|
PLATE ACULOC 2 VDR PRXSTD 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 PRXSTD 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 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 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 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 STD 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 STD 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 STD 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 STD 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 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: 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 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 WIDE 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 WIDE 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 WIDE 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 WIDE 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 DORSAL NAR LEFT
|
Facility
|
IP
|
$4,573.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.49 |
| Max. Negotiated Rate |
$4,390.08 |
| Rate for Payer: Aetna Commercial |
$3,521.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,566.94
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cigna Commercial |
$3,795.59
|
| Rate for Payer: First Health Commercial |
$4,344.35
|
| Rate for Payer: Humana Commercial |
$3,887.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,749.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,374.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,371.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,417.63
|
| Rate for Payer: PHCS Commercial |
$4,390.08
|
| Rate for Payer: United Healthcare All Payer |
$4,024.24
|
|
|
PLATE ACU-LOC DORSAL NAR LEFT
|
Facility
|
OP
|
$4,573.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.49 |
| Max. Negotiated Rate |
$4,390.08 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,566.94
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cigna Commercial |
$3,795.59
|
| Rate for Payer: First Health Commercial |
$4,344.35
|
| Rate for Payer: Humana Commercial |
$3,887.05
|
| Rate for Payer: Humana KY Medicaid |
$1,572.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,588.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,749.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,374.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,371.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,604.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,417.63
|
| Rate for Payer: PHCS Commercial |
$4,390.08
|
| Rate for Payer: United Healthcare All Payer |
$4,024.24
|
| Rate for Payer: Aetna Commercial |
$3,521.21
|
| Rate for Payer: Anthem Medicaid |
$1,572.65
|
|
|
PLATE ACU-LOC DORSAL NAR RIGHT
|
Facility
|
OP
|
$4,573.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.49 |
| Max. Negotiated Rate |
$4,390.08 |
| Rate for Payer: Aetna Commercial |
$3,521.21
|
| Rate for Payer: Anthem Medicaid |
$1,572.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,566.94
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cigna Commercial |
$3,795.59
|
| Rate for Payer: First Health Commercial |
$4,344.35
|
| Rate for Payer: Humana Commercial |
$3,887.05
|
| Rate for Payer: Humana KY Medicaid |
$1,572.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,588.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,749.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,374.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,371.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,604.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,417.63
|
| Rate for Payer: PHCS Commercial |
$4,390.08
|
| Rate for Payer: United Healthcare All Payer |
$4,024.24
|
|
|
PLATE ACU-LOC DORSAL NAR RIGHT
|
Facility
|
IP
|
$4,573.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.49 |
| Max. Negotiated Rate |
$4,390.08 |
| Rate for Payer: Aetna Commercial |
$3,521.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,566.94
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cigna Commercial |
$3,795.59
|
| Rate for Payer: First Health Commercial |
$4,344.35
|
| Rate for Payer: Humana Commercial |
$3,887.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,749.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,374.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,371.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,417.63
|
| Rate for Payer: PHCS Commercial |
$4,390.08
|
| Rate for Payer: United Healthcare All Payer |
$4,024.24
|
|
|
PLATE ACU-LOC DORSAL STD LEFT
|
Facility
|
IP
|
$4,573.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.49 |
| Max. Negotiated Rate |
$4,390.08 |
| Rate for Payer: Aetna Commercial |
$3,521.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,566.94
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cigna Commercial |
$3,795.59
|
| Rate for Payer: First Health Commercial |
$4,344.35
|
| Rate for Payer: Humana Commercial |
$3,887.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,749.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,374.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,371.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,417.63
|
| Rate for Payer: PHCS Commercial |
$4,390.08
|
| Rate for Payer: United Healthcare All Payer |
$4,024.24
|
|
|
PLATE ACU-LOC DORSAL STD LEFT
|
Facility
|
OP
|
$4,573.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.49 |
| Max. Negotiated Rate |
$4,390.08 |
| Rate for Payer: Aetna Commercial |
$3,521.21
|
| Rate for Payer: Anthem Medicaid |
$1,572.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,566.94
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cigna Commercial |
$3,795.59
|
| Rate for Payer: First Health Commercial |
$4,344.35
|
| Rate for Payer: Humana Commercial |
$3,887.05
|
| Rate for Payer: Humana KY Medicaid |
$1,572.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,588.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,749.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,374.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,371.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,604.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,417.63
|
| Rate for Payer: PHCS Commercial |
$4,390.08
|
| Rate for Payer: United Healthcare All Payer |
$4,024.24
|
|
|
PLATE ACU-LOC DORSAL STD RIGHT
|
Facility
|
OP
|
$4,573.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.49 |
| Max. Negotiated Rate |
$4,390.08 |
| Rate for Payer: Aetna Commercial |
$3,521.21
|
| Rate for Payer: Anthem Medicaid |
$1,572.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,566.94
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cigna Commercial |
$3,795.59
|
| Rate for Payer: First Health Commercial |
$4,344.35
|
| Rate for Payer: Humana Commercial |
$3,887.05
|
| Rate for Payer: Humana KY Medicaid |
$1,572.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,588.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,749.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,374.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,371.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,604.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,417.63
|
| Rate for Payer: PHCS Commercial |
$4,390.08
|
| Rate for Payer: United Healthcare All Payer |
$4,024.24
|
|
|
PLATE ACU-LOC DORSAL STD RIGHT
|
Facility
|
IP
|
$4,573.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.49 |
| Max. Negotiated Rate |
$4,390.08 |
| Rate for Payer: Aetna Commercial |
$3,521.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,566.94
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cigna Commercial |
$3,795.59
|
| Rate for Payer: First Health Commercial |
$4,344.35
|
| Rate for Payer: Humana Commercial |
$3,887.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,749.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,374.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,371.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,417.63
|
| Rate for Payer: PHCS Commercial |
$4,390.08
|
| Rate for Payer: United Healthcare All Payer |
$4,024.24
|
|
|
PLATE ACU-LOC VDU LEFT LONG
|
Facility
|
IP
|
$4,573.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.49 |
| Max. Negotiated Rate |
$4,390.08 |
| Rate for Payer: Aetna Commercial |
$3,521.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,566.94
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cigna Commercial |
$3,795.59
|
| Rate for Payer: First Health Commercial |
$4,344.35
|
| Rate for Payer: Humana Commercial |
$3,887.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,749.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,374.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,371.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,417.63
|
| Rate for Payer: PHCS Commercial |
$4,390.08
|
| Rate for Payer: United Healthcare All Payer |
$4,024.24
|
|
|
PLATE ACU-LOC VDU LEFT LONG
|
Facility
|
OP
|
$4,573.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.49 |
| Max. Negotiated Rate |
$4,390.08 |
| Rate for Payer: Aetna Commercial |
$3,521.21
|
| Rate for Payer: Anthem Medicaid |
$1,572.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,566.94
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cigna Commercial |
$3,795.59
|
| Rate for Payer: First Health Commercial |
$4,344.35
|
| Rate for Payer: Humana Commercial |
$3,887.05
|
| Rate for Payer: Humana KY Medicaid |
$1,572.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,588.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,749.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,374.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,371.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,604.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,417.63
|
| Rate for Payer: PHCS Commercial |
$4,390.08
|
| Rate for Payer: United Healthcare All Payer |
$4,024.24
|
|
