|
PLATE T OBLIQUE W PF 5H
|
Facility
|
IP
|
$3,168.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.92 |
| Max. Negotiated Rate |
$3,041.88 |
| Rate for Payer: Aetna Commercial |
$2,439.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,471.52
|
| Rate for Payer: Cash Price |
$1,584.31
|
| Rate for Payer: Cigna Commercial |
$2,629.95
|
| Rate for Payer: First Health Commercial |
$3,010.19
|
| Rate for Payer: Humana Commercial |
$2,693.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,598.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,338.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$950.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,788.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,376.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$982.27
|
| Rate for Payer: PHCS Commercial |
$3,041.88
|
| Rate for Payer: United Healthcare All Payer |
$2,788.39
|
|
|
PLATE T PROFYLE 2.3 WIDE 8H
|
Facility
|
IP
|
$3,569.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.00 |
| Max. Negotiated Rate |
$3,426.43 |
| Rate for Payer: Aetna Commercial |
$2,748.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,783.98
|
| Rate for Payer: Cash Price |
$1,784.60
|
| Rate for Payer: Cigna Commercial |
$2,962.44
|
| Rate for Payer: First Health Commercial |
$3,390.74
|
| Rate for Payer: Humana Commercial |
$3,033.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,926.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,634.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,070.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,140.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,676.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$713.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,106.45
|
| Rate for Payer: PHCS Commercial |
$3,426.43
|
| Rate for Payer: United Healthcare All Payer |
$3,140.90
|
|
|
PLATE T PROFYLE 2.3 WIDE 8H
|
Facility
|
OP
|
$3,569.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.00 |
| Max. Negotiated Rate |
$3,426.43 |
| Rate for Payer: Aetna Commercial |
$2,748.28
|
| Rate for Payer: Anthem Medicaid |
$1,227.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,783.98
|
| Rate for Payer: Cash Price |
$1,784.60
|
| Rate for Payer: Cigna Commercial |
$2,962.44
|
| Rate for Payer: First Health Commercial |
$3,390.74
|
| Rate for Payer: Humana Commercial |
$3,033.82
|
| Rate for Payer: Humana KY Medicaid |
$1,227.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,239.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,926.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,634.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,070.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,252.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,140.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,676.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$713.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,106.45
|
| Rate for Payer: PHCS Commercial |
$3,426.43
|
| Rate for Payer: United Healthcare All Payer |
$3,140.90
|
|
|
PLATE T PROFYLE 90D 2.3 6H
|
Facility
|
IP
|
$3,684.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.92 |
| Max. Negotiated Rate |
$3,536.64 |
| Rate for Payer: Aetna Commercial |
$2,836.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,873.52
|
| Rate for Payer: Cash Price |
$1,842.00
|
| Rate for Payer: Cigna Commercial |
$3,057.72
|
| Rate for Payer: First Health Commercial |
$3,499.80
|
| Rate for Payer: Humana Commercial |
$3,131.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,020.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,718.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,105.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,241.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,763.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,142.04
|
| Rate for Payer: PHCS Commercial |
$3,536.64
|
| Rate for Payer: United Healthcare All Payer |
$3,241.92
|
|
|
PLATE T PROFYLE 90D 2.3 6H
|
Facility
|
OP
|
$3,684.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.92 |
| Max. Negotiated Rate |
$3,536.64 |
| Rate for Payer: Aetna Commercial |
$2,836.68
|
| Rate for Payer: Anthem Medicaid |
$1,266.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,873.52
|
| Rate for Payer: Cash Price |
$1,842.00
|
| Rate for Payer: Cigna Commercial |
$3,057.72
|
| Rate for Payer: First Health Commercial |
$3,499.80
|
| Rate for Payer: Humana Commercial |
$3,131.40
|
| Rate for Payer: Humana KY Medicaid |
$1,266.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,279.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,020.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,718.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,105.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,292.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,241.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,763.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,142.04
|
| Rate for Payer: PHCS Commercial |
$3,536.64
|
| Rate for Payer: United Healthcare All Payer |
$3,241.92
|
|
|
PLATE T PROFYLE 90D 2.3 6H LT
|
Facility
|
IP
|
$1,799.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.94 |
| Max. Negotiated Rate |
$1,727.56 |
| Rate for Payer: Humana Commercial |
$1,529.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,475.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,583.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,349.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.86
|
| Rate for Payer: PHCS Commercial |
$1,727.56
|
| Rate for Payer: United Healthcare All Payer |
$1,583.60
|
| Rate for Payer: Aetna Commercial |
$1,385.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,403.64
|
| Rate for Payer: Cash Price |
$899.77
|
| Rate for Payer: Cigna Commercial |
$1,493.62
|
| Rate for Payer: First Health Commercial |
$1,709.56
|
|
|
PLATE T PROFYLE 90D 2.3 6H LT
|
Facility
|
OP
|
$1,799.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.94 |
| Max. Negotiated Rate |
$1,727.56 |
| Rate for Payer: Aetna Commercial |
$1,385.65
|
| Rate for Payer: Anthem Medicaid |
$618.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,403.64
|
| Rate for Payer: Cash Price |
$899.77
|
| Rate for Payer: Cigna Commercial |
$1,493.62
|
| Rate for Payer: First Health Commercial |
$1,709.56
|
| Rate for Payer: Humana Commercial |
$1,529.61
|
| Rate for Payer: Humana KY Medicaid |
$618.86
|
| Rate for Payer: Kentucky WC Medicaid |
$625.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,475.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,583.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,349.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.86
|
| Rate for Payer: PHCS Commercial |
$1,727.56
|
| Rate for Payer: United Healthcare All Payer |
$1,583.60
|
|
|
PLATE T PROFYLE 90D 2.3 6H RT
|
Facility
|
OP
|
$1,806.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.85 |
| Max. Negotiated Rate |
$1,734.28 |
| Rate for Payer: Aetna Commercial |
$1,391.04
|
| Rate for Payer: Anthem Medicaid |
$621.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,409.10
|
| Rate for Payer: Cash Price |
$903.27
|
| Rate for Payer: Cigna Commercial |
$1,499.43
|
| Rate for Payer: First Health Commercial |
$1,716.21
|
| Rate for Payer: Humana Commercial |
$1,535.56
|
| Rate for Payer: Humana KY Medicaid |
$621.27
|
| Rate for Payer: Kentucky WC Medicaid |
$627.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,481.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,333.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$633.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,589.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,354.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.03
|
| Rate for Payer: PHCS Commercial |
$1,734.28
|
| Rate for Payer: United Healthcare All Payer |
$1,589.76
|
|
|
PLATE T PROFYLE 90D 2.3 6H RT
|
Facility
|
IP
|
$1,806.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.85 |
| Max. Negotiated Rate |
$1,734.28 |
| Rate for Payer: Aetna Commercial |
$1,391.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,409.10
|
| Rate for Payer: Cash Price |
$903.27
|
| Rate for Payer: Cigna Commercial |
$1,499.43
|
| Rate for Payer: First Health Commercial |
$1,716.21
|
| Rate for Payer: Humana Commercial |
$1,535.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,481.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,333.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,589.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,354.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.03
|
| Rate for Payer: PHCS Commercial |
$1,734.28
|
| Rate for Payer: United Healthcare All Payer |
$1,589.76
|
|
|
PLATE T PROFYLE 90D 2.3 7H
|
Facility
|
IP
|
$3,684.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.92 |
| Max. Negotiated Rate |
$3,536.64 |
| Rate for Payer: Aetna Commercial |
$2,836.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,873.52
|
| Rate for Payer: Cash Price |
$1,842.00
|
| Rate for Payer: Cigna Commercial |
$3,057.72
|
| Rate for Payer: First Health Commercial |
$3,499.80
|
| Rate for Payer: Humana Commercial |
$3,131.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,020.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,718.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,105.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,241.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,763.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,142.04
|
| Rate for Payer: PHCS Commercial |
$3,536.64
|
| Rate for Payer: United Healthcare All Payer |
$3,241.92
|
|
|
PLATE T PROFYLE 90D 2.3 7H
|
Facility
|
OP
|
$3,684.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.92 |
| Max. Negotiated Rate |
$3,536.64 |
| Rate for Payer: Aetna Commercial |
$2,836.68
|
| Rate for Payer: Anthem Medicaid |
$1,266.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,873.52
|
| Rate for Payer: Cash Price |
$1,842.00
|
| Rate for Payer: Cigna Commercial |
$3,057.72
|
| Rate for Payer: First Health Commercial |
$3,499.80
|
| Rate for Payer: Humana Commercial |
$3,131.40
|
| Rate for Payer: Humana KY Medicaid |
$1,266.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,279.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,020.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,718.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,105.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,292.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,241.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,763.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,142.04
|
| Rate for Payer: PHCS Commercial |
$3,536.64
|
| Rate for Payer: United Healthcare All Payer |
$3,241.92
|
|
|
PLATE T PROFYLE COMP 6H
|
Facility
|
OP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem Medicaid |
$1,363.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Humana KY Medicaid |
$1,363.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,377.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,390.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE T PROFYLE COMP 6H
|
Facility
|
IP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE T PROFYLE COMP NAR 10H
|
Facility
|
OP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Humana KY Medicaid |
$1,363.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,377.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,390.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem Medicaid |
$1,363.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
|
|
PLATE T PROFYLE COMP NAR 10H
|
Facility
|
IP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE T PROFYLE COMP NAR 6H L
|
Facility
|
IP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE T PROFYLE COMP NAR 6H L
|
Facility
|
OP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem Medicaid |
$1,363.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Humana KY Medicaid |
$1,363.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,377.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,390.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE T PROFYLE COMP OBL LE 6H
|
Facility
|
IP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE T PROFYLE COMP OBL LE 6H
|
Facility
|
OP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem Medicaid |
$1,363.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Humana KY Medicaid |
$1,363.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,377.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,390.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE T PROFYLE COMP OBL RI 6H
|
Facility
|
OP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem Medicaid |
$1,363.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Humana KY Medicaid |
$1,363.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,377.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,390.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE T PROFYLE COMP OBL RI 6H
|
Facility
|
IP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE T PROFYLE HAND S WIDE 8H
|
Facility
|
OP
|
$3,569.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.00 |
| Max. Negotiated Rate |
$3,426.43 |
| Rate for Payer: Aetna Commercial |
$2,748.28
|
| Rate for Payer: Anthem Medicaid |
$1,227.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,783.98
|
| Rate for Payer: Cash Price |
$1,784.60
|
| Rate for Payer: Cigna Commercial |
$2,962.44
|
| Rate for Payer: First Health Commercial |
$3,390.74
|
| Rate for Payer: Humana Commercial |
$3,033.82
|
| Rate for Payer: Humana KY Medicaid |
$1,227.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,239.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,926.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,634.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,070.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,252.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,140.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,676.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$713.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,106.45
|
| Rate for Payer: PHCS Commercial |
$3,426.43
|
| Rate for Payer: United Healthcare All Payer |
$3,140.90
|
|
|
PLATE T PROFYLE HAND S WIDE 8H
|
Facility
|
IP
|
$3,569.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.00 |
| Max. Negotiated Rate |
$3,426.43 |
| Rate for Payer: Aetna Commercial |
$2,748.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,783.98
|
| Rate for Payer: Cash Price |
$1,784.60
|
| Rate for Payer: Cigna Commercial |
$2,962.44
|
| Rate for Payer: First Health Commercial |
$3,390.74
|
| Rate for Payer: Humana Commercial |
$3,033.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,926.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,634.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,070.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,140.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,676.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$713.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,106.45
|
| Rate for Payer: PHCS Commercial |
$3,426.43
|
| Rate for Payer: United Healthcare All Payer |
$3,140.90
|
|
|
PLATE T PROFYLE LCK 2.3 REG 7H
|
Facility
|
OP
|
$3,913.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.72 |
| Max. Negotiated Rate |
$3,756.72 |
| Rate for Payer: Aetna Commercial |
$3,013.20
|
| Rate for Payer: Anthem Medicaid |
$1,345.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,052.34
|
| Rate for Payer: Cash Price |
$1,956.62
|
| Rate for Payer: Cigna Commercial |
$3,248.00
|
| Rate for Payer: First Health Commercial |
$3,717.59
|
| Rate for Payer: Humana Commercial |
$3,326.26
|
| Rate for Payer: Humana KY Medicaid |
$1,345.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,359.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,208.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,887.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,173.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,372.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,443.66
|
| Rate for Payer: Ohio Health Group HMO |
$2,934.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$782.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,213.11
|
| Rate for Payer: PHCS Commercial |
$3,756.72
|
| Rate for Payer: United Healthcare All Payer |
$3,443.66
|
|
|
PLATE T PROFYLE LCK 2.3 REG 7H
|
Facility
|
IP
|
$3,913.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.72 |
| Max. Negotiated Rate |
$3,756.72 |
| Rate for Payer: Aetna Commercial |
$3,013.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,052.34
|
| Rate for Payer: Cash Price |
$1,956.62
|
| Rate for Payer: Cigna Commercial |
$3,248.00
|
| Rate for Payer: First Health Commercial |
$3,717.59
|
| Rate for Payer: Humana Commercial |
$3,326.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,208.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,887.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,173.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,443.66
|
| Rate for Payer: Ohio Health Group HMO |
$2,934.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$782.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,213.11
|
| Rate for Payer: PHCS Commercial |
$3,756.72
|
| Rate for Payer: United Healthcare All Payer |
$3,443.66
|
|
