|
PLATE PROFYLE LCK ROT 1.7 5H
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE PROFYLE L CMP 2.3 7H
|
Facility
|
IP
|
$3,044.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.20 |
| Max. Negotiated Rate |
$2,922.24 |
| Rate for Payer: Aetna Commercial |
$2,343.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,374.32
|
| Rate for Payer: Cash Price |
$1,522.00
|
| Rate for Payer: Cigna Commercial |
$2,526.52
|
| Rate for Payer: First Health Commercial |
$2,891.80
|
| Rate for Payer: Humana Commercial |
$2,587.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,496.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,246.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$913.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,678.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,283.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,648.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,100.36
|
| Rate for Payer: PHCS Commercial |
$2,922.24
|
| Rate for Payer: United Healthcare All Payer |
$2,678.72
|
|
|
PLATE PROFYLE L CMP 2.3 7H
|
Facility
|
OP
|
$3,044.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.20 |
| Max. Negotiated Rate |
$2,922.24 |
| Rate for Payer: Aetna Commercial |
$2,343.88
|
| Rate for Payer: Anthem Medicaid |
$1,046.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,374.32
|
| Rate for Payer: Cash Price |
$1,522.00
|
| Rate for Payer: Cigna Commercial |
$2,526.52
|
| Rate for Payer: First Health Commercial |
$2,891.80
|
| Rate for Payer: Humana Commercial |
$2,587.40
|
| Rate for Payer: Humana KY Medicaid |
$1,046.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,057.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,496.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,246.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$913.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,067.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,678.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,283.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,648.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,100.36
|
| Rate for Payer: PHCS Commercial |
$2,922.24
|
| Rate for Payer: United Healthcare All Payer |
$2,678.72
|
|
|
PLATE PROFYLE L CMP 2.3 8H
|
Facility
|
OP
|
$1,916.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$575.01 |
| Max. Negotiated Rate |
$1,840.03 |
| Rate for Payer: Aetna Commercial |
$1,475.86
|
| Rate for Payer: Anthem Medicaid |
$659.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,495.03
|
| Rate for Payer: Cash Price |
$958.35
|
| Rate for Payer: Cigna Commercial |
$1,590.86
|
| Rate for Payer: First Health Commercial |
$1,820.87
|
| Rate for Payer: Humana Commercial |
$1,629.19
|
| Rate for Payer: Humana KY Medicaid |
$659.15
|
| Rate for Payer: Kentucky WC Medicaid |
$665.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,571.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,414.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$672.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,686.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,437.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,533.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,667.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,322.52
|
| Rate for Payer: PHCS Commercial |
$1,840.03
|
| Rate for Payer: United Healthcare All Payer |
$1,686.70
|
|
|
PLATE PROFYLE L CMP 2.3 8H
|
Facility
|
IP
|
$1,916.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$575.01 |
| Max. Negotiated Rate |
$1,840.03 |
| Rate for Payer: Aetna Commercial |
$1,475.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,495.03
|
| Rate for Payer: Cash Price |
$958.35
|
| Rate for Payer: Cigna Commercial |
$1,590.86
|
| Rate for Payer: First Health Commercial |
$1,820.87
|
| Rate for Payer: Humana Commercial |
$1,629.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,571.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,414.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,686.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,437.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,533.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,667.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,322.52
|
| Rate for Payer: PHCS Commercial |
$1,840.03
|
| Rate for Payer: United Healthcare All Payer |
$1,686.70
|
|
|
PLATE PROFYLE LOCK 2.3 3D 2X2H
|
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
|
|
|
PLATE PROFYLE LOCK 2.3 3D 2X2H
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE PROFYLE LOCK 2.3 3D 3X2H
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE PROFYLE LOCK 2.3 3D 3X2H
|
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
|
|
|
PLATE PROFYLE LOCK 2.3 3D 4X2H
|
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
|
|
|
PLATE PROFYLE LOCK 2.3 3D 4X2H
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE PROFYLE LOCK 2.3 STR 16H
|
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 LOCK 2.3 STR 16H
|
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 LOCK 2.3 STR 4H
|
Facility
|
OP
|
$4,175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.50 |
| Max. Negotiated Rate |
$4,008.00 |
| Rate for Payer: Aetna Commercial |
$3,214.75
|
| Rate for Payer: Anthem Medicaid |
$1,435.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,256.50
|
| Rate for Payer: Cash Price |
$2,087.50
|
| Rate for Payer: Cigna Commercial |
$3,465.25
|
| Rate for Payer: First Health Commercial |
$3,966.25
|
| Rate for Payer: Humana Commercial |
$3,548.75
|
| Rate for Payer: Humana KY Medicaid |
$1,435.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,450.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,423.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,081.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,252.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,464.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,674.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,632.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,880.75
|
| Rate for Payer: PHCS Commercial |
$4,008.00
|
| Rate for Payer: United Healthcare All Payer |
$3,674.00
|
|
|
PLATE PROFYLE LOCK 2.3 STR 4H
|
Facility
|
IP
|
$4,175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.50 |
| Max. Negotiated Rate |
$4,008.00 |
| Rate for Payer: Aetna Commercial |
$3,214.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,256.50
|
| Rate for Payer: Cash Price |
$2,087.50
|
| Rate for Payer: Cigna Commercial |
$3,465.25
|
| Rate for Payer: First Health Commercial |
$3,966.25
|
| Rate for Payer: Humana Commercial |
$3,548.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,423.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,081.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,252.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,674.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,632.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,880.75
|
| Rate for Payer: PHCS Commercial |
$4,008.00
|
| Rate for Payer: United Healthcare All Payer |
$3,674.00
|
|
|
PLATE PROFYLE LOCK STR 1.7 16H
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE PROFYLE LOCK STR 1.7 16H
|
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
|
|
|
PLATE PROFYLE LOCK STR 1.7 4H
|
Facility
|
OP
|
$4,175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.50 |
| Max. Negotiated Rate |
$4,008.00 |
| Rate for Payer: Aetna Commercial |
$3,214.75
|
| Rate for Payer: Anthem Medicaid |
$1,435.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,256.50
|
| Rate for Payer: Cash Price |
$2,087.50
|
| Rate for Payer: Cigna Commercial |
$3,465.25
|
| Rate for Payer: First Health Commercial |
$3,966.25
|
| Rate for Payer: Humana Commercial |
$3,548.75
|
| Rate for Payer: Humana KY Medicaid |
$1,435.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,450.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,423.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,081.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,252.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,464.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,674.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,632.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,880.75
|
| Rate for Payer: PHCS Commercial |
$4,008.00
|
| Rate for Payer: United Healthcare All Payer |
$3,674.00
|
|
|
PLATE PROFYLE LOCK STR 1.7 4H
|
Facility
|
IP
|
$4,175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.50 |
| Max. Negotiated Rate |
$4,008.00 |
| Rate for Payer: Aetna Commercial |
$3,214.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,256.50
|
| Rate for Payer: Cash Price |
$2,087.50
|
| Rate for Payer: Cigna Commercial |
$3,465.25
|
| Rate for Payer: First Health Commercial |
$3,966.25
|
| Rate for Payer: Humana Commercial |
$3,548.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,423.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,081.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,252.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,674.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,632.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,880.75
|
| Rate for Payer: PHCS Commercial |
$4,008.00
|
| Rate for Payer: United Healthcare All Payer |
$3,674.00
|
|
|
PLATE PROFYLE M COMP STR 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 M COMP STR 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 M COND 2.3 5H 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 M COND 2.3 5H 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 M COND 2.3 5H 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 M COND 2.3 5H 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
|
|
