|
PLATE VLP MIN-MOD 1.5M STR 8H
|
Facility
|
OP
|
$4,509.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.28 |
| Max. Negotiated Rate |
$4,329.43 |
| Rate for Payer: Aetna Commercial |
$3,472.56
|
| Rate for Payer: Anthem Medicaid |
$1,550.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,517.66
|
| Rate for Payer: Cash Price |
$2,254.91
|
| Rate for Payer: Cigna Commercial |
$3,743.15
|
| Rate for Payer: First Health Commercial |
$4,284.33
|
| Rate for Payer: Humana Commercial |
$3,833.35
|
| Rate for Payer: Humana KY Medicaid |
$1,550.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,566.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,698.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,328.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,352.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,582.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,968.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,382.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$901.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$586.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,398.04
|
| Rate for Payer: PHCS Commercial |
$4,329.43
|
| Rate for Payer: United Healthcare All Payer |
$3,968.64
|
|
|
PLATE VLP MIN-MOD 1.5M T 2H*6H
|
Facility
|
IP
|
$4,216.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.17 |
| Max. Negotiated Rate |
$4,048.03 |
| Rate for Payer: Aetna Commercial |
$3,246.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,289.03
|
| Rate for Payer: Cash Price |
$2,108.35
|
| Rate for Payer: Cigna Commercial |
$3,499.86
|
| Rate for Payer: First Health Commercial |
$4,005.86
|
| Rate for Payer: Humana Commercial |
$3,584.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,457.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,111.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,265.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,710.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,162.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$843.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,307.18
|
| Rate for Payer: PHCS Commercial |
$4,048.03
|
| Rate for Payer: United Healthcare All Payer |
$3,710.70
|
|
|
PLATE VLP MIN-MOD 1.5M T 2H*6H
|
Facility
|
OP
|
$4,216.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.17 |
| Max. Negotiated Rate |
$4,048.03 |
| Rate for Payer: Aetna Commercial |
$3,246.86
|
| Rate for Payer: Anthem Medicaid |
$1,450.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,289.03
|
| Rate for Payer: Cash Price |
$2,108.35
|
| Rate for Payer: Cigna Commercial |
$3,499.86
|
| Rate for Payer: First Health Commercial |
$4,005.86
|
| Rate for Payer: Humana Commercial |
$3,584.20
|
| Rate for Payer: Humana KY Medicaid |
$1,450.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,464.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,457.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,111.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,265.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,479.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,710.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,162.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$843.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,307.18
|
| Rate for Payer: PHCS Commercial |
$4,048.03
|
| Rate for Payer: United Healthcare All Payer |
$3,710.70
|
|
|
PLATE VLP MIN-MOD 1.5M T 2H*8H
|
Facility
|
IP
|
$4,791.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.86 |
| Max. Negotiated Rate |
$4,599.58 |
| Rate for Payer: Aetna Commercial |
$3,689.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,737.16
|
| Rate for Payer: Cash Price |
$2,395.61
|
| Rate for Payer: Cigna Commercial |
$3,976.72
|
| Rate for Payer: First Health Commercial |
$4,551.67
|
| Rate for Payer: Humana Commercial |
$4,072.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,928.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,535.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,437.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,216.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,593.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$622.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,485.28
|
| Rate for Payer: PHCS Commercial |
$4,599.58
|
| Rate for Payer: United Healthcare All Payer |
$4,216.28
|
|
|
PLATE VLP MIN-MOD 1.5M T 2H*8H
|
Facility
|
OP
|
$4,791.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.86 |
| Max. Negotiated Rate |
$4,599.58 |
| Rate for Payer: Aetna Commercial |
$3,689.25
|
| Rate for Payer: Anthem Medicaid |
$1,647.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,737.16
|
| Rate for Payer: Cash Price |
$2,395.61
|
| Rate for Payer: Cigna Commercial |
$3,976.72
|
| Rate for Payer: First Health Commercial |
$4,551.67
|
| Rate for Payer: Humana Commercial |
$4,072.55
|
| Rate for Payer: Humana KY Medicaid |
$1,647.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,664.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,928.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,535.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,437.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,680.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,216.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,593.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$622.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,485.28
|
| Rate for Payer: PHCS Commercial |
$4,599.58
|
| Rate for Payer: United Healthcare All Payer |
$4,216.28
|
|
|
PLATE VLP MIN-MOD 1.5M T 3H*6H
|
Facility
|
OP
|
$5,084.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.97 |
| Max. Negotiated Rate |
$4,880.98 |
| Rate for Payer: Aetna Commercial |
$3,914.95
|
| Rate for Payer: Anthem Medicaid |
$1,748.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,965.79
|
| Rate for Payer: Cash Price |
$2,542.18
|
| Rate for Payer: Cigna Commercial |
$4,220.01
|
| Rate for Payer: First Health Commercial |
$4,830.13
|
| Rate for Payer: Humana Commercial |
$4,321.70
|
| Rate for Payer: Humana KY Medicaid |
$1,748.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,766.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,169.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,752.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,525.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,783.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,474.23
|
| Rate for Payer: Ohio Health Group HMO |
$3,813.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,016.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$660.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,576.15
|
| Rate for Payer: PHCS Commercial |
$4,880.98
|
| Rate for Payer: United Healthcare All Payer |
$4,474.23
|
|
|
PLATE VLP MIN-MOD 1.5M T 3H*6H
|
Facility
|
IP
|
$5,084.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.97 |
| Max. Negotiated Rate |
$4,880.98 |
| Rate for Payer: Humana Commercial |
$4,321.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,169.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,752.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,525.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,474.23
|
| Rate for Payer: Ohio Health Group HMO |
$3,813.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,016.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$660.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,576.15
|
| Rate for Payer: PHCS Commercial |
$4,880.98
|
| Rate for Payer: United Healthcare All Payer |
$4,474.23
|
| Rate for Payer: Aetna Commercial |
$3,914.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,965.79
|
| Rate for Payer: Cash Price |
$2,542.18
|
| Rate for Payer: Cigna Commercial |
$4,220.01
|
| Rate for Payer: First Health Commercial |
$4,830.13
|
|
|
PLATE VLP MIN-MOD 1.5M T 3H*8H
|
Facility
|
OP
|
$5,647.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$734.13 |
| Max. Negotiated Rate |
$5,421.26 |
| Rate for Payer: Aetna Commercial |
$4,348.31
|
| Rate for Payer: Anthem Medicaid |
$1,942.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,404.78
|
| Rate for Payer: Cash Price |
$2,823.57
|
| Rate for Payer: Cigna Commercial |
$4,687.13
|
| Rate for Payer: First Health Commercial |
$5,364.79
|
| Rate for Payer: Humana Commercial |
$4,800.08
|
| Rate for Payer: Humana KY Medicaid |
$1,942.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,961.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,630.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,167.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,694.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,981.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,969.49
|
| Rate for Payer: Ohio Health Group HMO |
$4,235.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,129.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$734.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,750.62
|
| Rate for Payer: PHCS Commercial |
$5,421.26
|
| Rate for Payer: United Healthcare All Payer |
$4,969.49
|
|
|
PLATE VLP MIN-MOD 1.5M T 3H*8H
|
Facility
|
IP
|
$5,647.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$734.13 |
| Max. Negotiated Rate |
$5,421.26 |
| Rate for Payer: Aetna Commercial |
$4,348.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,404.78
|
| Rate for Payer: Cash Price |
$2,823.57
|
| Rate for Payer: Cigna Commercial |
$4,687.13
|
| Rate for Payer: First Health Commercial |
$5,364.79
|
| Rate for Payer: Humana Commercial |
$4,800.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,630.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,167.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,694.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,969.49
|
| Rate for Payer: Ohio Health Group HMO |
$4,235.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,129.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$734.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,750.62
|
| Rate for Payer: PHCS Commercial |
$5,421.26
|
| Rate for Payer: United Healthcare All Payer |
$4,969.49
|
|
|
PLATE VOLAR 3H STD
|
Facility
|
IP
|
$5,549.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.44 |
| Max. Negotiated Rate |
$5,327.52 |
| Rate for Payer: Aetna Commercial |
$4,273.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,328.61
|
| Rate for Payer: Cash Price |
$2,774.75
|
| Rate for Payer: Cigna Commercial |
$4,606.08
|
| Rate for Payer: First Health Commercial |
$5,272.02
|
| Rate for Payer: Humana Commercial |
$4,717.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,550.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,095.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,664.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,883.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,162.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,109.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$721.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,720.34
|
| Rate for Payer: PHCS Commercial |
$5,327.52
|
| Rate for Payer: United Healthcare All Payer |
$4,883.56
|
|
|
PLATE VOLAR 3H STD
|
Facility
|
OP
|
$5,549.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.44 |
| Max. Negotiated Rate |
$5,327.52 |
| Rate for Payer: Aetna Commercial |
$4,273.12
|
| Rate for Payer: Anthem Medicaid |
$1,908.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,328.61
|
| Rate for Payer: Cash Price |
$2,774.75
|
| Rate for Payer: Cigna Commercial |
$4,606.08
|
| Rate for Payer: First Health Commercial |
$5,272.02
|
| Rate for Payer: Humana Commercial |
$4,717.08
|
| Rate for Payer: Humana KY Medicaid |
$1,908.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,927.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,550.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,095.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,664.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,946.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,883.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,162.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,109.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$721.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,720.34
|
| Rate for Payer: PHCS Commercial |
$5,327.52
|
| Rate for Payer: United Healthcare All Payer |
$4,883.56
|
|
|
PLATE VOLAR 4H L STD 56MM
|
Facility
|
OP
|
$6,461.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.02 |
| Max. Negotiated Rate |
$6,203.21 |
| Rate for Payer: Aetna Commercial |
$4,975.49
|
| Rate for Payer: Anthem Medicaid |
$2,222.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,040.11
|
| Rate for Payer: Cash Price |
$3,230.84
|
| Rate for Payer: Cigna Commercial |
$5,363.19
|
| Rate for Payer: First Health Commercial |
$6,138.60
|
| Rate for Payer: Humana Commercial |
$5,492.43
|
| Rate for Payer: Humana KY Medicaid |
$2,222.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,244.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,298.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,768.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,938.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,266.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,686.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,846.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,292.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$840.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,003.12
|
| Rate for Payer: PHCS Commercial |
$6,203.21
|
| Rate for Payer: United Healthcare All Payer |
$5,686.28
|
|
|
PLATE VOLAR 4H L STD 56MM
|
Facility
|
IP
|
$6,461.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.02 |
| Max. Negotiated Rate |
$6,203.21 |
| Rate for Payer: Aetna Commercial |
$4,975.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,040.11
|
| Rate for Payer: Cash Price |
$3,230.84
|
| Rate for Payer: Cigna Commercial |
$5,363.19
|
| Rate for Payer: First Health Commercial |
$6,138.60
|
| Rate for Payer: Humana Commercial |
$5,492.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,298.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,768.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,938.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,686.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,846.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,292.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$840.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,003.12
|
| Rate for Payer: PHCS Commercial |
$6,203.21
|
| Rate for Payer: United Healthcare All Payer |
$5,686.28
|
|
|
PLATE VOLAR DIS RAD TI NAR 3H
|
Facility
|
IP
|
$5,121.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.81 |
| Max. Negotiated Rate |
$4,916.76 |
| Rate for Payer: Aetna Commercial |
$3,943.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,994.86
|
| Rate for Payer: Cash Price |
$2,560.81
|
| Rate for Payer: Cigna Commercial |
$4,250.94
|
| Rate for Payer: First Health Commercial |
$4,865.54
|
| Rate for Payer: Humana Commercial |
$4,353.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,199.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,779.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,507.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,841.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.70
|
| Rate for Payer: PHCS Commercial |
$4,916.76
|
| Rate for Payer: United Healthcare All Payer |
$4,507.03
|
|
|
PLATE VOLAR DIS RAD TI NAR 3H
|
Facility
|
OP
|
$5,121.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.81 |
| Max. Negotiated Rate |
$4,916.76 |
| Rate for Payer: Humana Commercial |
$4,353.38
|
| Rate for Payer: Humana KY Medicaid |
$1,761.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,779.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,199.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,779.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,796.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,507.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,841.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.70
|
| Rate for Payer: PHCS Commercial |
$4,916.76
|
| Rate for Payer: United Healthcare All Payer |
$4,507.03
|
| Rate for Payer: Aetna Commercial |
$3,943.65
|
| Rate for Payer: Anthem Medicaid |
$1,761.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,994.86
|
| Rate for Payer: Cash Price |
$2,560.81
|
| Rate for Payer: Cigna Commercial |
$4,250.94
|
| Rate for Payer: First Health Commercial |
$4,865.54
|
|
|
PLATE VOLAR DIS RAD TI STD 3H
|
Facility
|
OP
|
$5,121.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.81 |
| Max. Negotiated Rate |
$4,916.76 |
| Rate for Payer: Aetna Commercial |
$3,943.65
|
| Rate for Payer: Anthem Medicaid |
$1,761.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,994.86
|
| Rate for Payer: Cash Price |
$2,560.81
|
| Rate for Payer: Cigna Commercial |
$4,250.94
|
| Rate for Payer: First Health Commercial |
$4,865.54
|
| Rate for Payer: Humana Commercial |
$4,353.38
|
| Rate for Payer: Humana KY Medicaid |
$1,761.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,779.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,199.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,779.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,796.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,507.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,841.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.70
|
| Rate for Payer: PHCS Commercial |
$4,916.76
|
| Rate for Payer: United Healthcare All Payer |
$4,507.03
|
|
|
PLATE VOLAR DIS RAD TI STD 3H
|
Facility
|
IP
|
$5,121.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.81 |
| Max. Negotiated Rate |
$4,916.76 |
| Rate for Payer: Aetna Commercial |
$3,943.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,994.86
|
| Rate for Payer: Cash Price |
$2,560.81
|
| Rate for Payer: Cigna Commercial |
$4,250.94
|
| Rate for Payer: First Health Commercial |
$4,865.54
|
| Rate for Payer: Humana Commercial |
$4,353.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,199.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,779.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,507.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,841.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.70
|
| Rate for Payer: PHCS Commercial |
$4,916.76
|
| Rate for Payer: United Healthcare All Payer |
$4,507.03
|
|
|
PLATE VOLAR DIS RD 6H 2.4*45 L
|
Facility
|
IP
|
$5,467.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.78 |
| Max. Negotiated Rate |
$5,248.83 |
| Rate for Payer: Aetna Commercial |
$4,210.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,264.67
|
| Rate for Payer: Cash Price |
$2,733.76
|
| Rate for Payer: Cigna Commercial |
$4,538.05
|
| Rate for Payer: First Health Commercial |
$5,194.15
|
| Rate for Payer: Humana Commercial |
$4,647.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,483.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,035.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,811.43
|
| Rate for Payer: Ohio Health Group HMO |
$4,100.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,093.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$710.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,694.93
|
| Rate for Payer: PHCS Commercial |
$5,248.83
|
| Rate for Payer: United Healthcare All Payer |
$4,811.43
|
|
|
PLATE VOLAR DIS RD 6H 2.4*45 L
|
Facility
|
OP
|
$5,467.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.78 |
| Max. Negotiated Rate |
$5,248.83 |
| Rate for Payer: Aetna Commercial |
$4,210.00
|
| Rate for Payer: Anthem Medicaid |
$1,880.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,264.67
|
| Rate for Payer: Cash Price |
$2,733.76
|
| Rate for Payer: Cigna Commercial |
$4,538.05
|
| Rate for Payer: First Health Commercial |
$5,194.15
|
| Rate for Payer: Humana Commercial |
$4,647.40
|
| Rate for Payer: Humana KY Medicaid |
$1,880.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,899.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,483.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,035.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,918.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,811.43
|
| Rate for Payer: Ohio Health Group HMO |
$4,100.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,093.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$710.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,694.93
|
| Rate for Payer: PHCS Commercial |
$5,248.83
|
| Rate for Payer: United Healthcare All Payer |
$4,811.43
|
|
|
PLATE VOLAR DIS RD 6H 2.4*45 R
|
Facility
|
OP
|
$5,614.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$729.89 |
| Max. Negotiated Rate |
$5,389.98 |
| Rate for Payer: Aetna Commercial |
$4,323.21
|
| Rate for Payer: Anthem Medicaid |
$1,930.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.36
|
| Rate for Payer: Cash Price |
$2,807.28
|
| Rate for Payer: Cigna Commercial |
$4,660.08
|
| Rate for Payer: First Health Commercial |
$5,333.83
|
| Rate for Payer: Humana Commercial |
$4,772.38
|
| Rate for Payer: Humana KY Medicaid |
$1,930.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,950.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,122.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$729.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,740.51
|
| Rate for Payer: PHCS Commercial |
$5,389.98
|
| Rate for Payer: United Healthcare All Payer |
$4,940.81
|
|
|
PLATE VOLAR DIS RD 6H 2.4*45 R
|
Facility
|
IP
|
$5,614.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$729.89 |
| Max. Negotiated Rate |
$5,389.98 |
| Rate for Payer: Aetna Commercial |
$4,323.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.36
|
| Rate for Payer: Cash Price |
$2,807.28
|
| Rate for Payer: Cigna Commercial |
$4,660.08
|
| Rate for Payer: First Health Commercial |
$5,333.83
|
| Rate for Payer: Humana Commercial |
$4,772.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,122.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$729.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,740.51
|
| Rate for Payer: PHCS Commercial |
$5,389.98
|
| Rate for Payer: United Healthcare All Payer |
$4,940.81
|
|
|
PLATE VOLAR DIS RD 6H 2.4*54 R
|
Facility
|
IP
|
$6,842.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.53 |
| Max. Negotiated Rate |
$6,568.86 |
| Rate for Payer: Aetna Commercial |
$5,268.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,337.20
|
| Rate for Payer: Cash Price |
$3,421.28
|
| Rate for Payer: Cigna Commercial |
$5,679.32
|
| Rate for Payer: First Health Commercial |
$6,500.43
|
| Rate for Payer: Humana Commercial |
$5,816.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,610.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,049.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,052.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,021.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,131.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,368.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$889.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,121.19
|
| Rate for Payer: PHCS Commercial |
$6,568.86
|
| Rate for Payer: United Healthcare All Payer |
$6,021.45
|
|
|
PLATE VOLAR DIS RD 6H 2.4*54 R
|
Facility
|
OP
|
$6,842.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.53 |
| Max. Negotiated Rate |
$6,568.86 |
| Rate for Payer: Aetna Commercial |
$5,268.77
|
| Rate for Payer: Anthem Medicaid |
$2,353.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,337.20
|
| Rate for Payer: Cash Price |
$3,421.28
|
| Rate for Payer: Cigna Commercial |
$5,679.32
|
| Rate for Payer: First Health Commercial |
$6,500.43
|
| Rate for Payer: Humana Commercial |
$5,816.18
|
| Rate for Payer: Humana KY Medicaid |
$2,353.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,377.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,610.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,049.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,052.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,400.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,021.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,131.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,368.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$889.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,121.19
|
| Rate for Payer: PHCS Commercial |
$6,568.86
|
| Rate for Payer: United Healthcare All Payer |
$6,021.45
|
|
|
PLATE VOLAR DIS RD 6H 2.4*66 R
|
Facility
|
IP
|
$6,643.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$863.59 |
| Max. Negotiated Rate |
$6,377.29 |
| Rate for Payer: Aetna Commercial |
$5,115.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,181.55
|
| Rate for Payer: Cash Price |
$3,321.51
|
| Rate for Payer: Cigna Commercial |
$5,513.70
|
| Rate for Payer: First Health Commercial |
$6,310.86
|
| Rate for Payer: Humana Commercial |
$5,646.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,447.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,902.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,992.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,845.85
|
| Rate for Payer: Ohio Health Group HMO |
$4,982.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,328.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$863.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,059.33
|
| Rate for Payer: PHCS Commercial |
$6,377.29
|
| Rate for Payer: United Healthcare All Payer |
$5,845.85
|
|
|
PLATE VOLAR DIS RD 6H 2.4*66 R
|
Facility
|
OP
|
$6,643.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$863.59 |
| Max. Negotiated Rate |
$6,377.29 |
| Rate for Payer: Aetna Commercial |
$5,115.12
|
| Rate for Payer: Anthem Medicaid |
$2,284.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,181.55
|
| Rate for Payer: Cash Price |
$3,321.51
|
| Rate for Payer: Cigna Commercial |
$5,513.70
|
| Rate for Payer: First Health Commercial |
$6,310.86
|
| Rate for Payer: Humana Commercial |
$5,646.56
|
| Rate for Payer: Humana KY Medicaid |
$2,284.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,307.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,447.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,902.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,992.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,330.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,845.85
|
| Rate for Payer: Ohio Health Group HMO |
$4,982.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,328.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$863.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,059.33
|
| Rate for Payer: PHCS Commercial |
$6,377.29
|
| Rate for Payer: United Healthcare All Payer |
$5,845.85
|
|
