|
PLATE VOLAR 4H L STD 56MM
|
Facility
|
IP
|
$6,661.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,998.50 |
| Max. Negotiated Rate |
$6,395.21 |
| Rate for Payer: Aetna Commercial |
$5,129.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,196.11
|
| Rate for Payer: Cash Price |
$3,330.84
|
| Rate for Payer: Cigna Commercial |
$5,529.19
|
| Rate for Payer: First Health Commercial |
$6,328.60
|
| Rate for Payer: Humana Commercial |
$5,662.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,462.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,916.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,998.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,862.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,996.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,329.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,795.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,596.56
|
| Rate for Payer: PHCS Commercial |
$6,395.21
|
| Rate for Payer: United Healthcare All Payer |
$5,862.28
|
|
|
PLATE VOLAR 4H L STD 56MM
|
Facility
|
OP
|
$6,661.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,998.50 |
| Max. Negotiated Rate |
$6,395.21 |
| Rate for Payer: Aetna Commercial |
$5,129.49
|
| Rate for Payer: Anthem Medicaid |
$2,290.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,196.11
|
| Rate for Payer: Cash Price |
$3,330.84
|
| Rate for Payer: Cigna Commercial |
$5,529.19
|
| Rate for Payer: First Health Commercial |
$6,328.60
|
| Rate for Payer: Humana Commercial |
$5,662.43
|
| Rate for Payer: Humana KY Medicaid |
$2,290.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,314.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,462.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,916.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,998.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,336.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,862.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,996.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,329.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,795.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,596.56
|
| Rate for Payer: PHCS Commercial |
$6,395.21
|
| Rate for Payer: United Healthcare All Payer |
$5,862.28
|
|
|
PLATE VOLAR DIS RAD TI NAR 3H
|
Facility
|
IP
|
$5,130.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,539.09 |
| Max. Negotiated Rate |
$4,925.10 |
| Rate for Payer: Aetna Commercial |
$3,950.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,001.64
|
| Rate for Payer: Cash Price |
$2,565.16
|
| Rate for Payer: Cigna Commercial |
$4,258.16
|
| Rate for Payer: First Health Commercial |
$4,873.79
|
| Rate for Payer: Humana Commercial |
$4,360.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,206.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,786.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,539.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,514.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,847.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,104.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,463.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,539.91
|
| Rate for Payer: PHCS Commercial |
$4,925.10
|
| Rate for Payer: United Healthcare All Payer |
$4,514.67
|
|
|
PLATE VOLAR DIS RAD TI NAR 3H
|
Facility
|
OP
|
$5,130.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,539.09 |
| Max. Negotiated Rate |
$4,925.10 |
| Rate for Payer: Aetna Commercial |
$3,950.34
|
| Rate for Payer: Anthem Medicaid |
$1,764.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,001.64
|
| Rate for Payer: Cash Price |
$2,565.16
|
| Rate for Payer: Cigna Commercial |
$4,258.16
|
| Rate for Payer: First Health Commercial |
$4,873.79
|
| Rate for Payer: Humana Commercial |
$4,360.76
|
| Rate for Payer: Humana KY Medicaid |
$1,764.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,782.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,206.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,786.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,539.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,799.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,514.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,847.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,104.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,463.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,539.91
|
| Rate for Payer: PHCS Commercial |
$4,925.10
|
| Rate for Payer: United Healthcare All Payer |
$4,514.67
|
|
|
PLATE VOLAR DIS RAD TI STD 3H
|
Facility
|
IP
|
$5,130.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,539.09 |
| Max. Negotiated Rate |
$4,925.10 |
| Rate for Payer: Aetna Commercial |
$3,950.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,001.64
|
| Rate for Payer: Cash Price |
$2,565.16
|
| Rate for Payer: Cigna Commercial |
$4,258.16
|
| Rate for Payer: First Health Commercial |
$4,873.79
|
| Rate for Payer: Humana Commercial |
$4,360.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,206.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,786.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,539.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,514.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,847.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,104.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,463.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,539.91
|
| Rate for Payer: PHCS Commercial |
$4,925.10
|
| Rate for Payer: United Healthcare All Payer |
$4,514.67
|
|
|
PLATE VOLAR DIS RAD TI STD 3H
|
Facility
|
OP
|
$5,130.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,539.09 |
| Max. Negotiated Rate |
$4,925.10 |
| Rate for Payer: Aetna Commercial |
$3,950.34
|
| Rate for Payer: Anthem Medicaid |
$1,764.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,001.64
|
| Rate for Payer: Cash Price |
$2,565.16
|
| Rate for Payer: Cigna Commercial |
$4,258.16
|
| Rate for Payer: First Health Commercial |
$4,873.79
|
| Rate for Payer: Humana Commercial |
$4,360.76
|
| Rate for Payer: Humana KY Medicaid |
$1,764.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,782.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,206.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,786.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,539.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,799.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,514.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,847.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,104.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,463.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,539.91
|
| Rate for Payer: PHCS Commercial |
$4,925.10
|
| Rate for Payer: United Healthcare All Payer |
$4,514.67
|
|
|
PLATE VOLAR DIS RD 6H 2.4*45 L
|
Facility
|
IP
|
$5,500.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.28 |
| Max. Negotiated Rate |
$5,280.88 |
| Rate for Payer: Aetna Commercial |
$4,235.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,290.72
|
| Rate for Payer: Cash Price |
$2,750.46
|
| Rate for Payer: Cigna Commercial |
$4,565.76
|
| Rate for Payer: First Health Commercial |
$5,225.87
|
| Rate for Payer: Humana Commercial |
$4,675.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,510.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,059.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,840.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,125.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,400.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,785.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.63
|
| Rate for Payer: PHCS Commercial |
$5,280.88
|
| Rate for Payer: United Healthcare All Payer |
$4,840.81
|
|
|
PLATE VOLAR DIS RD 6H 2.4*45 L
|
Facility
|
OP
|
$5,500.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.28 |
| Max. Negotiated Rate |
$5,280.88 |
| Rate for Payer: Aetna Commercial |
$4,235.71
|
| Rate for Payer: Anthem Medicaid |
$1,891.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,290.72
|
| Rate for Payer: Cash Price |
$2,750.46
|
| Rate for Payer: Cigna Commercial |
$4,565.76
|
| Rate for Payer: First Health Commercial |
$5,225.87
|
| Rate for Payer: Humana Commercial |
$4,675.78
|
| Rate for Payer: Humana KY Medicaid |
$1,891.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,911.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,510.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,059.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,929.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,840.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,125.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,400.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,785.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.63
|
| Rate for Payer: PHCS Commercial |
$5,280.88
|
| Rate for Payer: United Healthcare All Payer |
$4,840.81
|
|
|
PLATE VOLAR DIS RD 6H 2.4*45 R
|
Facility
|
IP
|
$5,658.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,697.54 |
| Max. Negotiated Rate |
$5,432.12 |
| Rate for Payer: Aetna Commercial |
$4,357.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,413.60
|
| Rate for Payer: Cash Price |
$2,829.23
|
| Rate for Payer: Cigna Commercial |
$4,696.52
|
| Rate for Payer: First Health Commercial |
$5,375.54
|
| Rate for Payer: Humana Commercial |
$4,809.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,639.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,175.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,697.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,979.44
|
| Rate for Payer: Ohio Health Group HMO |
$4,243.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,526.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,922.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,904.34
|
| Rate for Payer: PHCS Commercial |
$5,432.12
|
| Rate for Payer: United Healthcare All Payer |
$4,979.44
|
|
|
PLATE VOLAR DIS RD 6H 2.4*45 R
|
Facility
|
OP
|
$5,658.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,697.54 |
| Max. Negotiated Rate |
$5,432.12 |
| Rate for Payer: Aetna Commercial |
$4,357.01
|
| Rate for Payer: Anthem Medicaid |
$1,945.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,413.60
|
| Rate for Payer: Cash Price |
$2,829.23
|
| Rate for Payer: Cigna Commercial |
$4,696.52
|
| Rate for Payer: First Health Commercial |
$5,375.54
|
| Rate for Payer: Humana Commercial |
$4,809.69
|
| Rate for Payer: Humana KY Medicaid |
$1,945.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,965.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,639.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,175.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,697.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,984.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,979.44
|
| Rate for Payer: Ohio Health Group HMO |
$4,243.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,526.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,922.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,904.34
|
| Rate for Payer: PHCS Commercial |
$5,432.12
|
| Rate for Payer: United Healthcare All Payer |
$4,979.44
|
|
|
PLATE VOLAR DIS RD 6H 2.4*54 R
|
Facility
|
IP
|
$7,042.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,112.77 |
| Max. Negotiated Rate |
$6,760.86 |
| Rate for Payer: Aetna Commercial |
$5,422.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.20
|
| Rate for Payer: Cash Price |
$3,521.28
|
| Rate for Payer: Cigna Commercial |
$5,845.32
|
| Rate for Payer: First Health Commercial |
$6,690.43
|
| Rate for Payer: Humana Commercial |
$5,986.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,281.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,634.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,127.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,859.37
|
| Rate for Payer: PHCS Commercial |
$6,760.86
|
| Rate for Payer: United Healthcare All Payer |
$6,197.45
|
|
|
PLATE VOLAR DIS RD 6H 2.4*54 R
|
Facility
|
OP
|
$7,042.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,112.77 |
| Max. Negotiated Rate |
$6,760.86 |
| Rate for Payer: Aetna Commercial |
$5,422.77
|
| Rate for Payer: Anthem Medicaid |
$2,421.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.20
|
| Rate for Payer: Cash Price |
$3,521.28
|
| Rate for Payer: Cigna Commercial |
$5,845.32
|
| Rate for Payer: First Health Commercial |
$6,690.43
|
| Rate for Payer: Humana Commercial |
$5,986.18
|
| Rate for Payer: Humana KY Medicaid |
$2,421.94
|
| Rate for Payer: Kentucky WC Medicaid |
$2,446.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,470.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,281.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,634.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,127.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,859.37
|
| Rate for Payer: PHCS Commercial |
$6,760.86
|
| Rate for Payer: United Healthcare All Payer |
$6,197.45
|
|
|
PLATE VOLAR DIS RD 6H 2.4*66 R
|
Facility
|
OP
|
$6,843.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,052.90 |
| Max. Negotiated Rate |
$6,569.29 |
| Rate for Payer: Aetna Commercial |
$5,269.12
|
| Rate for Payer: Anthem Medicaid |
$2,353.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,337.55
|
| Rate for Payer: Cash Price |
$3,421.51
|
| Rate for Payer: Cigna Commercial |
$5,679.70
|
| Rate for Payer: First Health Commercial |
$6,500.86
|
| Rate for Payer: Humana Commercial |
$5,816.56
|
| Rate for Payer: Humana KY Medicaid |
$2,353.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,377.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,611.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,050.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,052.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,400.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,021.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,132.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,474.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,953.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,721.68
|
| Rate for Payer: PHCS Commercial |
$6,569.29
|
| Rate for Payer: United Healthcare All Payer |
$6,021.85
|
|
|
PLATE VOLAR DIS RD 6H 2.4*66 R
|
Facility
|
IP
|
$6,843.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,052.90 |
| Max. Negotiated Rate |
$6,569.29 |
| Rate for Payer: Aetna Commercial |
$5,269.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,337.55
|
| Rate for Payer: Cash Price |
$3,421.51
|
| Rate for Payer: Cigna Commercial |
$5,679.70
|
| Rate for Payer: First Health Commercial |
$6,500.86
|
| Rate for Payer: Humana Commercial |
$5,816.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,611.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,050.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,052.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,021.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,132.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,474.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,953.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,721.68
|
| Rate for Payer: PHCS Commercial |
$6,569.29
|
| Rate for Payer: United Healthcare All Payer |
$6,021.85
|
|
|
PLATE VOLAR DIST RAD 5H 2.4*48
|
Facility
|
OP
|
$7,042.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,112.77 |
| Max. Negotiated Rate |
$6,760.86 |
| Rate for Payer: Aetna Commercial |
$5,422.77
|
| Rate for Payer: Anthem Medicaid |
$2,421.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.20
|
| Rate for Payer: Cash Price |
$3,521.28
|
| Rate for Payer: Cigna Commercial |
$5,845.32
|
| Rate for Payer: First Health Commercial |
$6,690.43
|
| Rate for Payer: Humana Commercial |
$5,986.18
|
| Rate for Payer: Humana KY Medicaid |
$2,421.94
|
| Rate for Payer: Kentucky WC Medicaid |
$2,446.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,470.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,281.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,634.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,127.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,859.37
|
| Rate for Payer: PHCS Commercial |
$6,760.86
|
| Rate for Payer: United Healthcare All Payer |
$6,197.45
|
|
|
PLATE VOLAR DIST RAD 5H 2.4*48
|
Facility
|
IP
|
$7,042.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,112.77 |
| Max. Negotiated Rate |
$6,760.86 |
| Rate for Payer: Aetna Commercial |
$5,422.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.20
|
| Rate for Payer: Cash Price |
$3,521.28
|
| Rate for Payer: Cigna Commercial |
$5,845.32
|
| Rate for Payer: First Health Commercial |
$6,690.43
|
| Rate for Payer: Humana Commercial |
$5,986.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,281.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,634.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,127.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,859.37
|
| Rate for Payer: PHCS Commercial |
$6,760.86
|
| Rate for Payer: United Healthcare All Payer |
$6,197.45
|
|
|
PLATE VOLAR DIST RAD 5H 2.4*66
|
Facility
|
IP
|
$7,350.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,205.20 |
| Max. Negotiated Rate |
$7,056.62 |
| Rate for Payer: Aetna Commercial |
$5,660.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,733.51
|
| Rate for Payer: Cash Price |
$3,675.33
|
| Rate for Payer: Cigna Commercial |
$6,101.04
|
| Rate for Payer: First Health Commercial |
$6,983.12
|
| Rate for Payer: Humana Commercial |
$6,248.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,027.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,424.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,205.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,468.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,512.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,880.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,395.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,071.95
|
| Rate for Payer: PHCS Commercial |
$7,056.62
|
| Rate for Payer: United Healthcare All Payer |
$6,468.57
|
|
|
PLATE VOLAR DIST RAD 5H 2.4*66
|
Facility
|
OP
|
$7,350.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,205.20 |
| Max. Negotiated Rate |
$7,056.62 |
| Rate for Payer: Aetna Commercial |
$5,660.00
|
| Rate for Payer: Anthem Medicaid |
$2,527.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,733.51
|
| Rate for Payer: Cash Price |
$3,675.33
|
| Rate for Payer: Cigna Commercial |
$6,101.04
|
| Rate for Payer: First Health Commercial |
$6,983.12
|
| Rate for Payer: Humana Commercial |
$6,248.05
|
| Rate for Payer: Humana KY Medicaid |
$2,527.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,553.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,027.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,424.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,205.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,578.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,468.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,512.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,880.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,395.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,071.95
|
| Rate for Payer: PHCS Commercial |
$7,056.62
|
| Rate for Payer: United Healthcare All Payer |
$6,468.57
|
|
|
PLATE VOLAR DR INTER SHORT 11H
|
Facility
|
IP
|
$5,071.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,521.38 |
| Max. Negotiated Rate |
$4,868.40 |
| Rate for Payer: Aetna Commercial |
$3,904.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,955.57
|
| Rate for Payer: Cash Price |
$2,535.62
|
| Rate for Payer: Cigna Commercial |
$4,209.14
|
| Rate for Payer: First Health Commercial |
$4,817.69
|
| Rate for Payer: Humana Commercial |
$4,310.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,158.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,742.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,521.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,462.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,803.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,057.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,411.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,499.16
|
| Rate for Payer: PHCS Commercial |
$4,868.40
|
| Rate for Payer: United Healthcare All Payer |
$4,462.70
|
|
|
PLATE VOLAR DR INTER SHORT 11H
|
Facility
|
OP
|
$5,071.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,521.38 |
| Max. Negotiated Rate |
$4,868.40 |
| Rate for Payer: Aetna Commercial |
$3,904.86
|
| Rate for Payer: Anthem Medicaid |
$1,744.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,955.57
|
| Rate for Payer: Cash Price |
$2,535.62
|
| Rate for Payer: Cigna Commercial |
$4,209.14
|
| Rate for Payer: First Health Commercial |
$4,817.69
|
| Rate for Payer: Humana Commercial |
$4,310.56
|
| Rate for Payer: Humana KY Medicaid |
$1,744.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,761.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,158.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,742.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,521.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,778.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,462.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,803.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,057.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,411.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,499.16
|
| Rate for Payer: PHCS Commercial |
$4,868.40
|
| Rate for Payer: United Healthcare All Payer |
$4,462.70
|
|
|
PLATE VOLAR DR INTER SHRT L 10
|
Facility
|
OP
|
$5,071.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,521.38 |
| Max. Negotiated Rate |
$4,868.40 |
| Rate for Payer: Aetna Commercial |
$3,904.86
|
| Rate for Payer: Anthem Medicaid |
$1,744.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,955.57
|
| Rate for Payer: Cash Price |
$2,535.62
|
| Rate for Payer: Cigna Commercial |
$4,209.14
|
| Rate for Payer: First Health Commercial |
$4,817.69
|
| Rate for Payer: Humana Commercial |
$4,310.56
|
| Rate for Payer: Humana KY Medicaid |
$1,744.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,761.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,158.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,742.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,521.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,778.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,462.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,803.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,057.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,411.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,499.16
|
| Rate for Payer: PHCS Commercial |
$4,868.40
|
| Rate for Payer: United Healthcare All Payer |
$4,462.70
|
|
|
PLATE VOLAR DR INTER SHRT L 10
|
Facility
|
IP
|
$5,071.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,521.38 |
| Max. Negotiated Rate |
$4,868.40 |
| Rate for Payer: Aetna Commercial |
$3,904.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,955.57
|
| Rate for Payer: Cash Price |
$2,535.62
|
| Rate for Payer: Cigna Commercial |
$4,209.14
|
| Rate for Payer: First Health Commercial |
$4,817.69
|
| Rate for Payer: Humana Commercial |
$4,310.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,158.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,742.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,521.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,462.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,803.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,057.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,411.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,499.16
|
| Rate for Payer: PHCS Commercial |
$4,868.40
|
| Rate for Payer: United Healthcare All Payer |
$4,462.70
|
|
|
PLATE VOLAR DR INTER SHRT R 11
|
Facility
|
IP
|
$4,779.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,433.71 |
| Max. Negotiated Rate |
$4,587.89 |
| Rate for Payer: Aetna Commercial |
$3,679.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,727.66
|
| Rate for Payer: Cash Price |
$2,389.52
|
| Rate for Payer: Cigna Commercial |
$3,966.61
|
| Rate for Payer: First Health Commercial |
$4,540.10
|
| Rate for Payer: Humana Commercial |
$4,062.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,918.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,526.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,205.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,823.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,157.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,297.54
|
| Rate for Payer: PHCS Commercial |
$4,587.89
|
| Rate for Payer: United Healthcare All Payer |
$4,205.56
|
|
|
PLATE VOLAR DR INTER SHRT R 11
|
Facility
|
OP
|
$4,779.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,433.71 |
| Max. Negotiated Rate |
$4,587.89 |
| Rate for Payer: Aetna Commercial |
$3,679.87
|
| Rate for Payer: Anthem Medicaid |
$1,643.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,727.66
|
| Rate for Payer: Cash Price |
$2,389.52
|
| Rate for Payer: Cigna Commercial |
$3,966.61
|
| Rate for Payer: First Health Commercial |
$4,540.10
|
| Rate for Payer: Humana Commercial |
$4,062.19
|
| Rate for Payer: Humana KY Medicaid |
$1,643.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,660.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,918.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,526.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,676.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,205.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,823.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,157.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,297.54
|
| Rate for Payer: PHCS Commercial |
$4,587.89
|
| Rate for Payer: United Healthcare All Payer |
$4,205.56
|
|
|
PLATE VOLAR DR INTER XL R 10H
|
Facility
|
IP
|
$5,071.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,521.38 |
| Max. Negotiated Rate |
$4,868.40 |
| Rate for Payer: Aetna Commercial |
$3,904.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,955.57
|
| Rate for Payer: Cash Price |
$2,535.62
|
| Rate for Payer: Cigna Commercial |
$4,209.14
|
| Rate for Payer: First Health Commercial |
$4,817.69
|
| Rate for Payer: Humana Commercial |
$4,310.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,158.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,742.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,521.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,462.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,803.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,057.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,411.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,499.16
|
| Rate for Payer: PHCS Commercial |
$4,868.40
|
| Rate for Payer: United Healthcare All Payer |
$4,462.70
|
|
