|
PLATE T OBLIQUE 4H 63MM
|
Facility
|
IP
|
$2,108.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.53 |
| Max. Negotiated Rate |
$2,024.11 |
| Rate for Payer: Aetna Commercial |
$1,623.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,644.59
|
| Rate for Payer: Cash Price |
$1,054.22
|
| Rate for Payer: Cigna Commercial |
$1,750.01
|
| Rate for Payer: First Health Commercial |
$2,003.03
|
| Rate for Payer: Humana Commercial |
$1,792.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,728.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,556.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$632.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,855.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,581.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,686.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,834.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,454.83
|
| Rate for Payer: PHCS Commercial |
$2,024.11
|
| Rate for Payer: United Healthcare All Payer |
$1,855.44
|
|
|
PLATE T OBLIQUE 4H 71829614
|
Facility
|
OP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem Medicaid |
$728.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Humana KY Medicaid |
$728.04
|
| Rate for Payer: Kentucky WC Medicaid |
$735.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$742.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
PLATE T OBLIQUE 4H 71829614
|
Facility
|
IP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
PLATE T OBLIQUE 5H 71829615
|
Facility
|
IP
|
$2,139.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.94 |
| Max. Negotiated Rate |
$2,054.21 |
| Rate for Payer: Aetna Commercial |
$1,647.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,669.04
|
| Rate for Payer: Cash Price |
$1,069.90
|
| Rate for Payer: Cigna Commercial |
$1,776.03
|
| Rate for Payer: First Health Commercial |
$2,032.81
|
| Rate for Payer: Humana Commercial |
$1,818.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,754.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,579.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,883.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,604.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,711.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,861.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,476.46
|
| Rate for Payer: PHCS Commercial |
$2,054.21
|
| Rate for Payer: United Healthcare All Payer |
$1,883.02
|
|
|
PLATE T OBLIQUE 5H 71829615
|
Facility
|
OP
|
$2,139.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.94 |
| Max. Negotiated Rate |
$2,054.21 |
| Rate for Payer: Aetna Commercial |
$1,647.65
|
| Rate for Payer: Anthem Medicaid |
$735.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,669.04
|
| Rate for Payer: Cash Price |
$1,069.90
|
| Rate for Payer: Cigna Commercial |
$1,776.03
|
| Rate for Payer: First Health Commercial |
$2,032.81
|
| Rate for Payer: Humana Commercial |
$1,818.83
|
| Rate for Payer: Humana KY Medicaid |
$735.88
|
| Rate for Payer: Kentucky WC Medicaid |
$743.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,754.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,579.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$750.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,883.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,604.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,711.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,861.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,476.46
|
| Rate for Payer: PHCS Commercial |
$2,054.21
|
| Rate for Payer: United Healthcare All Payer |
$1,883.02
|
|
|
PLATE T OBLIQUE 5H 73MM
|
Facility
|
IP
|
$2,129.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.86 |
| Max. Negotiated Rate |
$2,044.36 |
| Rate for Payer: Aetna Commercial |
$1,639.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,661.04
|
| Rate for Payer: Cash Price |
$1,064.77
|
| Rate for Payer: Cigna Commercial |
$1,767.52
|
| Rate for Payer: First Health Commercial |
$2,023.06
|
| Rate for Payer: Humana Commercial |
$1,810.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,746.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,571.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,874.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,597.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,703.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,852.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,469.38
|
| Rate for Payer: PHCS Commercial |
$2,044.36
|
| Rate for Payer: United Healthcare All Payer |
$1,874.00
|
|
|
PLATE T OBLIQUE 5H 73MM
|
Facility
|
OP
|
$2,129.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.86 |
| Max. Negotiated Rate |
$2,044.36 |
| Rate for Payer: Aetna Commercial |
$1,639.75
|
| Rate for Payer: Anthem Medicaid |
$732.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,661.04
|
| Rate for Payer: Cash Price |
$1,064.77
|
| Rate for Payer: Cigna Commercial |
$1,767.52
|
| Rate for Payer: First Health Commercial |
$2,023.06
|
| Rate for Payer: Humana Commercial |
$1,810.11
|
| Rate for Payer: Humana KY Medicaid |
$732.35
|
| Rate for Payer: Kentucky WC Medicaid |
$739.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,746.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,571.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$747.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,874.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,597.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,703.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,852.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,469.38
|
| Rate for Payer: PHCS Commercial |
$2,044.36
|
| Rate for Payer: United Healthcare All Payer |
$1,874.00
|
|
|
PLATE T OBLIQUE SM
|
Facility
|
IP
|
$2,219.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.77 |
| Max. Negotiated Rate |
$2,130.45 |
| Rate for Payer: Aetna Commercial |
$1,708.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,730.99
|
| Rate for Payer: Cash Price |
$1,109.61
|
| Rate for Payer: Cigna Commercial |
$1,841.95
|
| Rate for Payer: First Health Commercial |
$2,108.26
|
| Rate for Payer: Humana Commercial |
$1,886.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,819.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,637.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$665.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,952.91
|
| Rate for Payer: Ohio Health Group HMO |
$1,664.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,775.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,930.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.26
|
| Rate for Payer: PHCS Commercial |
$2,130.45
|
| Rate for Payer: United Healthcare All Payer |
$1,952.91
|
|
|
PLATE T OBLIQUE SM
|
Facility
|
OP
|
$2,219.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.77 |
| Max. Negotiated Rate |
$2,130.45 |
| Rate for Payer: Aetna Commercial |
$1,708.80
|
| Rate for Payer: Anthem Medicaid |
$763.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,730.99
|
| Rate for Payer: Cash Price |
$1,109.61
|
| Rate for Payer: Cigna Commercial |
$1,841.95
|
| Rate for Payer: First Health Commercial |
$2,108.26
|
| Rate for Payer: Humana Commercial |
$1,886.34
|
| Rate for Payer: Humana KY Medicaid |
$763.19
|
| Rate for Payer: Kentucky WC Medicaid |
$770.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,819.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,637.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$665.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$778.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,952.91
|
| Rate for Payer: Ohio Health Group HMO |
$1,664.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,775.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,930.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.26
|
| Rate for Payer: PHCS Commercial |
$2,130.45
|
| Rate for Payer: United Healthcare All Payer |
$1,952.91
|
|
|
PLATE T OBLIQUE W PF 3H
|
Facility
|
OP
|
$2,937.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.36 |
| Max. Negotiated Rate |
$2,820.36 |
| Rate for Payer: Aetna Commercial |
$2,262.17
|
| Rate for Payer: Anthem Medicaid |
$1,010.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.55
|
| Rate for Payer: Cash Price |
$1,468.94
|
| Rate for Payer: Cigna Commercial |
$2,438.44
|
| Rate for Payer: First Health Commercial |
$2,790.99
|
| Rate for Payer: Humana Commercial |
$2,497.20
|
| Rate for Payer: Humana KY Medicaid |
$1,010.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,409.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,168.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.33
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,027.14
|
| Rate for Payer: PHCS Commercial |
$2,820.36
|
| Rate for Payer: United Healthcare All Payer |
$2,585.33
|
|
|
PLATE T OBLIQUE W PF 3H
|
Facility
|
IP
|
$2,937.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.36 |
| Max. Negotiated Rate |
$2,820.36 |
| Rate for Payer: Aetna Commercial |
$2,262.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.55
|
| Rate for Payer: Cash Price |
$1,468.94
|
| Rate for Payer: Cigna Commercial |
$2,438.44
|
| Rate for Payer: First Health Commercial |
$2,790.99
|
| Rate for Payer: Humana Commercial |
$2,497.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,409.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,168.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.33
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,027.14
|
| Rate for Payer: PHCS Commercial |
$2,820.36
|
| Rate for Payer: United Healthcare All Payer |
$2,585.33
|
|
|
PLATE T OBLIQUE W PF 4H
|
Facility
|
OP
|
$3,014.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.42 |
| Max. Negotiated Rate |
$2,894.16 |
| Rate for Payer: Aetna Commercial |
$2,321.36
|
| Rate for Payer: Anthem Medicaid |
$1,036.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,351.51
|
| Rate for Payer: Cash Price |
$1,507.38
|
| Rate for Payer: Cigna Commercial |
$2,502.24
|
| Rate for Payer: First Health Commercial |
$2,864.01
|
| Rate for Payer: Humana Commercial |
$2,562.54
|
| Rate for Payer: Humana KY Medicaid |
$1,036.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,047.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,472.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,224.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$904.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,057.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,652.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,261.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,411.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,622.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.18
|
| Rate for Payer: PHCS Commercial |
$2,894.16
|
| Rate for Payer: United Healthcare All Payer |
$2,652.98
|
|
|
PLATE T OBLIQUE W PF 4H
|
Facility
|
IP
|
$3,014.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.42 |
| Max. Negotiated Rate |
$2,894.16 |
| Rate for Payer: Aetna Commercial |
$2,321.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,351.51
|
| Rate for Payer: Cash Price |
$1,507.38
|
| Rate for Payer: Cigna Commercial |
$2,502.24
|
| Rate for Payer: First Health Commercial |
$2,864.01
|
| Rate for Payer: Humana Commercial |
$2,562.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,472.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,224.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$904.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,652.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,261.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,411.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,622.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,080.18
|
| Rate for Payer: PHCS Commercial |
$2,894.16
|
| Rate for Payer: United Healthcare All Payer |
$2,652.98
|
|
|
PLATE T OBLIQUE W PF 5H
|
Facility
|
OP
|
$3,037.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$911.34 |
| Max. Negotiated Rate |
$2,916.30 |
| Rate for Payer: Aetna Commercial |
$2,339.11
|
| Rate for Payer: Anthem Medicaid |
$1,044.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,369.49
|
| Rate for Payer: Cash Price |
$1,518.91
|
| Rate for Payer: Cigna Commercial |
$2,521.38
|
| Rate for Payer: First Health Commercial |
$2,885.92
|
| Rate for Payer: Humana Commercial |
$2,582.14
|
| Rate for Payer: Humana KY Medicaid |
$1,044.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,055.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,491.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,241.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$911.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,065.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,673.27
|
| Rate for Payer: Ohio Health Group HMO |
$2,278.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,430.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,642.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,096.09
|
| Rate for Payer: PHCS Commercial |
$2,916.30
|
| Rate for Payer: United Healthcare All Payer |
$2,673.27
|
|
|
PLATE T OBLIQUE W PF 5H
|
Facility
|
IP
|
$3,037.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$911.34 |
| Max. Negotiated Rate |
$2,916.30 |
| Rate for Payer: Aetna Commercial |
$2,339.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,369.49
|
| Rate for Payer: Cash Price |
$1,518.91
|
| Rate for Payer: Cigna Commercial |
$2,521.38
|
| Rate for Payer: First Health Commercial |
$2,885.92
|
| Rate for Payer: Humana Commercial |
$2,582.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,491.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,241.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$911.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,673.27
|
| Rate for Payer: Ohio Health Group HMO |
$2,278.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,430.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,642.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,096.09
|
| Rate for Payer: PHCS Commercial |
$2,916.30
|
| Rate for Payer: United Healthcare All Payer |
$2,673.27
|
|
|
PLATE T PROFYLE 2.3 WIDE 8H
|
Facility
|
IP
|
$3,467.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.10 |
| Max. Negotiated Rate |
$3,328.32 |
| Rate for Payer: Aetna Commercial |
$2,669.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,704.26
|
| Rate for Payer: Cash Price |
$1,733.50
|
| Rate for Payer: Cigna Commercial |
$2,877.61
|
| Rate for Payer: First Health Commercial |
$3,293.65
|
| Rate for Payer: Humana Commercial |
$2,946.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,842.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,558.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,040.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,050.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,600.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,773.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,016.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,392.23
|
| Rate for Payer: PHCS Commercial |
$3,328.32
|
| Rate for Payer: United Healthcare All Payer |
$3,050.96
|
|
|
PLATE T PROFYLE 2.3 WIDE 8H
|
Facility
|
OP
|
$3,467.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.10 |
| Max. Negotiated Rate |
$3,328.32 |
| Rate for Payer: Aetna Commercial |
$2,669.59
|
| Rate for Payer: Anthem Medicaid |
$1,192.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,704.26
|
| Rate for Payer: Cash Price |
$1,733.50
|
| Rate for Payer: Cigna Commercial |
$2,877.61
|
| Rate for Payer: First Health Commercial |
$3,293.65
|
| Rate for Payer: Humana Commercial |
$2,946.95
|
| Rate for Payer: Humana KY Medicaid |
$1,192.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,204.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,842.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,558.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,040.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,216.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,050.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,600.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,773.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,016.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,392.23
|
| Rate for Payer: PHCS Commercial |
$3,328.32
|
| Rate for Payer: United Healthcare All Payer |
$3,050.96
|
|
|
PLATE T PROFYLE 90D 2.3 6H
|
Facility
|
IP
|
$3,590.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,077.00 |
| Max. Negotiated Rate |
$3,446.40 |
| Rate for Payer: Aetna Commercial |
$2,764.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,800.20
|
| Rate for Payer: Cash Price |
$1,795.00
|
| Rate for Payer: Cigna Commercial |
$2,979.70
|
| Rate for Payer: First Health Commercial |
$3,410.50
|
| Rate for Payer: Humana Commercial |
$3,051.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,943.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,649.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,159.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,692.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,872.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,123.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,477.10
|
| Rate for Payer: PHCS Commercial |
$3,446.40
|
| Rate for Payer: United Healthcare All Payer |
$3,159.20
|
|
|
PLATE T PROFYLE 90D 2.3 6H
|
Facility
|
OP
|
$3,590.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,077.00 |
| Max. Negotiated Rate |
$3,446.40 |
| Rate for Payer: Aetna Commercial |
$2,764.30
|
| Rate for Payer: Anthem Medicaid |
$1,234.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,800.20
|
| Rate for Payer: Cash Price |
$1,795.00
|
| Rate for Payer: Cigna Commercial |
$2,979.70
|
| Rate for Payer: First Health Commercial |
$3,410.50
|
| Rate for Payer: Humana Commercial |
$3,051.50
|
| Rate for Payer: Humana KY Medicaid |
$1,234.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,247.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,943.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,649.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,259.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,159.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,692.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,872.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,123.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,477.10
|
| Rate for Payer: PHCS Commercial |
$3,446.40
|
| Rate for Payer: United Healthcare All Payer |
$3,159.20
|
|
|
PLATE T PROFYLE 90D 2.3 6H LT
|
Facility
|
IP
|
$1,788.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.42 |
| Max. Negotiated Rate |
$1,716.55 |
| Rate for Payer: Aetna Commercial |
$1,376.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.69
|
| Rate for Payer: Cash Price |
$894.04
|
| Rate for Payer: Cigna Commercial |
$1,484.10
|
| Rate for Payer: First Health Commercial |
$1,698.67
|
| Rate for Payer: Humana Commercial |
$1,519.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,466.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,341.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,430.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,233.77
|
| Rate for Payer: PHCS Commercial |
$1,716.55
|
| Rate for Payer: United Healthcare All Payer |
$1,573.50
|
|
|
PLATE T PROFYLE 90D 2.3 6H LT
|
Facility
|
OP
|
$1,788.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.42 |
| Max. Negotiated Rate |
$1,716.55 |
| Rate for Payer: Aetna Commercial |
$1,376.81
|
| Rate for Payer: Anthem Medicaid |
$614.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.69
|
| Rate for Payer: Cash Price |
$894.04
|
| Rate for Payer: Cigna Commercial |
$1,484.10
|
| Rate for Payer: First Health Commercial |
$1,698.67
|
| Rate for Payer: Humana Commercial |
$1,519.86
|
| Rate for Payer: Humana KY Medicaid |
$614.92
|
| Rate for Payer: Kentucky WC Medicaid |
$621.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,466.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,341.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,430.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,233.77
|
| Rate for Payer: PHCS Commercial |
$1,716.55
|
| Rate for Payer: United Healthcare All Payer |
$1,573.50
|
|
|
PLATE T PROFYLE 90D 2.3 6H RT
|
Facility
|
IP
|
$1,795.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.70 |
| Max. Negotiated Rate |
$1,723.84 |
| Rate for Payer: Aetna Commercial |
$1,382.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,400.62
|
| Rate for Payer: Cash Price |
$897.84
|
| Rate for Payer: Cigna Commercial |
$1,490.41
|
| Rate for Payer: First Health Commercial |
$1,705.89
|
| Rate for Payer: Humana Commercial |
$1,526.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,472.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,325.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,580.19
|
| Rate for Payer: Ohio Health Group HMO |
$1,346.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,562.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,239.01
|
| Rate for Payer: PHCS Commercial |
$1,723.84
|
| Rate for Payer: United Healthcare All Payer |
$1,580.19
|
|
|
PLATE T PROFYLE 90D 2.3 6H RT
|
Facility
|
OP
|
$1,795.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.70 |
| Max. Negotiated Rate |
$1,723.84 |
| Rate for Payer: Aetna Commercial |
$1,382.67
|
| Rate for Payer: Anthem Medicaid |
$617.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,400.62
|
| Rate for Payer: Cash Price |
$897.84
|
| Rate for Payer: Cigna Commercial |
$1,490.41
|
| Rate for Payer: First Health Commercial |
$1,705.89
|
| Rate for Payer: Humana Commercial |
$1,526.32
|
| Rate for Payer: Humana KY Medicaid |
$617.53
|
| Rate for Payer: Kentucky WC Medicaid |
$623.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,472.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,325.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$629.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,580.19
|
| Rate for Payer: Ohio Health Group HMO |
$1,346.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,562.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,239.01
|
| Rate for Payer: PHCS Commercial |
$1,723.84
|
| Rate for Payer: United Healthcare All Payer |
$1,580.19
|
|
|
PLATE T PROFYLE 90D 2.3 7H
|
Facility
|
IP
|
$3,590.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,077.00 |
| Max. Negotiated Rate |
$3,446.40 |
| Rate for Payer: Aetna Commercial |
$2,764.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,800.20
|
| Rate for Payer: Cash Price |
$1,795.00
|
| Rate for Payer: Cigna Commercial |
$2,979.70
|
| Rate for Payer: First Health Commercial |
$3,410.50
|
| Rate for Payer: Humana Commercial |
$3,051.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,943.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,649.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,159.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,692.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,872.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,123.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,477.10
|
| Rate for Payer: PHCS Commercial |
$3,446.40
|
| Rate for Payer: United Healthcare All Payer |
$3,159.20
|
|
|
PLATE T PROFYLE 90D 2.3 7H
|
Facility
|
OP
|
$3,590.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,077.00 |
| Max. Negotiated Rate |
$3,446.40 |
| Rate for Payer: Aetna Commercial |
$2,764.30
|
| Rate for Payer: Anthem Medicaid |
$1,234.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,800.20
|
| Rate for Payer: Cash Price |
$1,795.00
|
| Rate for Payer: Cigna Commercial |
$2,979.70
|
| Rate for Payer: First Health Commercial |
$3,410.50
|
| Rate for Payer: Humana Commercial |
$3,051.50
|
| Rate for Payer: Humana KY Medicaid |
$1,234.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,247.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,943.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,649.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,259.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,159.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,692.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,872.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,123.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,477.10
|
| Rate for Payer: PHCS Commercial |
$3,446.40
|
| Rate for Payer: United Healthcare All Payer |
$3,159.20
|
|
