|
PLATE PROFYLE STRAIGHT 1.7 4H
|
Facility
|
IP
|
$1,535.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.72 |
| Max. Negotiated Rate |
$1,474.30 |
| Rate for Payer: Aetna Commercial |
$1,182.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,197.87
|
| Rate for Payer: Cash Price |
$767.86
|
| Rate for Payer: Cigna Commercial |
$1,274.66
|
| Rate for Payer: First Health Commercial |
$1,458.94
|
| Rate for Payer: Humana Commercial |
$1,305.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,259.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,133.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$460.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,351.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,151.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,228.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,336.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.65
|
| Rate for Payer: PHCS Commercial |
$1,474.30
|
| Rate for Payer: United Healthcare All Payer |
$1,351.44
|
|
|
PLATE PROFYLE STRAIGHT 2.3 4H
|
Facility
|
IP
|
$1,558.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$467.60 |
| Max. Negotiated Rate |
$1,496.33 |
| Rate for Payer: Aetna Commercial |
$1,200.18
|
| Rate for Payer: Aetna Commercial |
$2,600.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,215.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,634.06
|
| Rate for Payer: Cash Price |
$779.34
|
| Rate for Payer: Cash Price |
$1,688.50
|
| Rate for Payer: Cigna Commercial |
$1,293.70
|
| Rate for Payer: Cigna Commercial |
$2,802.91
|
| Rate for Payer: First Health Commercial |
$3,208.15
|
| Rate for Payer: First Health Commercial |
$1,480.75
|
| Rate for Payer: Humana Commercial |
$2,870.45
|
| Rate for Payer: Humana Commercial |
$1,324.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,278.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,769.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,150.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,492.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,013.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,371.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,971.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,169.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,532.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,246.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,701.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,356.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,937.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,330.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,075.49
|
| Rate for Payer: PHCS Commercial |
$1,496.33
|
| Rate for Payer: PHCS Commercial |
$3,241.92
|
| Rate for Payer: United Healthcare All Payer |
$1,371.64
|
| Rate for Payer: United Healthcare All Payer |
$2,971.76
|
|
|
PLATE PROFYLE STRAIGHT 2.3 4H
|
Facility
|
OP
|
$1,558.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$467.60 |
| Max. Negotiated Rate |
$1,496.33 |
| Rate for Payer: Aetna Commercial |
$1,200.18
|
| Rate for Payer: Aetna Commercial |
$2,600.29
|
| Rate for Payer: Anthem Medicaid |
$536.03
|
| Rate for Payer: Anthem Medicaid |
$1,161.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,215.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,634.06
|
| Rate for Payer: Cash Price |
$779.34
|
| Rate for Payer: Cash Price |
$1,688.50
|
| Rate for Payer: Cigna Commercial |
$2,802.91
|
| Rate for Payer: Cigna Commercial |
$1,293.70
|
| Rate for Payer: First Health Commercial |
$3,208.15
|
| Rate for Payer: First Health Commercial |
$1,480.75
|
| Rate for Payer: Humana Commercial |
$1,324.88
|
| Rate for Payer: Humana Commercial |
$2,870.45
|
| Rate for Payer: Humana KY Medicaid |
$536.03
|
| Rate for Payer: Humana KY Medicaid |
$1,161.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,173.17
|
| Rate for Payer: Kentucky WC Medicaid |
$541.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,278.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,769.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,492.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,150.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,013.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$546.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,184.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,371.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,971.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,169.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,532.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,246.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,701.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,356.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,937.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,075.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,330.13
|
| Rate for Payer: PHCS Commercial |
$3,241.92
|
| Rate for Payer: PHCS Commercial |
$1,496.33
|
| Rate for Payer: United Healthcare All Payer |
$2,971.76
|
| Rate for Payer: United Healthcare All Payer |
$1,371.64
|
|
|
PLATE PROFYLE STRGHT 1.2 16H
|
Facility
|
IP
|
$3,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.50 |
| Max. Negotiated Rate |
$3,432.00 |
| Rate for Payer: Aetna Commercial |
$2,752.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,788.50
|
| Rate for Payer: Cash Price |
$1,787.50
|
| Rate for Payer: Cigna Commercial |
$2,967.25
|
| Rate for Payer: First Health Commercial |
$3,396.25
|
| Rate for Payer: Humana Commercial |
$3,038.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,931.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,638.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,072.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,146.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,681.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,110.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,466.75
|
| Rate for Payer: PHCS Commercial |
$3,432.00
|
| Rate for Payer: United Healthcare All Payer |
$3,146.00
|
|
|
PLATE PROFYLE STRGHT 1.2 16H
|
Facility
|
OP
|
$3,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.50 |
| Max. Negotiated Rate |
$3,432.00 |
| Rate for Payer: Aetna Commercial |
$2,752.75
|
| Rate for Payer: Anthem Medicaid |
$1,229.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,788.50
|
| Rate for Payer: Cash Price |
$1,787.50
|
| Rate for Payer: Cigna Commercial |
$2,967.25
|
| Rate for Payer: First Health Commercial |
$3,396.25
|
| Rate for Payer: Humana Commercial |
$3,038.75
|
| Rate for Payer: Humana KY Medicaid |
$1,229.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,241.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,931.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,638.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,072.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,254.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,146.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,681.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,110.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,466.75
|
| Rate for Payer: PHCS Commercial |
$3,432.00
|
| Rate for Payer: United Healthcare All Payer |
$3,146.00
|
|
|
PLATE PROFYLE STRGHT 1.2 4H
|
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 STRGHT 1.2 4H
|
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 STRGHT M 1.7 4H
|
Facility
|
IP
|
$2,014.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.32 |
| Max. Negotiated Rate |
$1,933.82 |
| Rate for Payer: Aetna Commercial |
$1,551.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,571.23
|
| Rate for Payer: Cash Price |
$1,007.20
|
| Rate for Payer: Cigna Commercial |
$1,671.95
|
| Rate for Payer: First Health Commercial |
$1,913.68
|
| Rate for Payer: Humana Commercial |
$1,712.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,651.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,486.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$604.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,772.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,510.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,752.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,389.94
|
| Rate for Payer: PHCS Commercial |
$1,933.82
|
| Rate for Payer: United Healthcare All Payer |
$1,772.67
|
|
|
PLATE PROFYLE STRGHT M 1.7 4H
|
Facility
|
OP
|
$2,014.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.32 |
| Max. Negotiated Rate |
$1,933.82 |
| Rate for Payer: Aetna Commercial |
$1,551.09
|
| Rate for Payer: Anthem Medicaid |
$692.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,571.23
|
| Rate for Payer: Cash Price |
$1,007.20
|
| Rate for Payer: Cigna Commercial |
$1,671.95
|
| Rate for Payer: First Health Commercial |
$1,913.68
|
| Rate for Payer: Humana Commercial |
$1,712.24
|
| Rate for Payer: Humana KY Medicaid |
$692.75
|
| Rate for Payer: Kentucky WC Medicaid |
$699.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,651.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,486.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$604.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$706.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,772.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,510.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,752.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,389.94
|
| Rate for Payer: PHCS Commercial |
$1,933.82
|
| Rate for Payer: United Healthcare All Payer |
$1,772.67
|
|
|
PLATE PROFYLE STRGHT M 2.3 16H
|
Facility
|
OP
|
$3,185.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.75 |
| Max. Negotiated Rate |
$3,058.39 |
| Rate for Payer: Aetna Commercial |
$2,453.08
|
| Rate for Payer: Anthem Medicaid |
$1,095.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,484.94
|
| Rate for Payer: Cash Price |
$1,592.91
|
| Rate for Payer: Cigna Commercial |
$2,644.23
|
| Rate for Payer: First Health Commercial |
$3,026.53
|
| Rate for Payer: Humana Commercial |
$2,707.95
|
| Rate for Payer: Humana KY Medicaid |
$1,095.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,106.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,612.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,351.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,117.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,803.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,389.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,548.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,771.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.22
|
| Rate for Payer: PHCS Commercial |
$3,058.39
|
| Rate for Payer: United Healthcare All Payer |
$2,803.52
|
|
|
PLATE PROFYLE STRGHT M 2.3 16H
|
Facility
|
IP
|
$3,185.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.75 |
| Max. Negotiated Rate |
$3,058.39 |
| Rate for Payer: Aetna Commercial |
$2,453.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,484.94
|
| Rate for Payer: Cash Price |
$1,592.91
|
| Rate for Payer: Cigna Commercial |
$2,644.23
|
| Rate for Payer: First Health Commercial |
$3,026.53
|
| Rate for Payer: Humana Commercial |
$2,707.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,612.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,351.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,803.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,389.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,548.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,771.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.22
|
| Rate for Payer: PHCS Commercial |
$3,058.39
|
| Rate for Payer: United Healthcare All Payer |
$2,803.52
|
|
|
PLATE PROFYLE STRGHT M 2.3 4H
|
Facility
|
OP
|
$3,377.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,013.10 |
| Max. Negotiated Rate |
$3,241.92 |
| Rate for Payer: Aetna Commercial |
$2,600.29
|
| Rate for Payer: Anthem Medicaid |
$1,161.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,634.06
|
| Rate for Payer: Cash Price |
$1,688.50
|
| Rate for Payer: Cigna Commercial |
$2,802.91
|
| Rate for Payer: First Health Commercial |
$3,208.15
|
| Rate for Payer: Humana Commercial |
$2,870.45
|
| Rate for Payer: Humana KY Medicaid |
$1,161.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,173.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,769.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,492.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,013.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,184.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,971.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,532.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,701.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,937.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,330.13
|
| Rate for Payer: PHCS Commercial |
$3,241.92
|
| Rate for Payer: United Healthcare All Payer |
$2,971.76
|
|
|
PLATE PROFYLE STRGHT M 2.3 4H
|
Facility
|
IP
|
$3,377.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,013.10 |
| Max. Negotiated Rate |
$3,241.92 |
| Rate for Payer: Aetna Commercial |
$2,600.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,634.06
|
| Rate for Payer: Cash Price |
$1,688.50
|
| Rate for Payer: Cigna Commercial |
$2,802.91
|
| Rate for Payer: First Health Commercial |
$3,208.15
|
| Rate for Payer: Humana Commercial |
$2,870.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,769.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,492.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,013.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,971.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,532.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,701.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,937.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,330.13
|
| Rate for Payer: PHCS Commercial |
$3,241.92
|
| Rate for Payer: United Healthcare All Payer |
$2,971.76
|
|
|
PLATE PROFYLE STRGHT S 1.7 16H
|
Facility
|
OP
|
$2,040.39
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.12 |
| Max. Negotiated Rate |
$1,958.77 |
| Rate for Payer: Aetna Commercial |
$1,571.10
|
| Rate for Payer: Anthem Medicaid |
$701.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.50
|
| Rate for Payer: Cash Price |
$1,020.20
|
| Rate for Payer: Cigna Commercial |
$1,693.52
|
| Rate for Payer: First Health Commercial |
$1,938.37
|
| Rate for Payer: Humana Commercial |
$1,734.33
|
| Rate for Payer: Humana KY Medicaid |
$701.69
|
| Rate for Payer: Kentucky WC Medicaid |
$708.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,505.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,795.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,407.87
|
| Rate for Payer: PHCS Commercial |
$1,958.77
|
| Rate for Payer: United Healthcare All Payer |
$1,795.54
|
|
|
PLATE PROFYLE STRGHT S 1.7 16H
|
Facility
|
IP
|
$2,040.39
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.12 |
| Max. Negotiated Rate |
$1,958.77 |
| Rate for Payer: Aetna Commercial |
$1,571.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.50
|
| Rate for Payer: Cash Price |
$1,020.20
|
| Rate for Payer: Cigna Commercial |
$1,693.52
|
| Rate for Payer: First Health Commercial |
$1,938.37
|
| Rate for Payer: Humana Commercial |
$1,734.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,505.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,795.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,407.87
|
| Rate for Payer: PHCS Commercial |
$1,958.77
|
| Rate for Payer: United Healthcare All Payer |
$1,795.54
|
|
|
PLATE PROFYLE T 90D 1.2 5H
|
Facility
|
IP
|
$3,035.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.50 |
| Max. Negotiated Rate |
$2,913.60 |
| Rate for Payer: Aetna Commercial |
$2,336.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,367.30
|
| Rate for Payer: Cash Price |
$1,517.50
|
| Rate for Payer: Cigna Commercial |
$2,519.05
|
| Rate for Payer: First Health Commercial |
$2,883.25
|
| Rate for Payer: Humana Commercial |
$2,579.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,488.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,239.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,670.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,276.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,428.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,640.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,094.15
|
| Rate for Payer: PHCS Commercial |
$2,913.60
|
| Rate for Payer: United Healthcare All Payer |
$2,670.80
|
|
|
PLATE PROFYLE T 90D 1.2 5H
|
Facility
|
OP
|
$3,035.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.50 |
| Max. Negotiated Rate |
$2,913.60 |
| Rate for Payer: Aetna Commercial |
$2,336.95
|
| Rate for Payer: Anthem Medicaid |
$1,043.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,367.30
|
| Rate for Payer: Cash Price |
$1,517.50
|
| Rate for Payer: Cigna Commercial |
$2,519.05
|
| Rate for Payer: First Health Commercial |
$2,883.25
|
| Rate for Payer: Humana Commercial |
$2,579.75
|
| Rate for Payer: Humana KY Medicaid |
$1,043.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,054.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,488.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,239.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,064.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,670.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,276.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,428.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,640.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,094.15
|
| Rate for Payer: PHCS Commercial |
$2,913.60
|
| Rate for Payer: United Healthcare All Payer |
$2,670.80
|
|
|
PLATE PROFYLE T 90D 1.2 8H
|
Facility
|
OP
|
$3,194.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$958.20 |
| Max. Negotiated Rate |
$3,066.24 |
| Rate for Payer: Aetna Commercial |
$2,459.38
|
| Rate for Payer: Anthem Medicaid |
$1,098.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,491.32
|
| Rate for Payer: Cash Price |
$1,597.00
|
| Rate for Payer: Cigna Commercial |
$2,651.02
|
| Rate for Payer: First Health Commercial |
$3,034.30
|
| Rate for Payer: Humana Commercial |
$2,714.90
|
| Rate for Payer: Humana KY Medicaid |
$1,098.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,109.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,619.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,357.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$958.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,120.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,810.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,395.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,555.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,778.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,203.86
|
| Rate for Payer: PHCS Commercial |
$3,066.24
|
| Rate for Payer: United Healthcare All Payer |
$2,810.72
|
|
|
PLATE PROFYLE T 90D 1.2 8H
|
Facility
|
IP
|
$3,194.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$958.20 |
| Max. Negotiated Rate |
$3,066.24 |
| Rate for Payer: Aetna Commercial |
$2,459.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,491.32
|
| Rate for Payer: Cash Price |
$1,597.00
|
| Rate for Payer: Cigna Commercial |
$2,651.02
|
| Rate for Payer: First Health Commercial |
$3,034.30
|
| Rate for Payer: Humana Commercial |
$2,714.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,619.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,357.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$958.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,810.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,395.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,555.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,778.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,203.86
|
| Rate for Payer: PHCS Commercial |
$3,066.24
|
| Rate for Payer: United Healthcare All Payer |
$2,810.72
|
|
|
PLATE PROFYLE T 90D 1.7 6H
|
Facility
|
IP
|
$2,026.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.97 |
| Max. Negotiated Rate |
$1,945.50 |
| Rate for Payer: Aetna Commercial |
$1,560.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,580.72
|
| Rate for Payer: Cash Price |
$1,013.28
|
| Rate for Payer: Cigna Commercial |
$1,682.04
|
| Rate for Payer: First Health Commercial |
$1,925.23
|
| Rate for Payer: Humana Commercial |
$1,722.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,661.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,495.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,783.37
|
| Rate for Payer: Ohio Health Group HMO |
$1,519.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,621.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,763.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,398.33
|
| Rate for Payer: PHCS Commercial |
$1,945.50
|
| Rate for Payer: United Healthcare All Payer |
$1,783.37
|
|
|
PLATE PROFYLE T 90D 1.7 6H
|
Facility
|
OP
|
$2,026.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.97 |
| Max. Negotiated Rate |
$1,945.50 |
| Rate for Payer: Aetna Commercial |
$1,560.45
|
| Rate for Payer: Anthem Medicaid |
$696.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,580.72
|
| Rate for Payer: Cash Price |
$1,013.28
|
| Rate for Payer: Cigna Commercial |
$1,682.04
|
| Rate for Payer: First Health Commercial |
$1,925.23
|
| Rate for Payer: Humana Commercial |
$1,722.58
|
| Rate for Payer: Humana KY Medicaid |
$696.93
|
| Rate for Payer: Kentucky WC Medicaid |
$704.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,661.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,495.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,783.37
|
| Rate for Payer: Ohio Health Group HMO |
$1,519.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,621.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,763.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,398.33
|
| Rate for Payer: PHCS Commercial |
$1,945.50
|
| Rate for Payer: United Healthcare All Payer |
$1,783.37
|
|
|
PLATE PROFYLE T 90D 1.7 7H
|
Facility
|
IP
|
$2,026.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.97 |
| Max. Negotiated Rate |
$1,945.50 |
| Rate for Payer: Aetna Commercial |
$1,560.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,580.72
|
| Rate for Payer: Cash Price |
$1,013.28
|
| Rate for Payer: Cigna Commercial |
$1,682.04
|
| Rate for Payer: First Health Commercial |
$1,925.23
|
| Rate for Payer: Humana Commercial |
$1,722.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,661.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,495.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,783.37
|
| Rate for Payer: Ohio Health Group HMO |
$1,519.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,621.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,763.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,398.33
|
| Rate for Payer: PHCS Commercial |
$1,945.50
|
| Rate for Payer: United Healthcare All Payer |
$1,783.37
|
|
|
PLATE PROFYLE T 90D 1.7 7H
|
Facility
|
OP
|
$2,026.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.97 |
| Max. Negotiated Rate |
$1,945.50 |
| Rate for Payer: Aetna Commercial |
$1,560.45
|
| Rate for Payer: Anthem Medicaid |
$696.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,580.72
|
| Rate for Payer: Cash Price |
$1,013.28
|
| Rate for Payer: Cigna Commercial |
$1,682.04
|
| Rate for Payer: First Health Commercial |
$1,925.23
|
| Rate for Payer: Humana Commercial |
$1,722.58
|
| Rate for Payer: Humana KY Medicaid |
$696.93
|
| Rate for Payer: Kentucky WC Medicaid |
$704.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,661.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,495.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,783.37
|
| Rate for Payer: Ohio Health Group HMO |
$1,519.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,621.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,763.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,398.33
|
| Rate for Payer: PHCS Commercial |
$1,945.50
|
| Rate for Payer: United Healthcare All Payer |
$1,783.37
|
|
|
PLATE PROFYLE T 90D REG 1.7 7H
|
Facility
|
IP
|
$3,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.00 |
| Max. Negotiated Rate |
$2,928.00 |
| Rate for Payer: Aetna Commercial |
$2,348.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,379.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cigna Commercial |
$2,531.50
|
| Rate for Payer: First Health Commercial |
$2,897.50
|
| Rate for Payer: Humana Commercial |
$2,592.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,501.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,250.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$915.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,684.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,653.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.50
|
| Rate for Payer: PHCS Commercial |
$2,928.00
|
| Rate for Payer: United Healthcare All Payer |
$2,684.00
|
|
|
PLATE PROFYLE T 90D REG 1.7 7H
|
Facility
|
OP
|
$3,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.00 |
| Max. Negotiated Rate |
$2,928.00 |
| Rate for Payer: Aetna Commercial |
$2,348.50
|
| Rate for Payer: Anthem Medicaid |
$1,048.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,379.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cigna Commercial |
$2,531.50
|
| Rate for Payer: First Health Commercial |
$2,897.50
|
| Rate for Payer: Humana Commercial |
$2,592.50
|
| Rate for Payer: Humana KY Medicaid |
$1,048.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,059.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,501.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,250.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$915.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,069.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,684.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,653.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.50
|
| Rate for Payer: PHCS Commercial |
$2,928.00
|
| Rate for Payer: United Healthcare All Payer |
$2,684.00
|
|
