|
PLATE PROFYLE Y NARROW 1.7 7H
|
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 NARROW 1.7 7H
|
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 Z 1.7 9H
|
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 Z 1.7 9H
|
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 PROFYL L CMP 2.3 4H W/BR
|
Facility
|
IP
|
$1,732.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.22 |
| Max. Negotiated Rate |
$1,663.18 |
| Rate for Payer: Aetna Commercial |
$1,334.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.33
|
| Rate for Payer: Cash Price |
$866.24
|
| Rate for Payer: Cigna Commercial |
$1,437.96
|
| Rate for Payer: First Health Commercial |
$1,645.86
|
| Rate for Payer: Humana Commercial |
$1,472.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,420.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,278.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,524.58
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$537.07
|
| Rate for Payer: PHCS Commercial |
$1,663.18
|
| Rate for Payer: United Healthcare All Payer |
$1,524.58
|
|
|
PLATE PROFYL L CMP 2.3 4H W/BR
|
Facility
|
OP
|
$1,732.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.22 |
| Max. Negotiated Rate |
$1,663.18 |
| Rate for Payer: Aetna Commercial |
$1,334.01
|
| Rate for Payer: Anthem Medicaid |
$595.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.33
|
| Rate for Payer: Cash Price |
$866.24
|
| Rate for Payer: Cigna Commercial |
$1,437.96
|
| Rate for Payer: First Health Commercial |
$1,645.86
|
| Rate for Payer: Humana Commercial |
$1,472.61
|
| Rate for Payer: Humana KY Medicaid |
$595.80
|
| Rate for Payer: Kentucky WC Medicaid |
$601.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,420.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,278.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$607.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,524.58
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$537.07
|
| Rate for Payer: PHCS Commercial |
$1,663.18
|
| Rate for Payer: United Healthcare All Payer |
$1,524.58
|
|
|
PLATE PROFYL L CMP 2.3 5H W/BR
|
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 PROFYL L CMP 2.3 5H W/BR
|
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 PROFYL L CMP 2.3 6H W/BR
|
Facility
|
IP
|
$2,083.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.87 |
| Max. Negotiated Rate |
$2,000.26 |
| Rate for Payer: Aetna Commercial |
$1,604.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,625.21
|
| Rate for Payer: Cash Price |
$1,041.80
|
| Rate for Payer: Cigna Commercial |
$1,729.39
|
| Rate for Payer: First Health Commercial |
$1,979.42
|
| Rate for Payer: Humana Commercial |
$1,771.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,708.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,537.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$625.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,833.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,562.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$270.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$645.92
|
| Rate for Payer: PHCS Commercial |
$2,000.26
|
| Rate for Payer: United Healthcare All Payer |
$1,833.57
|
|
|
PLATE PROFYL L CMP 2.3 6H W/BR
|
Facility
|
OP
|
$2,083.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.87 |
| Max. Negotiated Rate |
$2,000.26 |
| Rate for Payer: Anthem Medicaid |
$716.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,625.21
|
| Rate for Payer: Cash Price |
$1,041.80
|
| Rate for Payer: Cigna Commercial |
$1,729.39
|
| Rate for Payer: First Health Commercial |
$1,979.42
|
| Rate for Payer: Humana Commercial |
$1,771.06
|
| Rate for Payer: Humana KY Medicaid |
$716.55
|
| Rate for Payer: Kentucky WC Medicaid |
$723.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,708.55
|
| Rate for Payer: Aetna Commercial |
$1,604.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,537.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$625.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$730.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,833.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,562.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$270.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$645.92
|
| Rate for Payer: PHCS Commercial |
$2,000.26
|
| Rate for Payer: United Healthcare All Payer |
$1,833.57
|
|
|
PLATE PROFYL M CMP 2.3 10H 90^
|
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 PROFYL M CMP 2.3 10H 90^
|
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 PROFYL M COMP STR BAR 4H
|
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 PROFYL M COMP STR BAR 4H
|
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 PROFYL M CON 2.3 6H LP L
|
Facility
|
OP
|
$1,872.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.42 |
| Max. Negotiated Rate |
$1,797.54 |
| Rate for Payer: Aetna Commercial |
$1,441.78
|
| Rate for Payer: Anthem Medicaid |
$643.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,460.50
|
| Rate for Payer: Cash Price |
$936.22
|
| Rate for Payer: Cigna Commercial |
$1,554.13
|
| Rate for Payer: First Health Commercial |
$1,778.82
|
| Rate for Payer: Humana Commercial |
$1,591.57
|
| Rate for Payer: Humana KY Medicaid |
$643.93
|
| Rate for Payer: Kentucky WC Medicaid |
$650.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,535.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,647.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,404.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.46
|
| Rate for Payer: PHCS Commercial |
$1,797.54
|
| Rate for Payer: United Healthcare All Payer |
$1,647.75
|
|
|
PLATE PROFYL M CON 2.3 6H LP L
|
Facility
|
IP
|
$1,872.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.42 |
| Max. Negotiated Rate |
$1,797.54 |
| Rate for Payer: Aetna Commercial |
$1,441.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,460.50
|
| Rate for Payer: Cash Price |
$936.22
|
| Rate for Payer: Cigna Commercial |
$1,554.13
|
| Rate for Payer: First Health Commercial |
$1,778.82
|
| Rate for Payer: Humana Commercial |
$1,591.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,535.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,647.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,404.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.46
|
| Rate for Payer: PHCS Commercial |
$1,797.54
|
| Rate for Payer: United Healthcare All Payer |
$1,647.75
|
|
|
PLATE PROFYL M CON 2.3 6H LP R
|
Facility
|
IP
|
$1,872.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.42 |
| Max. Negotiated Rate |
$1,797.54 |
| Rate for Payer: Aetna Commercial |
$1,441.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,460.50
|
| Rate for Payer: Cash Price |
$936.22
|
| Rate for Payer: Cigna Commercial |
$1,554.13
|
| Rate for Payer: First Health Commercial |
$1,778.82
|
| Rate for Payer: Humana Commercial |
$1,591.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,535.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,647.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,404.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.46
|
| Rate for Payer: PHCS Commercial |
$1,797.54
|
| Rate for Payer: United Healthcare All Payer |
$1,647.75
|
|
|
PLATE PROFYL M CON 2.3 6H LP R
|
Facility
|
OP
|
$1,872.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.42 |
| Max. Negotiated Rate |
$1,797.54 |
| Rate for Payer: Aetna Commercial |
$1,441.78
|
| Rate for Payer: Anthem Medicaid |
$643.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,460.50
|
| Rate for Payer: Cash Price |
$936.22
|
| Rate for Payer: Cigna Commercial |
$1,554.13
|
| Rate for Payer: First Health Commercial |
$1,778.82
|
| Rate for Payer: Humana Commercial |
$1,591.57
|
| Rate for Payer: Humana KY Medicaid |
$643.93
|
| Rate for Payer: Kentucky WC Medicaid |
$650.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,535.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,647.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,404.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.46
|
| Rate for Payer: PHCS Commercial |
$1,797.54
|
| Rate for Payer: United Healthcare All Payer |
$1,647.75
|
|
|
PLATE PROFYL M CONDY CMP LE 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: 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: Aetna Commercial |
$3,052.28
|
| 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 PROFYL M CONDY CMP LE 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 PROFYL M CONDY CMP RI 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 PROFYL M CONDY CMP RI 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 PROX FEM 21HOLE L
|
Facility
|
IP
|
$11,184.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.92 |
| Max. Negotiated Rate |
$10,736.64 |
| Rate for Payer: Aetna Commercial |
$8,611.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,723.52
|
| Rate for Payer: Cash Price |
$5,592.00
|
| Rate for Payer: Cigna Commercial |
$9,282.72
|
| Rate for Payer: First Health Commercial |
$10,624.80
|
| Rate for Payer: Humana Commercial |
$9,506.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,170.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,253.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,355.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,841.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,388.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,236.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,453.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.04
|
| Rate for Payer: PHCS Commercial |
$10,736.64
|
| Rate for Payer: United Healthcare All Payer |
$9,841.92
|
|
|
PLATE PROX FEM 21HOLE L
|
Facility
|
OP
|
$11,184.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.92 |
| Max. Negotiated Rate |
$10,736.64 |
| Rate for Payer: Aetna Commercial |
$8,611.68
|
| Rate for Payer: Anthem Medicaid |
$3,846.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,723.52
|
| Rate for Payer: Cash Price |
$5,592.00
|
| Rate for Payer: Cigna Commercial |
$9,282.72
|
| Rate for Payer: First Health Commercial |
$10,624.80
|
| Rate for Payer: Humana Commercial |
$9,506.40
|
| Rate for Payer: Humana KY Medicaid |
$3,846.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,885.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,170.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,253.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,355.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,923.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,841.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,388.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,236.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,453.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.04
|
| Rate for Payer: PHCS Commercial |
$10,736.64
|
| Rate for Payer: United Healthcare All Payer |
$9,841.92
|
|
|
PLATE PROX FEM 21HOLE R
|
Facility
|
OP
|
$11,184.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.92 |
| Max. Negotiated Rate |
$10,736.64 |
| Rate for Payer: Aetna Commercial |
$8,611.68
|
| Rate for Payer: Anthem Medicaid |
$3,846.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,723.52
|
| Rate for Payer: Cash Price |
$5,592.00
|
| Rate for Payer: Cigna Commercial |
$9,282.72
|
| Rate for Payer: First Health Commercial |
$10,624.80
|
| Rate for Payer: Humana Commercial |
$9,506.40
|
| Rate for Payer: Humana KY Medicaid |
$3,846.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,885.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,170.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,253.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,355.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,923.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,841.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,388.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,236.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,453.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.04
|
| Rate for Payer: PHCS Commercial |
$10,736.64
|
| Rate for Payer: United Healthcare All Payer |
$9,841.92
|
|
