|
PLATE PROFYLE COMP STR BAR 5H
|
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 5H
|
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
|
|
|
PLATE PROFYLE COMP STR BAR 6H
|
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 6H
|
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
|
|
|
PLATE PROFYLE COMP STR BAR 8H
|
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 8H
|
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
|
|
|
PLATE PROFYLE COMP T 2.3 6H L
|
Facility
|
IP
|
$1,791.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$537.37 |
| Max. Negotiated Rate |
$1,719.58 |
| Rate for Payer: Aetna Commercial |
$1,379.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,397.16
|
| Rate for Payer: Cash Price |
$895.61
|
| Rate for Payer: Cigna Commercial |
$1,486.72
|
| Rate for Payer: First Health Commercial |
$1,701.67
|
| Rate for Payer: Humana Commercial |
$1,522.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,468.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,321.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,576.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,343.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,558.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.95
|
| Rate for Payer: PHCS Commercial |
$1,719.58
|
| Rate for Payer: United Healthcare All Payer |
$1,576.28
|
|
|
PLATE PROFYLE COMP T 2.3 6H L
|
Facility
|
OP
|
$1,791.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$537.37 |
| Max. Negotiated Rate |
$1,719.58 |
| Rate for Payer: Aetna Commercial |
$1,379.25
|
| Rate for Payer: Anthem Medicaid |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,397.16
|
| Rate for Payer: Cash Price |
$895.61
|
| Rate for Payer: Cigna Commercial |
$1,486.72
|
| Rate for Payer: First Health Commercial |
$1,701.67
|
| Rate for Payer: Humana Commercial |
$1,522.55
|
| Rate for Payer: Humana KY Medicaid |
$616.00
|
| Rate for Payer: Kentucky WC Medicaid |
$622.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,468.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,321.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$628.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,576.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,343.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,558.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.95
|
| Rate for Payer: PHCS Commercial |
$1,719.58
|
| Rate for Payer: United Healthcare All Payer |
$1,576.28
|
|
|
PLATE PROFYLE COMP T 2.3 6H R
|
Facility
|
OP
|
$1,791.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$537.37 |
| Max. Negotiated Rate |
$1,719.58 |
| Rate for Payer: Aetna Commercial |
$1,379.25
|
| Rate for Payer: Anthem Medicaid |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,397.16
|
| Rate for Payer: Cash Price |
$895.61
|
| Rate for Payer: Cigna Commercial |
$1,486.72
|
| Rate for Payer: First Health Commercial |
$1,701.67
|
| Rate for Payer: Humana Commercial |
$1,522.55
|
| Rate for Payer: Humana KY Medicaid |
$616.00
|
| Rate for Payer: Kentucky WC Medicaid |
$622.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,468.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,321.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$628.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,576.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,343.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,558.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.95
|
| Rate for Payer: PHCS Commercial |
$1,719.58
|
| Rate for Payer: United Healthcare All Payer |
$1,576.28
|
|
|
PLATE PROFYLE COMP T 2.3 6H R
|
Facility
|
IP
|
$1,791.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$537.37 |
| Max. Negotiated Rate |
$1,719.58 |
| Rate for Payer: Aetna Commercial |
$1,379.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,397.16
|
| Rate for Payer: Cash Price |
$895.61
|
| Rate for Payer: Cigna Commercial |
$1,486.72
|
| Rate for Payer: First Health Commercial |
$1,701.67
|
| Rate for Payer: Humana Commercial |
$1,522.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,468.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,321.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,576.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,343.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,558.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.95
|
| Rate for Payer: PHCS Commercial |
$1,719.58
|
| Rate for Payer: United Healthcare All Payer |
$1,576.28
|
|
|
PLATE PROFYLE CONDYLAR 1H
|
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 CONDYLAR 1H
|
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 CONDYLAR 5H LT
|
Facility
|
OP
|
$1,810.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.19 |
| Max. Negotiated Rate |
$1,738.21 |
| Rate for Payer: Aetna Commercial |
$1,394.19
|
| Rate for Payer: Anthem Medicaid |
$622.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,412.30
|
| Rate for Payer: Cash Price |
$905.32
|
| Rate for Payer: Cigna Commercial |
$1,502.83
|
| Rate for Payer: First Health Commercial |
$1,720.11
|
| Rate for Payer: Humana Commercial |
$1,539.04
|
| Rate for Payer: Humana KY Medicaid |
$622.68
|
| Rate for Payer: Kentucky WC Medicaid |
$629.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,484.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,336.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$635.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,593.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,357.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,448.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,575.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,249.34
|
| Rate for Payer: PHCS Commercial |
$1,738.21
|
| Rate for Payer: United Healthcare All Payer |
$1,593.36
|
|
|
PLATE PROFYLE CONDYLAR 5H LT
|
Facility
|
IP
|
$1,810.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.19 |
| Max. Negotiated Rate |
$1,738.21 |
| Rate for Payer: Aetna Commercial |
$1,394.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,412.30
|
| Rate for Payer: Cash Price |
$905.32
|
| Rate for Payer: Cigna Commercial |
$1,502.83
|
| Rate for Payer: First Health Commercial |
$1,720.11
|
| Rate for Payer: Humana Commercial |
$1,539.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,484.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,336.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,593.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,357.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,448.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,575.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,249.34
|
| Rate for Payer: PHCS Commercial |
$1,738.21
|
| Rate for Payer: United Healthcare All Payer |
$1,593.36
|
|
|
PLATE PROFYLE CONDYLAR 5H RT
|
Facility
|
IP
|
$1,810.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.19 |
| Max. Negotiated Rate |
$1,738.21 |
| Rate for Payer: Aetna Commercial |
$1,394.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,412.30
|
| Rate for Payer: Cash Price |
$905.32
|
| Rate for Payer: Cigna Commercial |
$1,502.83
|
| Rate for Payer: First Health Commercial |
$1,720.11
|
| Rate for Payer: Humana Commercial |
$1,539.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,484.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,336.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,593.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,357.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,448.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,575.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,249.34
|
| Rate for Payer: PHCS Commercial |
$1,738.21
|
| Rate for Payer: United Healthcare All Payer |
$1,593.36
|
|
|
PLATE PROFYLE CONDYLAR 5H RT
|
Facility
|
OP
|
$1,810.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.19 |
| Max. Negotiated Rate |
$1,738.21 |
| Rate for Payer: Aetna Commercial |
$1,394.19
|
| Rate for Payer: Anthem Medicaid |
$622.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,412.30
|
| Rate for Payer: Cash Price |
$905.32
|
| Rate for Payer: Cigna Commercial |
$1,502.83
|
| Rate for Payer: First Health Commercial |
$1,720.11
|
| Rate for Payer: Humana Commercial |
$1,539.04
|
| Rate for Payer: Humana KY Medicaid |
$622.68
|
| Rate for Payer: Kentucky WC Medicaid |
$629.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,484.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,336.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$635.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,593.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,357.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,448.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,575.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,249.34
|
| Rate for Payer: PHCS Commercial |
$1,738.21
|
| Rate for Payer: United Healthcare All Payer |
$1,593.36
|
|
|
PLATE PROFYLE CONDYLAR W/B 5H
|
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 CONDYLAR W/B 5H
|
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 L 90D 6H LT
|
Facility
|
OP
|
$3,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.90 |
| Max. Negotiated Rate |
$3,132.48 |
| Rate for Payer: Aetna Commercial |
$2,512.51
|
| Rate for Payer: Anthem Medicaid |
$1,122.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,545.14
|
| Rate for Payer: Cash Price |
$1,631.50
|
| Rate for Payer: Cigna Commercial |
$2,708.29
|
| Rate for Payer: First Health Commercial |
$3,099.85
|
| Rate for Payer: Humana Commercial |
$2,773.55
|
| Rate for Payer: Humana KY Medicaid |
$1,122.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,133.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,675.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,408.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$978.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,144.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,871.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,447.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,610.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,838.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,251.47
|
| Rate for Payer: PHCS Commercial |
$3,132.48
|
| Rate for Payer: United Healthcare All Payer |
$2,871.44
|
|
|
PLATE PROFYLE L 90D 6H LT
|
Facility
|
IP
|
$3,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.90 |
| Max. Negotiated Rate |
$3,132.48 |
| Rate for Payer: Aetna Commercial |
$2,512.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,545.14
|
| Rate for Payer: Cash Price |
$1,631.50
|
| Rate for Payer: Cigna Commercial |
$2,708.29
|
| Rate for Payer: First Health Commercial |
$3,099.85
|
| Rate for Payer: Humana Commercial |
$2,773.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,675.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,408.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$978.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,871.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,447.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,610.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,838.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,251.47
|
| Rate for Payer: PHCS Commercial |
$3,132.48
|
| Rate for Payer: United Healthcare All Payer |
$2,871.44
|
|
|
PLATE PROFYLE L 90D 6H RT
|
Facility
|
IP
|
$2,212.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.60 |
| Max. Negotiated Rate |
$2,123.52 |
| Rate for Payer: Aetna Commercial |
$1,703.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,725.36
|
| Rate for Payer: Cash Price |
$1,106.00
|
| Rate for Payer: Cigna Commercial |
$1,835.96
|
| Rate for Payer: First Health Commercial |
$2,101.40
|
| Rate for Payer: Humana Commercial |
$1,880.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,813.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,632.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,946.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,659.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,769.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,924.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,526.28
|
| Rate for Payer: PHCS Commercial |
$2,123.52
|
| Rate for Payer: United Healthcare All Payer |
$1,946.56
|
|
|
PLATE PROFYLE L 90D 6H RT
|
Facility
|
OP
|
$2,212.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.60 |
| Max. Negotiated Rate |
$2,123.52 |
| Rate for Payer: Aetna Commercial |
$1,703.24
|
| Rate for Payer: Anthem Medicaid |
$760.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,725.36
|
| Rate for Payer: Cash Price |
$1,106.00
|
| Rate for Payer: Cigna Commercial |
$1,835.96
|
| Rate for Payer: First Health Commercial |
$2,101.40
|
| Rate for Payer: Humana Commercial |
$1,880.20
|
| Rate for Payer: Humana KY Medicaid |
$760.71
|
| Rate for Payer: Kentucky WC Medicaid |
$768.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,813.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,632.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$775.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,946.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,659.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,769.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,924.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,526.28
|
| Rate for Payer: PHCS Commercial |
$2,123.52
|
| Rate for Payer: United Healthcare All Payer |
$1,946.56
|
|
|
PLATE PROFYLE LCK 2.3 ROT 5H
|
Facility
|
OP
|
$3,567.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,070.33 |
| Max. Negotiated Rate |
$3,425.05 |
| Rate for Payer: Aetna Commercial |
$2,747.18
|
| Rate for Payer: Anthem Medicaid |
$1,226.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,782.85
|
| Rate for Payer: Cash Price |
$1,783.88
|
| Rate for Payer: Cigna Commercial |
$2,961.24
|
| Rate for Payer: First Health Commercial |
$3,389.37
|
| Rate for Payer: Humana Commercial |
$3,032.60
|
| Rate for Payer: Humana KY Medicaid |
$1,226.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,239.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,925.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,633.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,070.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,251.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,139.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,675.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,854.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,103.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,461.75
|
| Rate for Payer: PHCS Commercial |
$3,425.05
|
| Rate for Payer: United Healthcare All Payer |
$3,139.63
|
|
|
PLATE PROFYLE LCK 2.3 ROT 5H
|
Facility
|
IP
|
$3,567.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,070.33 |
| Max. Negotiated Rate |
$3,425.05 |
| Rate for Payer: Aetna Commercial |
$2,747.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,782.85
|
| Rate for Payer: Cash Price |
$1,783.88
|
| Rate for Payer: Cigna Commercial |
$2,961.24
|
| Rate for Payer: First Health Commercial |
$3,389.37
|
| Rate for Payer: Humana Commercial |
$3,032.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,925.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,633.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,070.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,139.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,675.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,854.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,103.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,461.75
|
| Rate for Payer: PHCS Commercial |
$3,425.05
|
| Rate for Payer: United Healthcare All Payer |
$3,139.63
|
|
|
PLATE PROFYLE LCK ROT 1.7 5H
|
Facility
|
OP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem Medicaid |
$1,697.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Humana KY Medicaid |
$1,697.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,715.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,731.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
