Negotiated Rate |
$1,496.85 |
| Rate for Payer: Aetna Commercial |
$1,200.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,216.19
|
| Rate for Payer: Cash Price |
$779.61
|
| Rate for Payer: Cigna Commercial |
$1,294.15
|
| Rate for Payer: First Health Commercial |
$1,481.26
|
| Rate for Payer: Humana Commercial |
$1,325.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,278.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,150.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,372.11
|
| Rate for Payer: Ohio Health Group HMO |
$1,169.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$311.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$202.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.36
|
| Rate for Payer: PHCS Commercial |
$1,496.85
|
| Rate for Payer: United Healthcare All Payer |
$1,372.11
|
|
|
PLATE PROFYLE STRAIGHT 2.3 4H
|
Facility
|
OP
|
$1,580.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.45 |
| Max. Negotiated Rate |
$1,517.16 |
| Rate for Payer: Aetna Commercial |
$1,216.88
|
| Rate for Payer: Aetna Commercial |
$2,683.60
|
| Rate for Payer: Anthem Medicaid |
$543.49
|
| Rate for Payer: Anthem Medicaid |
$1,198.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,232.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,718.46
|
| Rate for Payer: Cash Price |
$790.18
|
| Rate for Payer: Cash Price |
$1,742.60
|
| Rate for Payer: Cigna Commercial |
$2,892.72
|
| Rate for Payer: Cigna Commercial |
$1,311.71
|
| Rate for Payer: First Health Commercial |
$3,310.94
|
| Rate for Payer: First Health Commercial |
$1,501.35
|
| Rate for Payer: Humana Commercial |
$1,343.31
|
| Rate for Payer: Humana Commercial |
$2,962.42
|
| Rate for Payer: Humana KY Medicaid |
$543.49
|
| Rate for Payer: Humana KY Medicaid |
$1,198.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,210.76
|
| Rate for Payer: Kentucky WC Medicaid |
$549.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,295.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,857.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,572.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,166.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,045.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$554.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,222.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,390.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,066.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,185.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,613.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$697.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$453.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,080.41
|
| Rate for Payer: PHCS Commercial |
$3,345.79
|
| Rate for Payer: PHCS Commercial |
$1,517.16
|
| Rate for Payer: United Healthcare All Payer |
$3,066.98
|
| Rate for Payer: United Healthcare All Payer |
$1,390.73
|
|
|
PLATE PROFYLE STRAIGHT 2.3 4H
|
Facility
|
IP
|
$1,580.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.45 |
| Max. Negotiated Rate |
$1,517.16 |
| Rate for Payer: Aetna Commercial |
$1,216.88
|
| Rate for Payer: Aetna Commercial |
$2,683.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,232.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,718.46
|
| Rate for Payer: Cash Price |
$790.18
|
| Rate for Payer: Cash Price |
$1,742.60
|
| Rate for Payer: Cigna Commercial |
$1,311.71
|
| Rate for Payer: Cigna Commercial |
$2,892.72
|
| Rate for Payer: First Health Commercial |
$3,310.94
|
| Rate for Payer: First Health Commercial |
$1,501.35
|
| Rate for Payer: Humana Commercial |
$2,962.42
|
| Rate for Payer: Humana Commercial |
$1,343.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,295.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,857.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,166.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,572.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,045.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,390.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,066.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,185.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,613.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$697.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$453.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,080.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.91
|
| Rate for Payer: PHCS Commercial |
$1,517.16
|
| Rate for Payer: PHCS Commercial |
$3,345.79
|
| Rate for Payer: United Healthcare All Payer |
$1,390.73
|
| Rate for Payer: United Healthcare All Payer |
$3,066.98
|
|
|
PLATE PROFYLE STRGHT 1.2 16H
|
Facility
|
OP
|
$3,670.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.10 |
| Max. Negotiated Rate |
$3,523.20 |
| Rate for Payer: Kentucky WC Medicaid |
$1,274.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,009.40
|
| Rate for Payer: Aetna Commercial |
$2,825.90
|
| Rate for Payer: Anthem Medicaid |
$1,262.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,862.60
|
| Rate for Payer: Cash Price |
$1,835.00
|
| Rate for Payer: Cigna Commercial |
$3,046.10
|
| Rate for Payer: First Health Commercial |
$3,486.50
|
| Rate for Payer: Humana Commercial |
$3,119.50
|
| Rate for Payer: Humana KY Medicaid |
$1,262.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,708.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,101.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,287.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,752.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$734.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$477.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,137.70
|
| Rate for Payer: PHCS Commercial |
$3,523.20
|
| Rate for Payer: United Healthcare All Payer |
$3,229.60
|
|
|
PLATE PROFYLE STRGHT 1.2 16H
|
Facility
|
IP
|
$3,670.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.10 |
| Max. Negotiated Rate |
$3,523.20 |
| Rate for Payer: Aetna Commercial |
$2,825.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,862.60
|
| Rate for Payer: Cash Price |
$1,835.00
|
| Rate for Payer: Cigna Commercial |
$3,046.10
|
| Rate for Payer: First Health Commercial |
$3,486.50
|
| Rate for Payer: Humana Commercial |
$3,119.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,009.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,708.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,101.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,752.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$734.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$477.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,137.70
|
| Rate for Payer: PHCS Commercial |
$3,523.20
|
| Rate for Payer: United Healthcare All Payer |
$3,229.60
|
|
|
PLATE PROFYLE STRGHT 1.2 4H
|
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: Aetna Commercial |
$1,686.30
|
| 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: 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 STRGHT 1.2 4H
|
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 STRGHT M 1.7 4H
|
Facility
|
OP
|
$2,008.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$261.04 |
| Max. Negotiated Rate |
$1,927.68 |
| Rate for Payer: Aetna Commercial |
$1,546.16
|
| Rate for Payer: Anthem Medicaid |
$690.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,566.24
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cigna Commercial |
$1,666.64
|
| Rate for Payer: First Health Commercial |
$1,907.60
|
| Rate for Payer: Humana Commercial |
$1,706.80
|
| Rate for Payer: Humana KY Medicaid |
$690.55
|
| Rate for Payer: Kentucky WC Medicaid |
$697.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,646.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,481.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$602.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$704.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,767.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,506.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$401.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$622.48
|
| Rate for Payer: PHCS Commercial |
$1,927.68
|
| Rate for Payer: United Healthcare All Payer |
$1,767.04
|
|
|
PLATE PROFYLE STRGHT M 1.7 4H
|
Facility
|
IP
|
$2,008.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$261.04 |
| Max. Negotiated Rate |
$1,927.68 |
| Rate for Payer: Aetna Commercial |
$1,546.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,566.24
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cigna Commercial |
$1,666.64
|
| Rate for Payer: First Health Commercial |
$1,907.60
|
| Rate for Payer: Humana Commercial |
$1,706.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,646.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,481.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$602.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,767.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,506.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$401.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$622.48
|
| Rate for Payer: PHCS Commercial |
$1,927.68
|
| Rate for Payer: United Healthcare All Payer |
$1,767.04
|
|
|
PLATE PROFYLE STRGHT M 2.3 16H
|
Facility
|
OP
|
$3,306.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.88 |
| Max. Negotiated Rate |
$3,174.50 |
| Rate for Payer: Aetna Commercial |
$2,546.21
|
| Rate for Payer: Anthem Medicaid |
$1,137.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,579.28
|
| Rate for Payer: Cash Price |
$1,653.38
|
| Rate for Payer: Cigna Commercial |
$2,744.62
|
| Rate for Payer: First Health Commercial |
$3,141.43
|
| Rate for Payer: Humana Commercial |
$2,810.75
|
| Rate for Payer: Humana KY Medicaid |
$1,137.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,148.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,711.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,440.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$992.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,160.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,909.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,480.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,025.10
|
| Rate for Payer: PHCS Commercial |
$3,174.50
|
| Rate for Payer: United Healthcare All Payer |
$2,909.96
|
|
