|
PLATE PROFYLE STRGHT M 2.3 16H
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE PROFYLE STRGHT M 2.3 4H
|
Facility
|
IP
|
$3,485.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$453.08 |
| Max. Negotiated Rate |
$3,345.79 |
| Rate for Payer: Aetna Commercial |
$2,683.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,718.46
|
| Rate for Payer: Cash Price |
$1,742.60
|
| Rate for Payer: Cigna Commercial |
$2,892.72
|
| Rate for Payer: First Health Commercial |
$3,310.94
|
| Rate for Payer: Humana Commercial |
$2,962.42
|
| 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: Molina Healthcare Benefit Exchange |
$1,045.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,066.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,613.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$697.04
|
| 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: PHCS Commercial |
$3,345.79
|
| Rate for Payer: United Healthcare All Payer |
$3,066.98
|
|
|
PLATE PROFYLE STRGHT M 2.3 4H
|
Facility
|
OP
|
$3,485.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$453.08 |
| Max. Negotiated Rate |
$3,345.79 |
| Rate for Payer: Aetna Commercial |
$2,683.60
|
| Rate for Payer: Anthem Medicaid |
$1,198.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,718.46
|
| Rate for Payer: Cash Price |
$1,742.60
|
| Rate for Payer: Cigna Commercial |
$2,892.72
|
| Rate for Payer: First Health Commercial |
$3,310.94
|
| Rate for Payer: Humana Commercial |
$2,962.42
|
| Rate for Payer: Humana KY Medicaid |
$1,198.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,210.76
|
| 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: Molina Healthcare Benefit Exchange |
$1,045.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,222.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,066.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,613.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$697.04
|
| 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: PHCS Commercial |
$3,345.79
|
| Rate for Payer: United Healthcare All Payer |
$3,066.98
|
|
|
PLATE PROFYLE STRGHT S 1.7 16H
|
Facility
|
OP
|
$2,031.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.15 |
| Max. Negotiated Rate |
$1,950.66 |
| Rate for Payer: Anthem Medicaid |
$698.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,584.91
|
| Rate for Payer: Cash Price |
$1,015.97
|
| Rate for Payer: Cigna Commercial |
$1,686.51
|
| Rate for Payer: First Health Commercial |
$1,930.34
|
| Rate for Payer: Humana Commercial |
$1,727.15
|
| Rate for Payer: Humana KY Medicaid |
$698.78
|
| Rate for Payer: Kentucky WC Medicaid |
$705.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.19
|
| Rate for Payer: Aetna Commercial |
$1,564.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$712.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.11
|
| Rate for Payer: Ohio Health Group HMO |
$1,523.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.90
|
| Rate for Payer: PHCS Commercial |
$1,950.66
|
| Rate for Payer: United Healthcare All Payer |
$1,788.11
|
|
|
PLATE PROFYLE STRGHT S 1.7 16H
|
Facility
|
IP
|
$2,031.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.15 |
| Max. Negotiated Rate |
$1,950.66 |
| Rate for Payer: Aetna Commercial |
$1,564.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,584.91
|
| Rate for Payer: Cash Price |
$1,015.97
|
| Rate for Payer: Cigna Commercial |
$1,686.51
|
| Rate for Payer: First Health Commercial |
$1,930.34
|
| Rate for Payer: Humana Commercial |
$1,727.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.11
|
| Rate for Payer: Ohio Health Group HMO |
$1,523.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.90
|
| Rate for Payer: PHCS Commercial |
$1,950.66
|
| Rate for Payer: United Healthcare All Payer |
$1,788.11
|
|
|
PLATE PROFYLE T 90D 1.2 5H
|
Facility
|
IP
|
$3,166.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.58 |
| Max. Negotiated Rate |
$3,039.36 |
| Rate for Payer: Aetna Commercial |
$2,437.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,469.48
|
| Rate for Payer: Cash Price |
$1,583.00
|
| Rate for Payer: Cigna Commercial |
$2,627.78
|
| Rate for Payer: First Health Commercial |
$3,007.70
|
| Rate for Payer: Humana Commercial |
$2,691.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,596.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,336.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$949.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,786.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,374.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.46
|
| Rate for Payer: PHCS Commercial |
$3,039.36
|
| Rate for Payer: United Healthcare All Payer |
$2,786.08
|
|
|
PLATE PROFYLE T 90D 1.2 5H
|
Facility
|
OP
|
$3,166.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.58 |
| Max. Negotiated Rate |
$3,039.36 |
| Rate for Payer: Aetna Commercial |
$2,437.82
|
| Rate for Payer: Anthem Medicaid |
$1,088.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,469.48
|
| Rate for Payer: Cash Price |
$1,583.00
|
| Rate for Payer: Cigna Commercial |
$2,627.78
|
| Rate for Payer: First Health Commercial |
$3,007.70
|
| Rate for Payer: Humana Commercial |
$2,691.10
|
| Rate for Payer: Humana KY Medicaid |
$1,088.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,099.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,596.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,336.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$949.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,110.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,786.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,374.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.46
|
| Rate for Payer: PHCS Commercial |
$3,039.36
|
| Rate for Payer: United Healthcare All Payer |
$2,786.08
|
|
|
PLATE PROFYLE T 90D 1.2 8H
|
Facility
|
IP
|
$3,314.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.87 |
| Max. Negotiated Rate |
$3,181.82 |
| Rate for Payer: Aetna Commercial |
$2,552.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,585.23
|
| Rate for Payer: Cash Price |
$1,657.20
|
| Rate for Payer: Cigna Commercial |
$2,750.95
|
| Rate for Payer: First Health Commercial |
$3,148.68
|
| Rate for Payer: Humana Commercial |
$2,817.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,717.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,446.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$994.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,916.67
|
| Rate for Payer: Ohio Health Group HMO |
$2,485.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$662.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,027.46
|
| Rate for Payer: PHCS Commercial |
$3,181.82
|
| Rate for Payer: United Healthcare All Payer |
$2,916.67
|
|
|
PLATE PROFYLE T 90D 1.2 8H
|
Facility
|
OP
|
$3,314.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.87 |
| Max. Negotiated Rate |
$3,181.82 |
| Rate for Payer: Aetna Commercial |
$2,552.09
|
| Rate for Payer: Anthem Medicaid |
$1,139.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,585.23
|
| Rate for Payer: Cash Price |
$1,657.20
|
| Rate for Payer: Cigna Commercial |
$2,750.95
|
| Rate for Payer: First Health Commercial |
$3,148.68
|
| Rate for Payer: Humana Commercial |
$2,817.24
|
| Rate for Payer: Humana KY Medicaid |
$1,139.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,151.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,717.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,446.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$994.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,162.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,916.67
|
| Rate for Payer: Ohio Health Group HMO |
$2,485.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$662.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,027.46
|
| Rate for Payer: PHCS Commercial |
$3,181.82
|
| Rate for Payer: United Healthcare All Payer |
$2,916.67
|
|
|
PLATE PROFYLE T 90D 1.7 6H
|
Facility
|
IP
|
$2,019.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$1,938.43 |
| Rate for Payer: Aetna Commercial |
$1,554.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,574.98
|
| Rate for Payer: Cash Price |
$1,009.60
|
| Rate for Payer: Cigna Commercial |
$1,675.94
|
| Rate for Payer: First Health Commercial |
$1,918.24
|
| Rate for Payer: Humana Commercial |
$1,716.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,655.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,490.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,776.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,514.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.95
|
| Rate for Payer: PHCS Commercial |
$1,938.43
|
| Rate for Payer: United Healthcare All Payer |
$1,776.90
|
|
|
PLATE PROFYLE T 90D 1.7 6H
|
Facility
|
OP
|
$2,019.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$1,938.43 |
| Rate for Payer: Aetna Commercial |
$1,554.78
|
| Rate for Payer: Anthem Medicaid |
$694.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,574.98
|
| Rate for Payer: Cash Price |
$1,009.60
|
| Rate for Payer: Cigna Commercial |
$1,675.94
|
| Rate for Payer: First Health Commercial |
$1,918.24
|
| Rate for Payer: Humana Commercial |
$1,716.32
|
| Rate for Payer: Humana KY Medicaid |
$694.40
|
| Rate for Payer: Kentucky WC Medicaid |
$701.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,655.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,490.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$708.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,776.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,514.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.95
|
| Rate for Payer: PHCS Commercial |
$1,938.43
|
| Rate for Payer: United Healthcare All Payer |
$1,776.90
|
|
|
PLATE PROFYLE T 90D 1.7 7H
|
Facility
|
IP
|
$2,019.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$1,938.43 |
| Rate for Payer: Aetna Commercial |
$1,554.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,574.98
|
| Rate for Payer: Cash Price |
$1,009.60
|
| Rate for Payer: Cigna Commercial |
$1,675.94
|
| Rate for Payer: First Health Commercial |
$1,918.24
|
| Rate for Payer: Humana Commercial |
$1,716.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,655.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,490.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,776.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,514.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.95
|
| Rate for Payer: PHCS Commercial |
$1,938.43
|
| Rate for Payer: United Healthcare All Payer |
$1,776.90
|
|
|
PLATE PROFYLE T 90D 1.7 7H
|
Facility
|
OP
|
$2,019.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$1,938.43 |
| Rate for Payer: Aetna Commercial |
$1,554.78
|
| Rate for Payer: Anthem Medicaid |
$694.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,574.98
|
| Rate for Payer: Cash Price |
$1,009.60
|
| Rate for Payer: Cigna Commercial |
$1,675.94
|
| Rate for Payer: First Health Commercial |
$1,918.24
|
| Rate for Payer: Humana Commercial |
$1,716.32
|
| Rate for Payer: Humana KY Medicaid |
$694.40
|
| Rate for Payer: Kentucky WC Medicaid |
$701.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,655.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,490.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$708.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,776.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,514.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.95
|
| Rate for Payer: PHCS Commercial |
$1,938.43
|
| Rate for Payer: United Healthcare All Payer |
$1,776.90
|
|
|
PLATE PROFYLE T 90D REG 1.7 7H
|
Facility
|
IP
|
$3,180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.40 |
| Max. Negotiated Rate |
$3,052.80 |
| Rate for Payer: Aetna Commercial |
$2,448.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,480.40
|
| Rate for Payer: Cash Price |
$1,590.00
|
| Rate for Payer: Cigna Commercial |
$2,639.40
|
| Rate for Payer: First Health Commercial |
$3,021.00
|
| Rate for Payer: Humana Commercial |
$2,703.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,607.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,346.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$954.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,798.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$985.80
|
| Rate for Payer: PHCS Commercial |
$3,052.80
|
| Rate for Payer: United Healthcare All Payer |
$2,798.40
|
|
|
PLATE PROFYLE T 90D REG 1.7 7H
|
Facility
|
OP
|
$3,180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.40 |
| Max. Negotiated Rate |
$3,052.80 |
| Rate for Payer: Anthem Medicaid |
$1,093.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,480.40
|
| Rate for Payer: Cash Price |
$1,590.00
|
| Rate for Payer: Cigna Commercial |
$2,639.40
|
| Rate for Payer: First Health Commercial |
$3,021.00
|
| Rate for Payer: Humana Commercial |
$2,703.00
|
| Rate for Payer: Humana KY Medicaid |
$1,093.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,104.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,607.60
|
| Rate for Payer: Aetna Commercial |
$2,448.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,346.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$954.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,115.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,798.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$985.80
|
| Rate for Payer: PHCS Commercial |
$3,052.80
|
| Rate for Payer: United Healthcare All Payer |
$2,798.40
|
|
|
PLATE PROFYLE T CMP 2.3 6H 90^
|
Facility
|
IP
|
$3,975.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.78 |
| Max. Negotiated Rate |
$3,816.19 |
| Rate for Payer: Aetna Commercial |
$3,060.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,100.66
|
| Rate for Payer: Cash Price |
$1,987.60
|
| Rate for Payer: Cigna Commercial |
$3,299.42
|
| Rate for Payer: First Health Commercial |
$3,776.44
|
| Rate for Payer: Humana Commercial |
$3,378.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,259.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,933.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,192.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,498.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,981.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$795.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,232.31
|
| Rate for Payer: PHCS Commercial |
$3,816.19
|
| Rate for Payer: United Healthcare All Payer |
$3,498.18
|
|
|
PLATE PROFYLE T CMP 2.3 6H 90^
|
Facility
|
OP
|
$3,975.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.78 |
| Max. Negotiated Rate |
$3,816.19 |
| Rate for Payer: Aetna Commercial |
$3,060.90
|
| Rate for Payer: Anthem Medicaid |
$1,367.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,100.66
|
| Rate for Payer: Cash Price |
$1,987.60
|
| Rate for Payer: Cigna Commercial |
$3,299.42
|
| Rate for Payer: First Health Commercial |
$3,776.44
|
| Rate for Payer: Humana Commercial |
$3,378.92
|
| Rate for Payer: Humana KY Medicaid |
$1,367.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,380.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,259.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,933.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,192.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,394.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,498.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,981.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$795.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,232.31
|
| Rate for Payer: PHCS Commercial |
$3,816.19
|
| Rate for Payer: United Healthcare All Payer |
$3,498.18
|
|
|
PLATE PROFYLE T L CMP 10H 90^
|
Facility
|
IP
|
$3,079.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.30 |
| Max. Negotiated Rate |
$2,956.03 |
| Rate for Payer: Aetna Commercial |
$2,370.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,401.78
|
| Rate for Payer: Cash Price |
$1,539.60
|
| Rate for Payer: Cigna Commercial |
$2,555.74
|
| Rate for Payer: First Health Commercial |
$2,925.24
|
| Rate for Payer: Humana Commercial |
$2,617.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,524.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,272.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$923.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,709.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,309.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$400.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$954.55
|
| Rate for Payer: PHCS Commercial |
$2,956.03
|
| Rate for Payer: United Healthcare All Payer |
$2,709.70
|
|
|
PLATE PROFYLE T L CMP 10H 90^
|
Facility
|
OP
|
$3,079.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.30 |
| Max. Negotiated Rate |
$2,956.03 |
| Rate for Payer: Aetna Commercial |
$2,370.98
|
| Rate for Payer: Anthem Medicaid |
$1,058.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,401.78
|
| Rate for Payer: Cash Price |
$1,539.60
|
| Rate for Payer: Cigna Commercial |
$2,555.74
|
| Rate for Payer: First Health Commercial |
$2,925.24
|
| Rate for Payer: Humana Commercial |
$2,617.32
|
| Rate for Payer: Humana KY Medicaid |
$1,058.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,069.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,524.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,272.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$923.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,080.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,709.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,309.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$400.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$954.55
|
| Rate for Payer: PHCS Commercial |
$2,956.03
|
| Rate for Payer: United Healthcare All Payer |
$2,709.70
|
|
|
PLATE PROFYLE T OBLIQUE 6H LT
|
Facility
|
IP
|
$2,019.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$1,938.43 |
| Rate for Payer: Aetna Commercial |
$1,554.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,574.98
|
| Rate for Payer: Cash Price |
$1,009.60
|
| Rate for Payer: Cigna Commercial |
$1,675.94
|
| Rate for Payer: First Health Commercial |
$1,918.24
|
| Rate for Payer: Humana Commercial |
$1,716.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,655.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,490.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,776.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,514.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.95
|
| Rate for Payer: PHCS Commercial |
$1,938.43
|
| Rate for Payer: United Healthcare All Payer |
$1,776.90
|
|
|
PLATE PROFYLE T OBLIQUE 6H LT
|
Facility
|
OP
|
$2,019.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$1,938.43 |
| Rate for Payer: Aetna Commercial |
$1,554.78
|
| Rate for Payer: Anthem Medicaid |
$694.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,574.98
|
| Rate for Payer: Cash Price |
$1,009.60
|
| Rate for Payer: Cigna Commercial |
$1,675.94
|
| Rate for Payer: First Health Commercial |
$1,918.24
|
| Rate for Payer: Humana Commercial |
$1,716.32
|
| Rate for Payer: Humana KY Medicaid |
$694.40
|
| Rate for Payer: Kentucky WC Medicaid |
$701.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,655.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,490.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$708.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,776.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,514.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.95
|
| Rate for Payer: PHCS Commercial |
$1,938.43
|
| Rate for Payer: United Healthcare All Payer |
$1,776.90
|
|
|
PLATE PROFYLE T OBLIQUE 6H RT
|
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 T OBLIQUE 6H RT
|
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 Y C0MP 2.3 7H NA
|
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 Y C0MP 2.3 7H NA
|
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
|
|
