|
PLATE VOLAR DIST RAD 5H 2.4*48
|
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 DIST RAD 5H 2.4*48
|
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 DIST RAD 5H 2.4*66
|
Facility
|
OP
|
$7,150.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.58 |
| Max. Negotiated Rate |
$6,864.62 |
| Rate for Payer: Aetna Commercial |
$5,506.00
|
| Rate for Payer: Anthem Medicaid |
$2,459.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,577.51
|
| Rate for Payer: Cash Price |
$3,575.33
|
| Rate for Payer: Cigna Commercial |
$5,935.04
|
| Rate for Payer: First Health Commercial |
$6,793.12
|
| Rate for Payer: Humana Commercial |
$6,078.05
|
| Rate for Payer: Humana KY Medicaid |
$2,459.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,484.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,863.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,277.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,145.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,508.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,292.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,362.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,430.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$929.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,216.70
|
| Rate for Payer: PHCS Commercial |
$6,864.62
|
| Rate for Payer: United Healthcare All Payer |
$6,292.57
|
|
|
PLATE VOLAR DIST RAD 5H 2.4*66
|
Facility
|
IP
|
$7,150.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.58 |
| Max. Negotiated Rate |
$6,864.62 |
| Rate for Payer: Aetna Commercial |
$5,506.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,577.51
|
| Rate for Payer: Cash Price |
$3,575.33
|
| Rate for Payer: Cigna Commercial |
$5,935.04
|
| Rate for Payer: First Health Commercial |
$6,793.12
|
| Rate for Payer: Humana Commercial |
$6,078.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,863.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,277.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,145.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,292.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,362.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,430.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$929.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,216.70
|
| Rate for Payer: PHCS Commercial |
$6,864.62
|
| Rate for Payer: United Healthcare All Payer |
$6,292.57
|
|
|
PLATE VOLAR DR INTER SHORT 11H
|
Facility
|
OP
|
$9,136.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,187.73 |
| Max. Negotiated Rate |
$8,770.94 |
| Rate for Payer: Aetna Commercial |
$7,035.03
|
| Rate for Payer: Anthem Medicaid |
$3,142.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,126.39
|
| Rate for Payer: Cash Price |
$4,568.20
|
| Rate for Payer: Cigna Commercial |
$7,583.21
|
| Rate for Payer: First Health Commercial |
$8,679.58
|
| Rate for Payer: Humana Commercial |
$7,765.94
|
| Rate for Payer: Humana KY Medicaid |
$3,142.01
|
| Rate for Payer: Kentucky WC Medicaid |
$3,173.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,491.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,742.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,205.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,040.03
|
| Rate for Payer: Ohio Health Group HMO |
$6,852.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,827.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,187.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,832.28
|
| Rate for Payer: PHCS Commercial |
$8,770.94
|
| Rate for Payer: United Healthcare All Payer |
$8,040.03
|
|
|
PLATE VOLAR DR INTER SHORT 11H
|
Facility
|
IP
|
$9,136.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,187.73 |
| Max. Negotiated Rate |
$8,770.94 |
| Rate for Payer: Aetna Commercial |
$7,035.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,126.39
|
| Rate for Payer: Cash Price |
$4,568.20
|
| Rate for Payer: Cigna Commercial |
$7,583.21
|
| Rate for Payer: First Health Commercial |
$8,679.58
|
| Rate for Payer: Humana Commercial |
$7,765.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,491.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,742.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,040.03
|
| Rate for Payer: Ohio Health Group HMO |
$6,852.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,827.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,187.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,832.28
|
| Rate for Payer: PHCS Commercial |
$8,770.94
|
| Rate for Payer: United Healthcare All Payer |
$8,040.03
|
|
|
PLATE VOLAR DR INTER SHRT L 10
|
Facility
|
OP
|
$4,793.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.19 |
| Max. Negotiated Rate |
$4,602.03 |
| Rate for Payer: Anthem Medicaid |
$1,648.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,739.15
|
| Rate for Payer: Cash Price |
$2,396.89
|
| Rate for Payer: Cigna Commercial |
$3,978.84
|
| Rate for Payer: First Health Commercial |
$4,554.09
|
| Rate for Payer: Humana Commercial |
$4,074.71
|
| Rate for Payer: Humana KY Medicaid |
$1,648.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,665.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,681.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.07
|
| Rate for Payer: PHCS Commercial |
$4,602.03
|
| Rate for Payer: United Healthcare All Payer |
$4,218.53
|
| Rate for Payer: Aetna Commercial |
$3,691.21
|
|
|
PLATE VOLAR DR INTER SHRT L 10
|
Facility
|
IP
|
$4,793.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.19 |
| Max. Negotiated Rate |
$4,602.03 |
| Rate for Payer: Aetna Commercial |
$3,691.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,739.15
|
| Rate for Payer: Cash Price |
$2,396.89
|
| Rate for Payer: Cigna Commercial |
$3,978.84
|
| Rate for Payer: First Health Commercial |
$4,554.09
|
| Rate for Payer: Humana Commercial |
$4,074.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.07
|
| Rate for Payer: PHCS Commercial |
$4,602.03
|
| Rate for Payer: United Healthcare All Payer |
$4,218.53
|
|
|
PLATE VOLAR DR INTER SHRT R 11
|
Facility
|
OP
|
$4,793.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.19 |
| Max. Negotiated Rate |
$4,602.03 |
| Rate for Payer: Aetna Commercial |
$3,691.21
|
| Rate for Payer: Anthem Medicaid |
$1,648.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,739.15
|
| Rate for Payer: Cash Price |
$2,396.89
|
| Rate for Payer: Cigna Commercial |
$3,978.84
|
| Rate for Payer: First Health Commercial |
$4,554.09
|
| Rate for Payer: Humana Commercial |
$4,074.71
|
| Rate for Payer: Humana KY Medicaid |
$1,648.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,665.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,681.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.07
|
| Rate for Payer: PHCS Commercial |
$4,602.03
|
| Rate for Payer: United Healthcare All Payer |
$4,218.53
|
|
|
PLATE VOLAR DR INTER SHRT R 11
|
Facility
|
IP
|
$4,793.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.19 |
| Max. Negotiated Rate |
$4,602.03 |
| Rate for Payer: Aetna Commercial |
$3,691.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,739.15
|
| Rate for Payer: Cash Price |
$2,396.89
|
| Rate for Payer: Cigna Commercial |
$3,978.84
|
| Rate for Payer: First Health Commercial |
$4,554.09
|
| Rate for Payer: Humana Commercial |
$4,074.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.07
|
| Rate for Payer: PHCS Commercial |
$4,602.03
|
| Rate for Payer: United Healthcare All Payer |
$4,218.53
|
|
|
PLATE VOLAR DR INTER XL R 10H
|
Facility
|
OP
|
$4,793.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.19 |
| Max. Negotiated Rate |
$4,602.03 |
| Rate for Payer: Aetna Commercial |
$3,691.21
|
| Rate for Payer: Anthem Medicaid |
$1,648.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,739.15
|
| Rate for Payer: Cash Price |
$2,396.89
|
| Rate for Payer: Cigna Commercial |
$3,978.84
|
| Rate for Payer: First Health Commercial |
$4,554.09
|
| Rate for Payer: Humana Commercial |
$4,074.71
|
| Rate for Payer: Humana KY Medicaid |
$1,648.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,665.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,681.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.07
|
| Rate for Payer: PHCS Commercial |
$4,602.03
|
| Rate for Payer: United Healthcare All Payer |
$4,218.53
|
|
|
PLATE VOLAR DR INTER XL R 10H
|
Facility
|
IP
|
$4,793.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.19 |
| Max. Negotiated Rate |
$4,602.03 |
| Rate for Payer: Aetna Commercial |
$3,691.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,739.15
|
| Rate for Payer: Cash Price |
$2,396.89
|
| Rate for Payer: Cigna Commercial |
$3,978.84
|
| Rate for Payer: First Health Commercial |
$4,554.09
|
| Rate for Payer: Humana Commercial |
$4,074.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.07
|
| Rate for Payer: PHCS Commercial |
$4,602.03
|
| Rate for Payer: United Healthcare All Payer |
$4,218.53
|
|
|
PLATE VOLAR DR NAR L 8H X-SHRT
|
Facility
|
OP
|
$4,793.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.19 |
| Max. Negotiated Rate |
$4,602.03 |
| Rate for Payer: Aetna Commercial |
$3,691.21
|
| Rate for Payer: Anthem Medicaid |
$1,648.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,739.15
|
| Rate for Payer: Cash Price |
$2,396.89
|
| Rate for Payer: Cigna Commercial |
$3,978.84
|
| Rate for Payer: First Health Commercial |
$4,554.09
|
| Rate for Payer: Humana Commercial |
$4,074.71
|
| Rate for Payer: Humana KY Medicaid |
$1,648.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,665.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,681.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.07
|
| Rate for Payer: PHCS Commercial |
$4,602.03
|
| Rate for Payer: United Healthcare All Payer |
$4,218.53
|
|
|
PLATE VOLAR DR NAR L 8H X-SHRT
|
Facility
|
IP
|
$4,793.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.19 |
| Max. Negotiated Rate |
$4,602.03 |
| Rate for Payer: Aetna Commercial |
$3,691.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,739.15
|
| Rate for Payer: Cash Price |
$2,396.89
|
| Rate for Payer: Cigna Commercial |
$3,978.84
|
| Rate for Payer: First Health Commercial |
$4,554.09
|
| Rate for Payer: Humana Commercial |
$4,074.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.07
|
| Rate for Payer: PHCS Commercial |
$4,602.03
|
| Rate for Payer: United Healthcare All Payer |
$4,218.53
|
|
|
PLATE VOLAR DR NAR R 8H X-SHRT
|
Facility
|
OP
|
$4,793.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.19 |
| Max. Negotiated Rate |
$4,602.03 |
| Rate for Payer: Aetna Commercial |
$3,691.21
|
| Rate for Payer: Anthem Medicaid |
$1,648.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,739.15
|
| Rate for Payer: Cash Price |
$2,396.89
|
| Rate for Payer: Cigna Commercial |
$3,978.84
|
| Rate for Payer: First Health Commercial |
$4,554.09
|
| Rate for Payer: Humana Commercial |
$4,074.71
|
| Rate for Payer: Humana KY Medicaid |
$1,648.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,665.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,681.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.07
|
| Rate for Payer: PHCS Commercial |
$4,602.03
|
| Rate for Payer: United Healthcare All Payer |
$4,218.53
|
|
|
PLATE VOLAR DR NAR R 8H X-SHRT
|
Facility
|
IP
|
$4,793.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.19 |
| Max. Negotiated Rate |
$4,602.03 |
| Rate for Payer: Aetna Commercial |
$3,691.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,739.15
|
| Rate for Payer: Cash Price |
$2,396.89
|
| Rate for Payer: Cigna Commercial |
$3,978.84
|
| Rate for Payer: First Health Commercial |
$4,554.09
|
| Rate for Payer: Humana Commercial |
$4,074.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.07
|
| Rate for Payer: PHCS Commercial |
$4,602.03
|
| Rate for Payer: United Healthcare All Payer |
$4,218.53
|
|
|
PLATE VOLAR DR STD 10H R EX SH
|
Facility
|
OP
|
$7,048.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.28 |
| Max. Negotiated Rate |
$6,766.41 |
| Rate for Payer: Aetna Commercial |
$5,427.22
|
| Rate for Payer: Anthem Medicaid |
$2,423.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,497.71
|
| Rate for Payer: Cash Price |
$3,524.17
|
| Rate for Payer: Cigna Commercial |
$5,850.12
|
| Rate for Payer: First Health Commercial |
$6,695.92
|
| Rate for Payer: Humana Commercial |
$5,991.09
|
| Rate for Payer: Humana KY Medicaid |
$2,423.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,448.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,779.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,201.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,114.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,472.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,202.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,286.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,409.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$916.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,184.99
|
| Rate for Payer: PHCS Commercial |
$6,766.41
|
| Rate for Payer: United Healthcare All Payer |
$6,202.54
|
|
|
PLATE VOLAR DR STD 10H R EX SH
|
Facility
|
IP
|
$7,048.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.28 |
| Max. Negotiated Rate |
$6,766.41 |
| Rate for Payer: Aetna Commercial |
$5,427.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,497.71
|
| Rate for Payer: Cash Price |
$3,524.17
|
| Rate for Payer: Cigna Commercial |
$5,850.12
|
| Rate for Payer: First Health Commercial |
$6,695.92
|
| Rate for Payer: Humana Commercial |
$5,991.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,779.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,201.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,114.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,202.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,286.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,409.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$916.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,184.99
|
| Rate for Payer: PHCS Commercial |
$6,766.41
|
| Rate for Payer: United Healthcare All Payer |
$6,202.54
|
|
|
PLATE VOLAR DR STRD 10H L EX S
|
Facility
|
IP
|
$4,793.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.19 |
| Max. Negotiated Rate |
$4,602.03 |
| Rate for Payer: Aetna Commercial |
$3,691.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,739.15
|
| Rate for Payer: Cash Price |
$2,396.89
|
| Rate for Payer: Cigna Commercial |
$3,978.84
|
| Rate for Payer: First Health Commercial |
$4,554.09
|
| Rate for Payer: Humana Commercial |
$4,074.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.07
|
| Rate for Payer: PHCS Commercial |
$4,602.03
|
| Rate for Payer: United Healthcare All Payer |
$4,218.53
|
|
|
PLATE VOLAR DR STRD 10H L EX S
|
Facility
|
OP
|
$4,793.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.19 |
| Max. Negotiated Rate |
$4,602.03 |
| Rate for Payer: Aetna Commercial |
$3,691.21
|
| Rate for Payer: Anthem Medicaid |
$1,648.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,739.15
|
| Rate for Payer: Cash Price |
$2,396.89
|
| Rate for Payer: Cigna Commercial |
$3,978.84
|
| Rate for Payer: First Health Commercial |
$4,554.09
|
| Rate for Payer: Humana Commercial |
$4,074.71
|
| Rate for Payer: Humana KY Medicaid |
$1,648.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,665.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,681.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.07
|
| Rate for Payer: PHCS Commercial |
$4,602.03
|
| Rate for Payer: United Healthcare All Payer |
$4,218.53
|
|
|
PLATE VOLAR HOOK DIS RAD 4H
|
Facility
|
OP
|
$4,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.22 |
| Max. Negotiated Rate |
$4,447.20 |
| Rate for Payer: Aetna Commercial |
$3,567.02
|
| Rate for Payer: Anthem Medicaid |
$1,593.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,613.35
|
| Rate for Payer: Cash Price |
$2,316.25
|
| Rate for Payer: Cigna Commercial |
$3,844.98
|
| Rate for Payer: First Health Commercial |
$4,400.88
|
| Rate for Payer: Humana Commercial |
$3,937.62
|
| Rate for Payer: Humana KY Medicaid |
$1,593.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,609.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,798.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,418.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,625.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,076.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,474.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.08
|
| Rate for Payer: PHCS Commercial |
$4,447.20
|
| Rate for Payer: United Healthcare All Payer |
$4,076.60
|
|
|
PLATE VOLAR HOOK DIS RAD 4H
|
Facility
|
IP
|
$4,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.22 |
| Max. Negotiated Rate |
$4,447.20 |
| Rate for Payer: Humana Commercial |
$3,937.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,798.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,418.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,076.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,474.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.08
|
| Rate for Payer: PHCS Commercial |
$4,447.20
|
| Rate for Payer: United Healthcare All Payer |
$4,076.60
|
| Rate for Payer: Aetna Commercial |
$3,567.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,613.35
|
| Rate for Payer: Cash Price |
$2,316.25
|
| Rate for Payer: Cigna Commercial |
$3,844.98
|
| Rate for Payer: First Health Commercial |
$4,400.88
|
|
|
PLATE VOLAR HOOK DIS RAD 6H
|
Facility
|
OP
|
$4,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.22 |
| Max. Negotiated Rate |
$4,447.20 |
| Rate for Payer: Aetna Commercial |
$3,567.02
|
| Rate for Payer: Anthem Medicaid |
$1,593.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,613.35
|
| Rate for Payer: Cash Price |
$2,316.25
|
| Rate for Payer: Cigna Commercial |
$3,844.98
|
| Rate for Payer: First Health Commercial |
$4,400.88
|
| Rate for Payer: Humana Commercial |
$3,937.62
|
| Rate for Payer: Humana KY Medicaid |
$1,593.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,609.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,798.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,418.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,625.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,076.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,474.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.08
|
| Rate for Payer: PHCS Commercial |
$4,447.20
|
| Rate for Payer: United Healthcare All Payer |
$4,076.60
|
|
|
PLATE VOLAR HOOK DIS RAD 6H
|
Facility
|
IP
|
$4,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.22 |
| Max. Negotiated Rate |
$4,447.20 |
| Rate for Payer: Aetna Commercial |
$3,567.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,613.35
|
| Rate for Payer: Cash Price |
$2,316.25
|
| Rate for Payer: Cigna Commercial |
$3,844.98
|
| Rate for Payer: First Health Commercial |
$4,400.88
|
| Rate for Payer: Humana Commercial |
$3,937.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,798.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,418.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,076.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,474.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.08
|
| Rate for Payer: PHCS Commercial |
$4,447.20
|
| Rate for Payer: United Healthcare All Payer |
$4,076.60
|
|
|
PLATE VOLAR LUNATE SUTURE
|
Facility
|
OP
|
$4,258.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.54 |
| Max. Negotiated Rate |
$4,087.68 |
| Rate for Payer: Aetna Commercial |
$3,278.66
|
| Rate for Payer: Anthem Medicaid |
$1,464.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,321.24
|
| Rate for Payer: Cash Price |
$2,129.00
|
| Rate for Payer: Cigna Commercial |
$3,534.14
|
| Rate for Payer: First Health Commercial |
$4,045.10
|
| Rate for Payer: Humana Commercial |
$3,619.30
|
| Rate for Payer: Humana KY Medicaid |
$1,464.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,479.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,491.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,142.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,493.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,319.98
|
| Rate for Payer: PHCS Commercial |
$4,087.68
|
| Rate for Payer: United Healthcare All Payer |
$3,747.04
|
|
