|
PLATE ACU-LOC 2 VDR PROX NAR L
|
Facility
|
IP
|
$14,176.03
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,252.81 |
| Max. Negotiated Rate |
$13,608.99 |
| Rate for Payer: Aetna Commercial |
$10,915.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,057.30
|
| Rate for Payer: Cash Price |
$7,088.02
|
| Rate for Payer: Cigna Commercial |
$11,766.10
|
| Rate for Payer: First Health Commercial |
$13,467.23
|
| Rate for Payer: Humana Commercial |
$12,049.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,624.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,461.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,252.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,474.91
|
| Rate for Payer: Ohio Health Group HMO |
$10,632.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,340.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,333.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,781.46
|
| Rate for Payer: PHCS Commercial |
$13,608.99
|
| Rate for Payer: United Healthcare All Payer |
$12,474.91
|
|
|
PLATE ACU-LOC 2 VDR PROX NAR L
|
Facility
|
OP
|
$14,176.03
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,252.81 |
| Max. Negotiated Rate |
$13,608.99 |
| Rate for Payer: Aetna Commercial |
$10,915.54
|
| Rate for Payer: Anthem Medicaid |
$4,875.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,057.30
|
| Rate for Payer: Cash Price |
$7,088.02
|
| Rate for Payer: Cigna Commercial |
$11,766.10
|
| Rate for Payer: First Health Commercial |
$13,467.23
|
| Rate for Payer: Humana Commercial |
$12,049.63
|
| Rate for Payer: Humana KY Medicaid |
$4,875.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,924.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,624.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,461.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,252.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,972.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,474.91
|
| Rate for Payer: Ohio Health Group HMO |
$10,632.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,340.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,333.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,781.46
|
| Rate for Payer: PHCS Commercial |
$13,608.99
|
| Rate for Payer: United Healthcare All Payer |
$12,474.91
|
|
|
PLATE ACU-LOC 2 VDR PROX NAR R
|
Facility
|
IP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACU-LOC 2 VDR PROX NAR R
|
Facility
|
OP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem Medicaid |
$1,778.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Humana KY Medicaid |
$1,778.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,796.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACU-LOC 2 VDR PROX STD L
|
Facility
|
IP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACU-LOC 2 VDR PROX STD L
|
Facility
|
OP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem Medicaid |
$1,778.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Humana KY Medicaid |
$1,778.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,796.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACU-LOC 2 VDR PROX STD R
|
Facility
|
IP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACU-LOC 2 VDR PROX STD R
|
Facility
|
OP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem Medicaid |
$1,778.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Humana KY Medicaid |
$1,778.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,796.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACU-LOC 2 VDR PROX WDE L
|
Facility
|
IP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACU-LOC 2 VDR PROX WDE L
|
Facility
|
OP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem Medicaid |
$1,778.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Humana KY Medicaid |
$1,778.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,796.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACU-LOC 2 VDR PROX WDE R
|
Facility
|
IP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACU-LOC 2 VDR PROX WDE R
|
Facility
|
OP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem Medicaid |
$1,778.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Humana KY Medicaid |
$1,778.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,796.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACULOC 2 VDR PRXNAR LG L
|
Facility
|
IP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACULOC 2 VDR PRXNAR LG L
|
Facility
|
OP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem Medicaid |
$1,778.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Humana KY Medicaid |
$1,778.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,796.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACULOC 2 VDR PRXNAR LG R
|
Facility
|
OP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem Medicaid |
$1,778.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Humana KY Medicaid |
$1,778.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,796.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACULOC 2 VDR PRXNAR LG R
|
Facility
|
IP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACULOC 2 VDR PRXSTD LG L
|
Facility
|
IP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACULOC 2 VDR PRXSTD LG L
|
Facility
|
OP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem Medicaid |
$1,778.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Humana KY Medicaid |
$1,778.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,796.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACULOC 2 VDR PRXSTD LG R
|
Facility
|
OP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem Medicaid |
$1,778.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Humana KY Medicaid |
$1,778.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,796.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACULOC 2 VDR PRXSTD LG R
|
Facility
|
IP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACU-LOC 2 VDR STD L
|
Facility
|
OP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem Medicaid |
$1,778.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Humana KY Medicaid |
$1,778.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,796.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACU-LOC 2 VDR STD L
|
Facility
|
IP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACU-LOC 2 VDR STD LONG L
|
Facility
|
OP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem Medicaid |
$1,778.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Humana KY Medicaid |
$1,778.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,796.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACU-LOC 2 VDR STD LONG L
|
Facility
|
IP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACU-LOC 2 VDR STD LONG R
|
Facility
|
OP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem Medicaid |
$1,778.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Humana KY Medicaid |
$1,778.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,796.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
