|
PLATE T PROFYLE LCK 2.3 WDE 8H
|
Facility
|
IP
|
$4,941.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$642.36 |
| Max. Negotiated Rate |
$4,743.55 |
| Rate for Payer: Aetna Commercial |
$3,804.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,854.14
|
| Rate for Payer: Cash Price |
$2,470.60
|
| Rate for Payer: Cigna Commercial |
$4,101.20
|
| Rate for Payer: First Health Commercial |
$4,694.14
|
| Rate for Payer: Humana Commercial |
$4,200.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,051.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,646.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,482.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,348.26
|
| Rate for Payer: Ohio Health Group HMO |
$3,705.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.77
|
| Rate for Payer: PHCS Commercial |
$4,743.55
|
| Rate for Payer: United Healthcare All Payer |
$4,348.26
|
|
|
PLATE T PROFYLE LCK 2.3 WDE 8H
|
Facility
|
OP
|
$4,941.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$642.36 |
| Max. Negotiated Rate |
$4,743.55 |
| Rate for Payer: Aetna Commercial |
$3,804.72
|
| Rate for Payer: Anthem Medicaid |
$1,699.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,854.14
|
| Rate for Payer: Cash Price |
$2,470.60
|
| Rate for Payer: Cigna Commercial |
$4,101.20
|
| Rate for Payer: First Health Commercial |
$4,694.14
|
| Rate for Payer: Humana Commercial |
$4,200.02
|
| Rate for Payer: Humana KY Medicaid |
$1,699.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,716.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,051.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,646.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,482.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,733.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,348.26
|
| Rate for Payer: Ohio Health Group HMO |
$3,705.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.77
|
| Rate for Payer: PHCS Commercial |
$4,743.55
|
| Rate for Payer: United Healthcare All Payer |
$4,348.26
|
|
|
PLATE T PROFYLE LOCK 2.3 NAR 6
|
Facility
|
IP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.79 |
| Max. Negotiated Rate |
$3,151.68 |
| Rate for Payer: Aetna Commercial |
$2,527.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,560.74
|
| Rate for Payer: Cash Price |
$1,641.50
|
| Rate for Payer: Cigna Commercial |
$2,724.89
|
| Rate for Payer: First Health Commercial |
$3,118.85
|
| Rate for Payer: Humana Commercial |
$2,790.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,422.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$984.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,889.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,462.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.73
|
| Rate for Payer: PHCS Commercial |
$3,151.68
|
| Rate for Payer: United Healthcare All Payer |
$2,889.04
|
|
|
PLATE T PROFYLE LOCK 2.3 NAR 6
|
Facility
|
OP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.79 |
| Max. Negotiated Rate |
$3,151.68 |
| Rate for Payer: Aetna Commercial |
$2,527.91
|
| Rate for Payer: Anthem Medicaid |
$1,129.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,560.74
|
| Rate for Payer: Cash Price |
$1,641.50
|
| Rate for Payer: Cigna Commercial |
$2,724.89
|
| Rate for Payer: First Health Commercial |
$3,118.85
|
| Rate for Payer: Humana Commercial |
$2,790.55
|
| Rate for Payer: Humana KY Medicaid |
$1,129.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,140.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,422.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$984.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,151.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,889.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,462.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.73
|
| Rate for Payer: PHCS Commercial |
$3,151.68
|
| Rate for Payer: United Healthcare All Payer |
$2,889.04
|
|
|
PLATE T PROFYLE LOCK NAR 1.7
|
Facility
|
IP
|
$4,230.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.90 |
| Max. Negotiated Rate |
$4,060.80 |
| Rate for Payer: Aetna Commercial |
$3,257.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,299.40
|
| Rate for Payer: Cash Price |
$2,115.00
|
| Rate for Payer: Cigna Commercial |
$3,510.90
|
| Rate for Payer: First Health Commercial |
$4,018.50
|
| Rate for Payer: Humana Commercial |
$3,595.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,468.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,121.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,269.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,722.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$846.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$549.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.30
|
| Rate for Payer: PHCS Commercial |
$4,060.80
|
| Rate for Payer: United Healthcare All Payer |
$3,722.40
|
|
|
PLATE T PROFYLE LOCK NAR 1.7
|
Facility
|
OP
|
$4,230.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.90 |
| Max. Negotiated Rate |
$4,060.80 |
| Rate for Payer: Aetna Commercial |
$3,257.10
|
| Rate for Payer: Anthem Medicaid |
$1,454.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,299.40
|
| Rate for Payer: Cash Price |
$2,115.00
|
| Rate for Payer: Cigna Commercial |
$3,510.90
|
| Rate for Payer: First Health Commercial |
$4,018.50
|
| Rate for Payer: Humana Commercial |
$3,595.50
|
| Rate for Payer: Humana KY Medicaid |
$1,454.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,469.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,468.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,121.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,269.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,483.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,722.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$846.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$549.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.30
|
| Rate for Payer: PHCS Commercial |
$4,060.80
|
| Rate for Payer: United Healthcare All Payer |
$3,722.40
|
|
|
PLATE T PROFYLE LOCK WD 1.7 8H
|
Facility
|
OP
|
$4,941.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$642.36 |
| Max. Negotiated Rate |
$4,743.55 |
| Rate for Payer: Anthem Medicaid |
$1,699.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,854.14
|
| Rate for Payer: Cash Price |
$2,470.60
|
| Rate for Payer: Cigna Commercial |
$4,101.20
|
| Rate for Payer: First Health Commercial |
$4,694.14
|
| Rate for Payer: Humana Commercial |
$4,200.02
|
| Rate for Payer: Humana KY Medicaid |
$1,699.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,716.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,051.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,646.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,482.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,733.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,348.26
|
| Rate for Payer: Ohio Health Group HMO |
$3,705.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.77
|
| Rate for Payer: PHCS Commercial |
$4,743.55
|
| Rate for Payer: United Healthcare All Payer |
$4,348.26
|
| Rate for Payer: Aetna Commercial |
$3,804.72
|
|
|
PLATE T PROFYLE LOCK WD 1.7 8H
|
Facility
|
IP
|
$4,941.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$642.36 |
| Max. Negotiated Rate |
$4,743.55 |
| Rate for Payer: Aetna Commercial |
$3,804.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,854.14
|
| Rate for Payer: Cash Price |
$2,470.60
|
| Rate for Payer: Cigna Commercial |
$4,101.20
|
| Rate for Payer: First Health Commercial |
$4,694.14
|
| Rate for Payer: Humana Commercial |
$4,200.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,051.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,646.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,482.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,348.26
|
| Rate for Payer: Ohio Health Group HMO |
$3,705.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.77
|
| Rate for Payer: PHCS Commercial |
$4,743.55
|
| Rate for Payer: United Healthcare All Payer |
$4,348.26
|
|
|
PLATE T PROFYLE M COMP NAR 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 M COMP NAR 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 M COMP REG 7H
|
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 M COMP REG 7H
|
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 OBLIQUE 5H LT
|
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 OBLIQUE 5H LT
|
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 OBLIQUE 5H RT
|
Facility
|
OP
|
$2,072.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.41 |
| Max. Negotiated Rate |
$1,989.50 |
| Rate for Payer: Aetna Commercial |
$1,595.75
|
| Rate for Payer: Anthem Medicaid |
$712.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,616.47
|
| Rate for Payer: Cash Price |
$1,036.20
|
| Rate for Payer: Cigna Commercial |
$1,720.09
|
| Rate for Payer: First Health Commercial |
$1,968.78
|
| Rate for Payer: Humana Commercial |
$1,761.54
|
| Rate for Payer: Humana KY Medicaid |
$712.70
|
| Rate for Payer: Kentucky WC Medicaid |
$719.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,699.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,529.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$727.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,823.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,554.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$414.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$642.44
|
| Rate for Payer: PHCS Commercial |
$1,989.50
|
| Rate for Payer: United Healthcare All Payer |
$1,823.71
|
|
|
PLATE T PROFYLE OBLIQUE 5H RT
|
Facility
|
IP
|
$2,072.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.41 |
| Max. Negotiated Rate |
$1,989.50 |
| Rate for Payer: Aetna Commercial |
$1,595.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,616.47
|
| Rate for Payer: Cash Price |
$1,036.20
|
| Rate for Payer: Cigna Commercial |
$1,720.09
|
| Rate for Payer: First Health Commercial |
$1,968.78
|
| Rate for Payer: Humana Commercial |
$1,761.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,699.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,529.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,823.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,554.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$414.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$642.44
|
| Rate for Payer: PHCS Commercial |
$1,989.50
|
| Rate for Payer: United Healthcare All Payer |
$1,823.71
|
|
|
PLATE T PROFYL LCK NAR 1.7 10H
|
Facility
|
OP
|
$4,941.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$642.36 |
| Max. Negotiated Rate |
$4,743.55 |
| Rate for Payer: Aetna Commercial |
$3,804.72
|
| Rate for Payer: Anthem Medicaid |
$1,699.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,854.14
|
| Rate for Payer: Cash Price |
$2,470.60
|
| Rate for Payer: Cigna Commercial |
$4,101.20
|
| Rate for Payer: First Health Commercial |
$4,694.14
|
| Rate for Payer: Humana Commercial |
$4,200.02
|
| Rate for Payer: Humana KY Medicaid |
$1,699.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,716.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,051.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,646.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,482.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,733.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,348.26
|
| Rate for Payer: Ohio Health Group HMO |
$3,705.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.77
|
| Rate for Payer: PHCS Commercial |
$4,743.55
|
| Rate for Payer: United Healthcare All Payer |
$4,348.26
|
|
|
PLATE T PROFYL LCK NAR 1.7 10H
|
Facility
|
IP
|
$4,941.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$642.36 |
| Max. Negotiated Rate |
$4,743.55 |
| Rate for Payer: Aetna Commercial |
$3,804.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,854.14
|
| Rate for Payer: Cash Price |
$2,470.60
|
| Rate for Payer: Cigna Commercial |
$4,101.20
|
| Rate for Payer: First Health Commercial |
$4,694.14
|
| Rate for Payer: Humana Commercial |
$4,200.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,051.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,646.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,482.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,348.26
|
| Rate for Payer: Ohio Health Group HMO |
$3,705.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.77
|
| Rate for Payer: PHCS Commercial |
$4,743.55
|
| Rate for Payer: United Healthcare All Payer |
$4,348.26
|
|
|
PLATE T PROFYL LOCK REG 1.7 7H
|
Facility
|
OP
|
$4,941.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$642.36 |
| Max. Negotiated Rate |
$4,743.55 |
| Rate for Payer: Aetna Commercial |
$3,804.72
|
| Rate for Payer: Anthem Medicaid |
$1,699.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,854.14
|
| Rate for Payer: Cash Price |
$2,470.60
|
| Rate for Payer: Cigna Commercial |
$4,101.20
|
| Rate for Payer: First Health Commercial |
$4,694.14
|
| Rate for Payer: Humana Commercial |
$4,200.02
|
| Rate for Payer: Humana KY Medicaid |
$1,699.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,716.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,051.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,646.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,482.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,733.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,348.26
|
| Rate for Payer: Ohio Health Group HMO |
$3,705.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.77
|
| Rate for Payer: PHCS Commercial |
$4,743.55
|
| Rate for Payer: United Healthcare All Payer |
$4,348.26
|
|
|
PLATE T PROFYL LOCK REG 1.7 7H
|
Facility
|
IP
|
$4,941.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$642.36 |
| Max. Negotiated Rate |
$4,743.55 |
| Rate for Payer: Aetna Commercial |
$3,804.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,854.14
|
| Rate for Payer: Cash Price |
$2,470.60
|
| Rate for Payer: Cigna Commercial |
$4,101.20
|
| Rate for Payer: First Health Commercial |
$4,694.14
|
| Rate for Payer: Humana Commercial |
$4,200.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,051.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,646.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,482.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,348.26
|
| Rate for Payer: Ohio Health Group HMO |
$3,705.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.77
|
| Rate for Payer: PHCS Commercial |
$4,743.55
|
| Rate for Payer: United Healthcare All Payer |
$4,348.26
|
|
|
PLATE TROCHANTERIC MED 200MM
|
Facility
|
IP
|
$12,434.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,616.44 |
| Max. Negotiated Rate |
$11,936.76 |
| Rate for Payer: Humana Commercial |
$10,569.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,195.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,176.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,730.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,942.03
|
| Rate for Payer: Ohio Health Group HMO |
$9,325.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,486.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,616.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,854.58
|
| Rate for Payer: PHCS Commercial |
$11,936.76
|
| Rate for Payer: United Healthcare All Payer |
$10,942.03
|
| Rate for Payer: Aetna Commercial |
$9,574.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,698.61
|
| Rate for Payer: Cash Price |
$6,217.06
|
| Rate for Payer: Cigna Commercial |
$10,320.32
|
| Rate for Payer: First Health Commercial |
$11,812.41
|
|
|
PLATE TROCHANTERIC MED 200MM
|
Facility
|
OP
|
$12,434.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,616.44 |
| Max. Negotiated Rate |
$11,936.76 |
| Rate for Payer: Aetna Commercial |
$9,574.27
|
| Rate for Payer: Anthem Medicaid |
$4,276.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,698.61
|
| Rate for Payer: Cash Price |
$6,217.06
|
| Rate for Payer: Cigna Commercial |
$10,320.32
|
| Rate for Payer: First Health Commercial |
$11,812.41
|
| Rate for Payer: Humana Commercial |
$10,569.00
|
| Rate for Payer: Humana KY Medicaid |
$4,276.09
|
| Rate for Payer: Kentucky WC Medicaid |
$4,319.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,195.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,176.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,730.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,361.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,942.03
|
| Rate for Payer: Ohio Health Group HMO |
$9,325.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,486.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,616.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,854.58
|
| Rate for Payer: PHCS Commercial |
$11,936.76
|
| Rate for Payer: United Healthcare All Payer |
$10,942.03
|
|
|
PLATE T RT ANGLE SM
|
Facility
|
OP
|
$1,823.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.06 |
| Max. Negotiated Rate |
$1,750.61 |
| Rate for Payer: Aetna Commercial |
$1,404.13
|
| Rate for Payer: Anthem Medicaid |
$627.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,422.37
|
| Rate for Payer: Cash Price |
$911.78
|
| Rate for Payer: Cigna Commercial |
$1,513.55
|
| Rate for Payer: First Health Commercial |
$1,732.37
|
| Rate for Payer: Humana Commercial |
$1,550.02
|
| Rate for Payer: Humana KY Medicaid |
$627.12
|
| Rate for Payer: Kentucky WC Medicaid |
$633.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,495.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$639.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,604.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,367.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.30
|
| Rate for Payer: PHCS Commercial |
$1,750.61
|
| Rate for Payer: United Healthcare All Payer |
$1,604.72
|
|
|
PLATE T RT ANGLE SM
|
Facility
|
IP
|
$1,823.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.06 |
| Max. Negotiated Rate |
$1,750.61 |
| Rate for Payer: Aetna Commercial |
$1,404.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,422.37
|
| Rate for Payer: Cash Price |
$911.78
|
| Rate for Payer: Cigna Commercial |
$1,513.55
|
| Rate for Payer: First Health Commercial |
$1,732.37
|
| Rate for Payer: Humana Commercial |
$1,550.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,495.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,604.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,367.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.30
|
| Rate for Payer: PHCS Commercial |
$1,750.61
|
| Rate for Payer: United Healthcare All Payer |
$1,604.72
|
|
|
PLATE T SM 4H 56MM
|
Facility
|
IP
|
$1,777.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.06 |
| Max. Negotiated Rate |
$1,706.26 |
| Rate for Payer: Aetna Commercial |
$1,368.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,386.33
|
| Rate for Payer: Cash Price |
$888.68
|
| Rate for Payer: Cigna Commercial |
$1,475.20
|
| Rate for Payer: First Health Commercial |
$1,688.48
|
| Rate for Payer: Humana Commercial |
$1,510.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,457.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,311.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$533.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,564.07
|
| Rate for Payer: Ohio Health Group HMO |
$1,333.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$550.98
|
| Rate for Payer: PHCS Commercial |
$1,706.26
|
| Rate for Payer: United Healthcare All Payer |
$1,564.07
|
|
