|
PLATE PROFYLE 3D 2.3
|
Facility
|
IP
|
$2,974.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.42 |
| Max. Negotiated Rate |
$2,855.75 |
| Rate for Payer: Aetna Commercial |
$2,290.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.30
|
| Rate for Payer: Cash Price |
$1,487.37
|
| Rate for Payer: Cigna Commercial |
$2,469.03
|
| Rate for Payer: First Health Commercial |
$2,826.00
|
| Rate for Payer: Humana Commercial |
$2,528.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,617.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,379.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,588.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.57
|
| Rate for Payer: PHCS Commercial |
$2,855.75
|
| Rate for Payer: United Healthcare All Payer |
$2,617.77
|
|
|
PLATE PROFYLE 3D 2.3 2*2+2H
|
Facility
|
IP
|
$4,223.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,266.90 |
| Max. Negotiated Rate |
$4,054.08 |
| Rate for Payer: Aetna Commercial |
$3,251.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,293.94
|
| Rate for Payer: Cash Price |
$2,111.50
|
| Rate for Payer: Cigna Commercial |
$3,505.09
|
| Rate for Payer: First Health Commercial |
$4,011.85
|
| Rate for Payer: Humana Commercial |
$3,589.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,116.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,266.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,716.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,167.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,378.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,674.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,913.87
|
| Rate for Payer: PHCS Commercial |
$4,054.08
|
| Rate for Payer: United Healthcare All Payer |
$3,716.24
|
|
|
PLATE PROFYLE 3D 2.3 2*2+2H
|
Facility
|
OP
|
$4,223.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,266.90 |
| Max. Negotiated Rate |
$4,054.08 |
| Rate for Payer: Aetna Commercial |
$3,251.71
|
| Rate for Payer: Anthem Medicaid |
$1,452.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,293.94
|
| Rate for Payer: Cash Price |
$2,111.50
|
| Rate for Payer: Cigna Commercial |
$3,505.09
|
| Rate for Payer: First Health Commercial |
$4,011.85
|
| Rate for Payer: Humana Commercial |
$3,589.55
|
| Rate for Payer: Humana KY Medicaid |
$1,452.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,467.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,116.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,266.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,481.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,716.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,167.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,378.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,674.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,913.87
|
| Rate for Payer: PHCS Commercial |
$4,054.08
|
| Rate for Payer: United Healthcare All Payer |
$3,716.24
|
|
|
PLATE PROFYLE 3D 2.3 2*2H
|
Facility
|
OP
|
$3,590.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,077.00 |
| Max. Negotiated Rate |
$3,446.40 |
| Rate for Payer: Aetna Commercial |
$2,764.30
|
| Rate for Payer: Anthem Medicaid |
$1,234.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,800.20
|
| Rate for Payer: Cash Price |
$1,795.00
|
| Rate for Payer: Cigna Commercial |
$2,979.70
|
| Rate for Payer: First Health Commercial |
$3,410.50
|
| Rate for Payer: Humana Commercial |
$3,051.50
|
| Rate for Payer: Humana KY Medicaid |
$1,234.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,247.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,943.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,649.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,259.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,159.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,692.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,872.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,123.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,477.10
|
| Rate for Payer: PHCS Commercial |
$3,446.40
|
| Rate for Payer: United Healthcare All Payer |
$3,159.20
|
|
|
PLATE PROFYLE 3D 2.3 2*2H
|
Facility
|
IP
|
$3,590.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,077.00 |
| Max. Negotiated Rate |
$3,446.40 |
| Rate for Payer: Aetna Commercial |
$2,764.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,800.20
|
| Rate for Payer: Cash Price |
$1,795.00
|
| Rate for Payer: Cigna Commercial |
$2,979.70
|
| Rate for Payer: First Health Commercial |
$3,410.50
|
| Rate for Payer: Humana Commercial |
$3,051.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,943.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,649.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,159.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,692.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,872.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,123.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,477.10
|
| Rate for Payer: PHCS Commercial |
$3,446.40
|
| Rate for Payer: United Healthcare All Payer |
$3,159.20
|
|
|
PLATE PROFYLE 3D 2.3 3*2H
|
Facility
|
IP
|
$3,590.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,077.00 |
| Max. Negotiated Rate |
$3,446.40 |
| Rate for Payer: Aetna Commercial |
$2,764.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,800.20
|
| Rate for Payer: Cash Price |
$1,795.00
|
| Rate for Payer: Cigna Commercial |
$2,979.70
|
| Rate for Payer: First Health Commercial |
$3,410.50
|
| Rate for Payer: Humana Commercial |
$3,051.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,943.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,649.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,159.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,692.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,872.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,123.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,477.10
|
| Rate for Payer: PHCS Commercial |
$3,446.40
|
| Rate for Payer: United Healthcare All Payer |
$3,159.20
|
|
|
PLATE PROFYLE 3D 2.3 3*2H
|
Facility
|
OP
|
$3,590.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,077.00 |
| Max. Negotiated Rate |
$3,446.40 |
| Rate for Payer: Aetna Commercial |
$2,764.30
|
| Rate for Payer: Anthem Medicaid |
$1,234.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,800.20
|
| Rate for Payer: Cash Price |
$1,795.00
|
| Rate for Payer: Cigna Commercial |
$2,979.70
|
| Rate for Payer: First Health Commercial |
$3,410.50
|
| Rate for Payer: Humana Commercial |
$3,051.50
|
| Rate for Payer: Humana KY Medicaid |
$1,234.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,247.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,943.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,649.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,259.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,159.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,692.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,872.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,123.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,477.10
|
| Rate for Payer: PHCS Commercial |
$3,446.40
|
| Rate for Payer: United Healthcare All Payer |
$3,159.20
|
|
|
PLATE PROFYLE 3D 2.3 4*2H
|
Facility
|
IP
|
$4,223.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,266.90 |
| Max. Negotiated Rate |
$4,054.08 |
| Rate for Payer: Aetna Commercial |
$3,251.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,293.94
|
| Rate for Payer: Cash Price |
$2,111.50
|
| Rate for Payer: Cigna Commercial |
$3,505.09
|
| Rate for Payer: First Health Commercial |
$4,011.85
|
| Rate for Payer: Humana Commercial |
$3,589.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,116.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,266.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,716.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,167.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,378.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,674.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,913.87
|
| Rate for Payer: PHCS Commercial |
$4,054.08
|
| Rate for Payer: United Healthcare All Payer |
$3,716.24
|
|
|
PLATE PROFYLE 3D 2.3 4*2H
|
Facility
|
OP
|
$4,223.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,266.90 |
| Max. Negotiated Rate |
$4,054.08 |
| Rate for Payer: Aetna Commercial |
$3,251.71
|
| Rate for Payer: Anthem Medicaid |
$1,452.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,293.94
|
| Rate for Payer: Cash Price |
$2,111.50
|
| Rate for Payer: Cigna Commercial |
$3,505.09
|
| Rate for Payer: First Health Commercial |
$4,011.85
|
| Rate for Payer: Humana Commercial |
$3,589.55
|
| Rate for Payer: Humana KY Medicaid |
$1,452.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,467.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,116.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,266.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,481.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,716.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,167.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,378.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,674.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,913.87
|
| Rate for Payer: PHCS Commercial |
$4,054.08
|
| Rate for Payer: United Healthcare All Payer |
$3,716.24
|
|
|
PLATE PROFYLE COMP L 2.3 6H L
|
Facility
|
OP
|
$1,754.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.24 |
| Max. Negotiated Rate |
$1,683.97 |
| Rate for Payer: Aetna Commercial |
$1,350.69
|
| Rate for Payer: Anthem Medicaid |
$603.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,368.23
|
| Rate for Payer: Cash Price |
$877.07
|
| Rate for Payer: Cigna Commercial |
$1,455.94
|
| Rate for Payer: First Health Commercial |
$1,666.43
|
| Rate for Payer: Humana Commercial |
$1,491.02
|
| Rate for Payer: Humana KY Medicaid |
$603.25
|
| Rate for Payer: Kentucky WC Medicaid |
$609.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,438.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,294.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$615.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,543.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,315.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,526.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,210.36
|
| Rate for Payer: PHCS Commercial |
$1,683.97
|
| Rate for Payer: United Healthcare All Payer |
$1,543.64
|
|
|
PLATE PROFYLE COMP L 2.3 6H L
|
Facility
|
IP
|
$1,754.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.24 |
| Max. Negotiated Rate |
$1,683.97 |
| Rate for Payer: Aetna Commercial |
$1,350.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,368.23
|
| Rate for Payer: Cash Price |
$877.07
|
| Rate for Payer: Cigna Commercial |
$1,455.94
|
| Rate for Payer: First Health Commercial |
$1,666.43
|
| Rate for Payer: Humana Commercial |
$1,491.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,438.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,294.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,543.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,315.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,526.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,210.36
|
| Rate for Payer: PHCS Commercial |
$1,683.97
|
| Rate for Payer: United Healthcare All Payer |
$1,543.64
|
|
|
PLATE PROFYLE COMP L 2.3 6H R
|
Facility
|
IP
|
$1,754.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.24 |
| Max. Negotiated Rate |
$1,683.97 |
| Rate for Payer: Aetna Commercial |
$1,350.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,368.23
|
| Rate for Payer: Cash Price |
$877.07
|
| Rate for Payer: Cigna Commercial |
$1,455.94
|
| Rate for Payer: First Health Commercial |
$1,666.43
|
| Rate for Payer: Humana Commercial |
$1,491.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,438.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,294.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,543.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,315.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,526.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,210.36
|
| Rate for Payer: PHCS Commercial |
$1,683.97
|
| Rate for Payer: United Healthcare All Payer |
$1,543.64
|
|
|
PLATE PROFYLE COMP L 2.3 6H R
|
Facility
|
OP
|
$1,754.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.24 |
| Max. Negotiated Rate |
$1,683.97 |
| Rate for Payer: Aetna Commercial |
$1,350.69
|
| Rate for Payer: Anthem Medicaid |
$603.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,368.23
|
| Rate for Payer: Cash Price |
$877.07
|
| Rate for Payer: Cigna Commercial |
$1,455.94
|
| Rate for Payer: First Health Commercial |
$1,666.43
|
| Rate for Payer: Humana Commercial |
$1,491.02
|
| Rate for Payer: Humana KY Medicaid |
$603.25
|
| Rate for Payer: Kentucky WC Medicaid |
$609.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,438.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,294.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$615.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,543.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,315.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,526.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,210.36
|
| Rate for Payer: PHCS Commercial |
$1,683.97
|
| Rate for Payer: United Healthcare All Payer |
$1,543.64
|
|
|
PLATE PROFYLE COMP OB L 2.3 6H
|
Facility
|
OP
|
$1,754.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.24 |
| Max. Negotiated Rate |
$1,683.97 |
| Rate for Payer: Aetna Commercial |
$1,350.69
|
| Rate for Payer: Anthem Medicaid |
$603.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,368.23
|
| Rate for Payer: Cash Price |
$877.07
|
| Rate for Payer: Cigna Commercial |
$1,455.94
|
| Rate for Payer: First Health Commercial |
$1,666.43
|
| Rate for Payer: Humana Commercial |
$1,491.02
|
| Rate for Payer: Humana KY Medicaid |
$603.25
|
| Rate for Payer: Kentucky WC Medicaid |
$609.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,438.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,294.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$615.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,543.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,315.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,526.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,210.36
|
| Rate for Payer: PHCS Commercial |
$1,683.97
|
| Rate for Payer: United Healthcare All Payer |
$1,543.64
|
|
|
PLATE PROFYLE COMP OB L 2.3 6H
|
Facility
|
IP
|
$1,754.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.24 |
| Max. Negotiated Rate |
$1,683.97 |
| Rate for Payer: Aetna Commercial |
$1,350.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,368.23
|
| Rate for Payer: Cash Price |
$877.07
|
| Rate for Payer: Cigna Commercial |
$1,455.94
|
| Rate for Payer: First Health Commercial |
$1,666.43
|
| Rate for Payer: Humana Commercial |
$1,491.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,438.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,294.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,543.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,315.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,526.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,210.36
|
| Rate for Payer: PHCS Commercial |
$1,683.97
|
| Rate for Payer: United Healthcare All Payer |
$1,543.64
|
|
|
PLATE PROFYLE COMP ST 2.3 4H
|
Facility
|
IP
|
$1,558.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$467.60 |
| Max. Negotiated Rate |
$1,496.33 |
| Rate for Payer: Aetna Commercial |
$1,200.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,215.77
|
| Rate for Payer: Cash Price |
$779.34
|
| Rate for Payer: Cigna Commercial |
$1,293.70
|
| Rate for Payer: First Health Commercial |
$1,480.75
|
| Rate for Payer: Humana Commercial |
$1,324.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,278.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,150.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,371.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,169.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,246.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,356.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,075.49
|
| Rate for Payer: PHCS Commercial |
$1,496.33
|
| Rate for Payer: United Healthcare All Payer |
$1,371.64
|
|
|
PLATE PROFYLE COMP ST 2.3 4H
|
Facility
|
OP
|
$1,558.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$467.60 |
| Max. Negotiated Rate |
$1,496.33 |
| Rate for Payer: Aetna Commercial |
$1,200.18
|
| Rate for Payer: Anthem Medicaid |
$536.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,215.77
|
| Rate for Payer: Cash Price |
$779.34
|
| Rate for Payer: Cigna Commercial |
$1,293.70
|
| Rate for Payer: First Health Commercial |
$1,480.75
|
| Rate for Payer: Humana Commercial |
$1,324.88
|
| Rate for Payer: Humana KY Medicaid |
$536.03
|
| Rate for Payer: Kentucky WC Medicaid |
$541.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,278.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,150.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$546.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,371.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,169.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,246.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,356.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,075.49
|
| Rate for Payer: PHCS Commercial |
$1,496.33
|
| Rate for Payer: United Healthcare All Payer |
$1,371.64
|
|
|
PLATE PROFYLE COMP ST 2.3 5H
|
Facility
|
IP
|
$1,558.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$467.60 |
| Max. Negotiated Rate |
$1,496.33 |
| Rate for Payer: Aetna Commercial |
$1,200.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,215.77
|
| Rate for Payer: Cash Price |
$779.34
|
| Rate for Payer: Cigna Commercial |
$1,293.70
|
| Rate for Payer: First Health Commercial |
$1,480.75
|
| Rate for Payer: Humana Commercial |
$1,324.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,278.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,150.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,371.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,169.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,246.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,356.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,075.49
|
| Rate for Payer: PHCS Commercial |
$1,496.33
|
| Rate for Payer: United Healthcare All Payer |
$1,371.64
|
|
|
PLATE PROFYLE COMP ST 2.3 5H
|
Facility
|
OP
|
$1,558.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$467.60 |
| Max. Negotiated Rate |
$1,496.33 |
| Rate for Payer: Aetna Commercial |
$1,200.18
|
| Rate for Payer: Anthem Medicaid |
$536.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,215.77
|
| Rate for Payer: Cash Price |
$779.34
|
| Rate for Payer: Cigna Commercial |
$1,293.70
|
| Rate for Payer: First Health Commercial |
$1,480.75
|
| Rate for Payer: Humana Commercial |
$1,324.88
|
| Rate for Payer: Humana KY Medicaid |
$536.03
|
| Rate for Payer: Kentucky WC Medicaid |
$541.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,278.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,150.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$546.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,371.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,169.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,246.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,356.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,075.49
|
| Rate for Payer: PHCS Commercial |
$1,496.33
|
| Rate for Payer: United Healthcare All Payer |
$1,371.64
|
|
|
PLATE PROFYLE COMP ST 2.3 6H
|
Facility
|
IP
|
$1,754.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.24 |
| Max. Negotiated Rate |
$1,683.97 |
| Rate for Payer: Aetna Commercial |
$1,350.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,368.23
|
| Rate for Payer: Cash Price |
$877.07
|
| Rate for Payer: Cigna Commercial |
$1,455.94
|
| Rate for Payer: First Health Commercial |
$1,666.43
|
| Rate for Payer: Humana Commercial |
$1,491.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,438.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,294.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,543.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,315.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,526.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,210.36
|
| Rate for Payer: PHCS Commercial |
$1,683.97
|
| Rate for Payer: United Healthcare All Payer |
$1,543.64
|
|
|
PLATE PROFYLE COMP ST 2.3 6H
|
Facility
|
OP
|
$1,754.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.24 |
| Max. Negotiated Rate |
$1,683.97 |
| Rate for Payer: Aetna Commercial |
$1,350.69
|
| Rate for Payer: Anthem Medicaid |
$603.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,368.23
|
| Rate for Payer: Cash Price |
$877.07
|
| Rate for Payer: Cigna Commercial |
$1,455.94
|
| Rate for Payer: First Health Commercial |
$1,666.43
|
| Rate for Payer: Humana Commercial |
$1,491.02
|
| Rate for Payer: Humana KY Medicaid |
$603.25
|
| Rate for Payer: Kentucky WC Medicaid |
$609.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,438.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,294.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$615.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,543.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,315.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,526.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,210.36
|
| Rate for Payer: PHCS Commercial |
$1,683.97
|
| Rate for Payer: United Healthcare All Payer |
$1,543.64
|
|
|
PLATE PROFYLE COMP ST 2.3 7H
|
Facility
|
IP
|
$1,754.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.24 |
| Max. Negotiated Rate |
$1,683.97 |
| Rate for Payer: Aetna Commercial |
$1,350.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,368.23
|
| Rate for Payer: Cash Price |
$877.07
|
| Rate for Payer: Cigna Commercial |
$1,455.94
|
| Rate for Payer: First Health Commercial |
$1,666.43
|
| Rate for Payer: Humana Commercial |
$1,491.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,438.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,294.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,543.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,315.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,526.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,210.36
|
| Rate for Payer: PHCS Commercial |
$1,683.97
|
| Rate for Payer: United Healthcare All Payer |
$1,543.64
|
|
|
PLATE PROFYLE COMP ST 2.3 7H
|
Facility
|
OP
|
$1,754.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.24 |
| Max. Negotiated Rate |
$1,683.97 |
| Rate for Payer: Aetna Commercial |
$1,350.69
|
| Rate for Payer: Anthem Medicaid |
$603.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,368.23
|
| Rate for Payer: Cash Price |
$877.07
|
| Rate for Payer: Cigna Commercial |
$1,455.94
|
| Rate for Payer: First Health Commercial |
$1,666.43
|
| Rate for Payer: Humana Commercial |
$1,491.02
|
| Rate for Payer: Humana KY Medicaid |
$603.25
|
| Rate for Payer: Kentucky WC Medicaid |
$609.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,438.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,294.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$615.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,543.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,315.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,526.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,210.36
|
| Rate for Payer: PHCS Commercial |
$1,683.97
|
| Rate for Payer: United Healthcare All Payer |
$1,543.64
|
|
|
PLATE PROFYLE COMP STR BAR 4H
|
Facility
|
IP
|
$3,890.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.00 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna Commercial |
$2,995.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,034.20
|
| Rate for Payer: Cash Price |
$1,945.00
|
| Rate for Payer: Cigna Commercial |
$3,228.70
|
| Rate for Payer: First Health Commercial |
$3,695.50
|
| Rate for Payer: Humana Commercial |
$3,306.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,189.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,870.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,423.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,917.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,384.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.10
|
| Rate for Payer: PHCS Commercial |
$3,734.40
|
| Rate for Payer: United Healthcare All Payer |
$3,423.20
|
|
|
PLATE PROFYLE COMP STR BAR 4H
|
Facility
|
OP
|
$3,890.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.00 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna Commercial |
$2,995.30
|
| Rate for Payer: Anthem Medicaid |
$1,337.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,034.20
|
| Rate for Payer: Cash Price |
$1,945.00
|
| Rate for Payer: Cigna Commercial |
$3,228.70
|
| Rate for Payer: First Health Commercial |
$3,695.50
|
| Rate for Payer: Humana Commercial |
$3,306.50
|
| Rate for Payer: Humana KY Medicaid |
$1,337.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,351.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,189.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,870.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,364.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,423.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,917.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,384.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.10
|
| Rate for Payer: PHCS Commercial |
$3,734.40
|
| Rate for Payer: United Healthcare All Payer |
$3,423.20
|
|
