|
PLATE DOR DIS RD 3H 2.4*37 -90
|
Facility
|
OP
|
$3,937.93
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.38 |
| Max. Negotiated Rate |
$3,780.41 |
| Rate for Payer: Aetna Commercial |
$3,032.21
|
| Rate for Payer: Anthem Medicaid |
$1,354.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,071.59
|
| Rate for Payer: Cash Price |
$1,968.96
|
| Rate for Payer: Cigna Commercial |
$3,268.48
|
| Rate for Payer: First Health Commercial |
$3,741.03
|
| Rate for Payer: Humana Commercial |
$3,347.24
|
| Rate for Payer: Humana KY Medicaid |
$1,354.25
|
| Rate for Payer: Kentucky WC Medicaid |
$1,368.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,229.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,906.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,381.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,465.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,953.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,150.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,426.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,717.17
|
| Rate for Payer: PHCS Commercial |
$3,780.41
|
| Rate for Payer: United Healthcare All Payer |
$3,465.38
|
|
|
PLATE DOR DIS RD 3H 2.4*41 +20
|
Facility
|
OP
|
$3,937.93
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.38 |
| Max. Negotiated Rate |
$3,780.41 |
| Rate for Payer: Aetna Commercial |
$3,032.21
|
| Rate for Payer: Anthem Medicaid |
$1,354.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,071.59
|
| Rate for Payer: Cash Price |
$1,968.96
|
| Rate for Payer: Cigna Commercial |
$3,268.48
|
| Rate for Payer: First Health Commercial |
$3,741.03
|
| Rate for Payer: Humana Commercial |
$3,347.24
|
| Rate for Payer: Humana KY Medicaid |
$1,354.25
|
| Rate for Payer: Kentucky WC Medicaid |
$1,368.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,229.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,906.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,381.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,465.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,953.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,150.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,426.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,717.17
|
| Rate for Payer: PHCS Commercial |
$3,780.41
|
| Rate for Payer: United Healthcare All Payer |
$3,465.38
|
|
|
PLATE DOR DIS RD 3H 2.4*41 +20
|
Facility
|
IP
|
$3,937.93
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.38 |
| Max. Negotiated Rate |
$3,780.41 |
| Rate for Payer: Aetna Commercial |
$3,032.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,071.59
|
| Rate for Payer: Cash Price |
$1,968.96
|
| Rate for Payer: Cigna Commercial |
$3,268.48
|
| Rate for Payer: First Health Commercial |
$3,741.03
|
| Rate for Payer: Humana Commercial |
$3,347.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,229.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,906.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,465.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,953.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,150.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,426.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,717.17
|
| Rate for Payer: PHCS Commercial |
$3,780.41
|
| Rate for Payer: United Healthcare All Payer |
$3,465.38
|
|
|
PLATE DOR DIS RD 3H 2.4*41 -20
|
Facility
|
OP
|
$3,937.93
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.38 |
| Max. Negotiated Rate |
$3,780.41 |
| Rate for Payer: Aetna Commercial |
$3,032.21
|
| Rate for Payer: Anthem Medicaid |
$1,354.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,071.59
|
| Rate for Payer: Cash Price |
$1,968.96
|
| Rate for Payer: Cigna Commercial |
$3,268.48
|
| Rate for Payer: First Health Commercial |
$3,741.03
|
| Rate for Payer: Humana Commercial |
$3,347.24
|
| Rate for Payer: Humana KY Medicaid |
$1,354.25
|
| Rate for Payer: Kentucky WC Medicaid |
$1,368.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,229.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,906.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,381.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,465.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,953.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,150.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,426.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,717.17
|
| Rate for Payer: PHCS Commercial |
$3,780.41
|
| Rate for Payer: United Healthcare All Payer |
$3,465.38
|
|
|
PLATE DOR DIS RD 3H 2.4*41 -20
|
Facility
|
IP
|
$3,937.93
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.38 |
| Max. Negotiated Rate |
$3,780.41 |
| Rate for Payer: Aetna Commercial |
$3,032.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,071.59
|
| Rate for Payer: Cash Price |
$1,968.96
|
| Rate for Payer: Cigna Commercial |
$3,268.48
|
| Rate for Payer: First Health Commercial |
$3,741.03
|
| Rate for Payer: Humana Commercial |
$3,347.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,229.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,906.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,465.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,953.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,150.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,426.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,717.17
|
| Rate for Payer: PHCS Commercial |
$3,780.41
|
| Rate for Payer: United Healthcare All Payer |
$3,465.38
|
|
|
PLATE DOR DIS RD 5H 2.4*51 +90
|
Facility
|
IP
|
$4,035.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.54 |
| Max. Negotiated Rate |
$3,873.72 |
| Rate for Payer: Aetna Commercial |
$3,107.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,147.39
|
| Rate for Payer: Cash Price |
$2,017.56
|
| Rate for Payer: Cigna Commercial |
$3,349.15
|
| Rate for Payer: First Health Commercial |
$3,833.36
|
| Rate for Payer: Humana Commercial |
$3,429.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,308.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,977.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,210.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,550.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,026.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,228.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,510.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,784.23
|
| Rate for Payer: PHCS Commercial |
$3,873.72
|
| Rate for Payer: United Healthcare All Payer |
$3,550.91
|
|
|
PLATE DOR DIS RD 5H 2.4*51 +90
|
Facility
|
OP
|
$4,035.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.54 |
| Max. Negotiated Rate |
$3,873.72 |
| Rate for Payer: Aetna Commercial |
$3,107.04
|
| Rate for Payer: Anthem Medicaid |
$1,387.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,147.39
|
| Rate for Payer: Cash Price |
$2,017.56
|
| Rate for Payer: Cigna Commercial |
$3,349.15
|
| Rate for Payer: First Health Commercial |
$3,833.36
|
| Rate for Payer: Humana Commercial |
$3,429.85
|
| Rate for Payer: Humana KY Medicaid |
$1,387.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,401.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,308.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,977.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,210.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,415.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,550.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,026.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,228.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,510.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,784.23
|
| Rate for Payer: PHCS Commercial |
$3,873.72
|
| Rate for Payer: United Healthcare All Payer |
$3,550.91
|
|
|
PLATE DOR DIS RD 5H 2.4*51 -90
|
Facility
|
OP
|
$4,035.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.54 |
| Max. Negotiated Rate |
$3,873.72 |
| Rate for Payer: Aetna Commercial |
$3,107.04
|
| Rate for Payer: Anthem Medicaid |
$1,387.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,147.39
|
| Rate for Payer: Cash Price |
$2,017.56
|
| Rate for Payer: Cigna Commercial |
$3,349.15
|
| Rate for Payer: First Health Commercial |
$3,833.36
|
| Rate for Payer: Humana Commercial |
$3,429.85
|
| Rate for Payer: Humana KY Medicaid |
$1,387.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,401.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,308.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,977.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,210.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,415.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,550.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,026.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,228.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,510.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,784.23
|
| Rate for Payer: PHCS Commercial |
$3,873.72
|
| Rate for Payer: United Healthcare All Payer |
$3,550.91
|
|
|
PLATE DOR DIS RD 5H 2.4*51 -90
|
Facility
|
IP
|
$4,035.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.54 |
| Max. Negotiated Rate |
$3,873.72 |
| Rate for Payer: Aetna Commercial |
$3,107.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,147.39
|
| Rate for Payer: Cash Price |
$2,017.56
|
| Rate for Payer: Cigna Commercial |
$3,349.15
|
| Rate for Payer: First Health Commercial |
$3,833.36
|
| Rate for Payer: Humana Commercial |
$3,429.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,308.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,977.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,210.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,550.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,026.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,228.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,510.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,784.23
|
| Rate for Payer: PHCS Commercial |
$3,873.72
|
| Rate for Payer: United Healthcare All Payer |
$3,550.91
|
|
|
PLATE DOR DIS RD 5H 2.4*55 +20
|
Facility
|
IP
|
$4,035.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.54 |
| Max. Negotiated Rate |
$3,873.72 |
| Rate for Payer: Aetna Commercial |
$3,107.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,147.39
|
| Rate for Payer: Cash Price |
$2,017.56
|
| Rate for Payer: Cigna Commercial |
$3,349.15
|
| Rate for Payer: First Health Commercial |
$3,833.36
|
| Rate for Payer: Humana Commercial |
$3,429.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,308.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,977.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,210.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,550.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,026.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,228.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,510.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,784.23
|
| Rate for Payer: PHCS Commercial |
$3,873.72
|
| Rate for Payer: United Healthcare All Payer |
$3,550.91
|
|
|
PLATE DOR DIS RD 5H 2.4*55 +20
|
Facility
|
OP
|
$4,035.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.54 |
| Max. Negotiated Rate |
$3,873.72 |
| Rate for Payer: Aetna Commercial |
$3,107.04
|
| Rate for Payer: Anthem Medicaid |
$1,387.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,147.39
|
| Rate for Payer: Cash Price |
$2,017.56
|
| Rate for Payer: Cigna Commercial |
$3,349.15
|
| Rate for Payer: First Health Commercial |
$3,833.36
|
| Rate for Payer: Humana Commercial |
$3,429.85
|
| Rate for Payer: Humana KY Medicaid |
$1,387.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,401.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,308.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,977.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,210.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,415.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,550.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,026.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,228.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,510.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,784.23
|
| Rate for Payer: PHCS Commercial |
$3,873.72
|
| Rate for Payer: United Healthcare All Payer |
$3,550.91
|
|
|
PLATE DOR DIS RD 5H 2.4*55 -20
|
Facility
|
IP
|
$4,035.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.54 |
| Max. Negotiated Rate |
$3,873.72 |
| Rate for Payer: Aetna Commercial |
$3,107.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,147.39
|
| Rate for Payer: Cash Price |
$2,017.56
|
| Rate for Payer: Cigna Commercial |
$3,349.15
|
| Rate for Payer: First Health Commercial |
$3,833.36
|
| Rate for Payer: Humana Commercial |
$3,429.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,308.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,977.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,210.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,550.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,026.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,228.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,510.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,784.23
|
| Rate for Payer: PHCS Commercial |
$3,873.72
|
| Rate for Payer: United Healthcare All Payer |
$3,550.91
|
|
|
PLATE DOR DIS RD 5H 2.4*55 -20
|
Facility
|
OP
|
$4,035.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.54 |
| Max. Negotiated Rate |
$3,873.72 |
| Rate for Payer: Aetna Commercial |
$3,107.04
|
| Rate for Payer: Anthem Medicaid |
$1,387.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,147.39
|
| Rate for Payer: Cash Price |
$2,017.56
|
| Rate for Payer: Cigna Commercial |
$3,349.15
|
| Rate for Payer: First Health Commercial |
$3,833.36
|
| Rate for Payer: Humana Commercial |
$3,429.85
|
| Rate for Payer: Humana KY Medicaid |
$1,387.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,401.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,308.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,977.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,210.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,415.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,550.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,026.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,228.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,510.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,784.23
|
| Rate for Payer: PHCS Commercial |
$3,873.72
|
| Rate for Payer: United Healthcare All Payer |
$3,550.91
|
|
|
PLATE DOR DIST RAD TI NAR R 4H
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
PLATE DOR DIST RAD TI NAR R 4H
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
PLATE DOR DIST RAD TI STD L 4H
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
PLATE DOR DIST RAD TI STD L 4H
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
PLATE DOR DIST RAD TI STD R 4H
|
Facility
|
IP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
PLATE DOR DIST RAD TI STD R 4H
|
Facility
|
OP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem Medicaid |
$2,657.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Humana KY Medicaid |
$2,657.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
PLATE DORSAL DIST RAD LT-XLNG
|
Facility
|
OP
|
$2,234.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.44 |
| Max. Negotiated Rate |
$2,145.41 |
| Rate for Payer: Aetna Commercial |
$1,720.80
|
| Rate for Payer: Anthem Medicaid |
$768.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,743.14
|
| Rate for Payer: Cash Price |
$1,117.40
|
| Rate for Payer: Cigna Commercial |
$1,854.88
|
| Rate for Payer: First Health Commercial |
$2,123.06
|
| Rate for Payer: Humana Commercial |
$1,899.58
|
| Rate for Payer: Humana KY Medicaid |
$768.55
|
| Rate for Payer: Kentucky WC Medicaid |
$776.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,832.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,649.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$670.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$783.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,966.62
|
| Rate for Payer: Ohio Health Group HMO |
$1,676.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,944.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,542.01
|
| Rate for Payer: PHCS Commercial |
$2,145.41
|
| Rate for Payer: United Healthcare All Payer |
$1,966.62
|
|
|
PLATE DORSAL DIST RAD LT-XLNG
|
Facility
|
IP
|
$2,234.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.44 |
| Max. Negotiated Rate |
$2,145.41 |
| Rate for Payer: Aetna Commercial |
$1,720.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,743.14
|
| Rate for Payer: Cash Price |
$1,117.40
|
| Rate for Payer: Cigna Commercial |
$1,854.88
|
| Rate for Payer: First Health Commercial |
$2,123.06
|
| Rate for Payer: Humana Commercial |
$1,899.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,832.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,649.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$670.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,966.62
|
| Rate for Payer: Ohio Health Group HMO |
$1,676.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,944.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,542.01
|
| Rate for Payer: PHCS Commercial |
$2,145.41
|
| Rate for Payer: United Healthcare All Payer |
$1,966.62
|
|
|
PLATE DORSAL DIST RAD RT-XLNG
|
Facility
|
IP
|
$2,234.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.44 |
| Max. Negotiated Rate |
$2,145.41 |
| Rate for Payer: Aetna Commercial |
$1,720.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,743.14
|
| Rate for Payer: Cash Price |
$1,117.40
|
| Rate for Payer: Cigna Commercial |
$1,854.88
|
| Rate for Payer: First Health Commercial |
$2,123.06
|
| Rate for Payer: Humana Commercial |
$1,899.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,832.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,649.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$670.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,966.62
|
| Rate for Payer: Ohio Health Group HMO |
$1,676.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,944.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,542.01
|
| Rate for Payer: PHCS Commercial |
$2,145.41
|
| Rate for Payer: United Healthcare All Payer |
$1,966.62
|
|
|
PLATE DORSAL DIST RAD RT-XLNG
|
Facility
|
OP
|
$2,234.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.44 |
| Max. Negotiated Rate |
$2,145.41 |
| Rate for Payer: Aetna Commercial |
$1,720.80
|
| Rate for Payer: Anthem Medicaid |
$768.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,743.14
|
| Rate for Payer: Cash Price |
$1,117.40
|
| Rate for Payer: Cigna Commercial |
$1,854.88
|
| Rate for Payer: First Health Commercial |
$2,123.06
|
| Rate for Payer: Humana Commercial |
$1,899.58
|
| Rate for Payer: Humana KY Medicaid |
$768.55
|
| Rate for Payer: Kentucky WC Medicaid |
$776.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,832.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,649.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$670.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$783.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,966.62
|
| Rate for Payer: Ohio Health Group HMO |
$1,676.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,944.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,542.01
|
| Rate for Payer: PHCS Commercial |
$2,145.41
|
| Rate for Payer: United Healthcare All Payer |
$1,966.62
|
|
|
PLATE DORSAL LEFT 3H
|
Facility
|
IP
|
$4,688.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,406.62 |
| Max. Negotiated Rate |
$4,501.20 |
| Rate for Payer: Aetna Commercial |
$3,610.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.22
|
| Rate for Payer: Cash Price |
$2,344.38
|
| Rate for Payer: Cigna Commercial |
$3,891.66
|
| Rate for Payer: First Health Commercial |
$4,454.31
|
| Rate for Payer: Humana Commercial |
$3,985.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,126.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,751.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,079.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,235.24
|
| Rate for Payer: PHCS Commercial |
$4,501.20
|
| Rate for Payer: United Healthcare All Payer |
$4,126.10
|
|
|
PLATE DORSAL LEFT 3H
|
Facility
|
OP
|
$4,688.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,406.62 |
| Max. Negotiated Rate |
$4,501.20 |
| Rate for Payer: Aetna Commercial |
$3,610.34
|
| Rate for Payer: Anthem Medicaid |
$1,612.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.22
|
| Rate for Payer: Cash Price |
$2,344.38
|
| Rate for Payer: Cigna Commercial |
$3,891.66
|
| Rate for Payer: First Health Commercial |
$4,454.31
|
| Rate for Payer: Humana Commercial |
$3,985.44
|
| Rate for Payer: Humana KY Medicaid |
$1,612.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,126.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,751.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,079.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,235.24
|
| Rate for Payer: PHCS Commercial |
$4,501.20
|
| Rate for Payer: United Healthcare All Payer |
$4,126.10
|
|
