|
PLATE ACU-LOC 2 VDR NAR L
|
Facility
|
OP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Humana KY Medicaid |
$1,774.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem Medicaid |
$1,774.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
|
|
PLATE ACU-LOC 2 VDR NAR L
|
Facility
|
IP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
PLATE ACU-LOC 2 VDR NAR LONG L
|
Facility
|
OP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem Medicaid |
$1,774.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Humana KY Medicaid |
$1,774.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
PLATE ACU-LOC 2 VDR NAR LONG L
|
Facility
|
IP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
PLATE ACU-LOC 2 VDR NAR LONG R
|
Facility
|
IP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
PLATE ACU-LOC 2 VDR NAR LONG R
|
Facility
|
OP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem Medicaid |
$1,774.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Humana KY Medicaid |
$1,774.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
PLATE ACU-LOC 2 VDR NAR R
|
Facility
|
IP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
PLATE ACU-LOC 2 VDR NAR R
|
Facility
|
OP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem Medicaid |
$1,774.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Humana KY Medicaid |
$1,774.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
PLATE ACU-LOC 2 VDR PROX NAR L
|
Facility
|
OP
|
$13,917.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,809.32 |
| Max. Negotiated Rate |
$13,361.14 |
| Rate for Payer: Aetna Commercial |
$10,716.74
|
| Rate for Payer: Anthem Medicaid |
$4,786.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,855.92
|
| Rate for Payer: Cash Price |
$6,958.92
|
| Rate for Payer: Cigna Commercial |
$11,551.82
|
| Rate for Payer: First Health Commercial |
$13,221.96
|
| Rate for Payer: Humana Commercial |
$11,830.17
|
| Rate for Payer: Humana KY Medicaid |
$4,786.35
|
| Rate for Payer: Kentucky WC Medicaid |
$4,835.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,412.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,271.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,175.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,882.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,247.71
|
| Rate for Payer: Ohio Health Group HMO |
$10,438.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,783.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,809.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,314.53
|
| Rate for Payer: PHCS Commercial |
$13,361.14
|
| Rate for Payer: United Healthcare All Payer |
$12,247.71
|
|
|
PLATE ACU-LOC 2 VDR PROX NAR L
|
Facility
|
IP
|
$13,917.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,809.32 |
| Max. Negotiated Rate |
$13,361.14 |
| Rate for Payer: Aetna Commercial |
$10,716.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,855.92
|
| Rate for Payer: Cash Price |
$6,958.92
|
| Rate for Payer: Cigna Commercial |
$11,551.82
|
| Rate for Payer: First Health Commercial |
$13,221.96
|
| Rate for Payer: Humana Commercial |
$11,830.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,412.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,271.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,175.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,247.71
|
| Rate for Payer: Ohio Health Group HMO |
$10,438.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,783.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,809.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,314.53
|
| Rate for Payer: PHCS Commercial |
$13,361.14
|
| Rate for Payer: United Healthcare All Payer |
$12,247.71
|
|
|
PLATE ACU-LOC 2 VDR PROX NAR R
|
Facility
|
OP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem Medicaid |
$1,774.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Humana KY Medicaid |
$1,774.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
PLATE ACU-LOC 2 VDR PROX NAR R
|
Facility
|
IP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
PLATE ACU-LOC 2 VDR PROX STD L
|
Facility
|
IP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
PLATE ACU-LOC 2 VDR PROX STD L
|
Facility
|
OP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem Medicaid |
$1,774.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Humana KY Medicaid |
$1,774.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
PLATE ACU-LOC 2 VDR PROX STD R
|
Facility
|
IP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
|
|
PLATE ACU-LOC 2 VDR PROX STD R
|
Facility
|
OP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem Medicaid |
$1,774.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Humana KY Medicaid |
$1,774.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
PLATE ACU-LOC 2 VDR PROX WDE L
|
Facility
|
OP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem Medicaid |
$1,774.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Humana KY Medicaid |
$1,774.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
PLATE ACU-LOC 2 VDR PROX WDE L
|
Facility
|
IP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
PLATE ACU-LOC 2 VDR PROX WDE R
|
Facility
|
OP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem Medicaid |
$1,774.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Humana KY Medicaid |
$1,774.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
PLATE ACU-LOC 2 VDR PROX WDE R
|
Facility
|
IP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
PLATE ACULOC 2 VDR PRXNAR LG L
|
Facility
|
OP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem Medicaid |
$1,774.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Humana KY Medicaid |
$1,774.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
PLATE ACULOC 2 VDR PRXNAR LG L
|
Facility
|
IP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
PLATE ACULOC 2 VDR PRXNAR LG R
|
Facility
|
IP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
PLATE ACULOC 2 VDR PRXNAR LG R
|
Facility
|
OP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem Medicaid |
$1,774.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Humana KY Medicaid |
$1,774.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
PLATE ACULOC 2 VDR PRXSTD LG L
|
Facility
|
IP
|
$5,161.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
