|
PLATE VOL DIST RAD 4H 2.4*66 L
|
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 VOL DIST RAD 4H 2.4*66 L
|
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 VOL DIST RD 4H 2.4*48 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 VOL DIST RD 4H 2.4*48 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 VOL DIST RD 4H 2.4*66 R
|
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 VOL DIST RD 4H 2.4*66 R
|
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 VOL DIST RD 5H 2.4*48 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 VOL DIST RD 5H 2.4*48 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 VOL DIST RD NAR 2.4*42 L
|
Facility
|
OP
|
$6,888.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,066.58 |
| Max. Negotiated Rate |
$6,613.06 |
| Rate for Payer: Aetna Commercial |
$5,304.22
|
| Rate for Payer: Anthem Medicaid |
$2,368.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,373.11
|
| Rate for Payer: Cash Price |
$3,444.30
|
| Rate for Payer: Cigna Commercial |
$5,717.54
|
| Rate for Payer: First Health Commercial |
$6,544.17
|
| Rate for Payer: Humana Commercial |
$5,855.31
|
| Rate for Payer: Humana KY Medicaid |
$2,368.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,393.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,648.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,083.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,066.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,416.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,061.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,166.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,510.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,993.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,753.13
|
| Rate for Payer: PHCS Commercial |
$6,613.06
|
| Rate for Payer: United Healthcare All Payer |
$6,061.97
|
|
|
PLATE VOL DIST RD NAR 2.4*42 L
|
Facility
|
IP
|
$6,888.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,066.58 |
| Max. Negotiated Rate |
$6,613.06 |
| Rate for Payer: Aetna Commercial |
$5,304.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,373.11
|
| Rate for Payer: Cash Price |
$3,444.30
|
| Rate for Payer: Cigna Commercial |
$5,717.54
|
| Rate for Payer: First Health Commercial |
$6,544.17
|
| Rate for Payer: Humana Commercial |
$5,855.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,648.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,083.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,066.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,061.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,166.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,510.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,993.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,753.13
|
| Rate for Payer: PHCS Commercial |
$6,613.06
|
| Rate for Payer: United Healthcare All Payer |
$6,061.97
|
|
|
PLATE VOL DOR DIS RD 2.4*46 5H
|
Facility
|
OP
|
$3,901.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,170.44 |
| Max. Negotiated Rate |
$3,745.42 |
| Rate for Payer: Aetna Commercial |
$3,004.14
|
| Rate for Payer: Anthem Medicaid |
$1,341.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,043.15
|
| Rate for Payer: Cash Price |
$1,950.74
|
| Rate for Payer: Cigna Commercial |
$3,238.23
|
| Rate for Payer: First Health Commercial |
$3,706.41
|
| Rate for Payer: Humana Commercial |
$3,316.26
|
| Rate for Payer: Humana KY Medicaid |
$1,341.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,355.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,199.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,879.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,368.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,433.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,926.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,121.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,394.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,692.02
|
| Rate for Payer: PHCS Commercial |
$3,745.42
|
| Rate for Payer: United Healthcare All Payer |
$3,433.30
|
|
|
PLATE VOL DOR DIS RD 2.4*46 5H
|
Facility
|
IP
|
$3,901.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,170.44 |
| Max. Negotiated Rate |
$3,745.42 |
| Rate for Payer: Aetna Commercial |
$3,004.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,043.15
|
| Rate for Payer: Cash Price |
$1,950.74
|
| Rate for Payer: Cigna Commercial |
$3,238.23
|
| Rate for Payer: First Health Commercial |
$3,706.41
|
| Rate for Payer: Humana Commercial |
$3,316.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,199.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,879.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,433.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,926.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,121.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,394.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,692.02
|
| Rate for Payer: PHCS Commercial |
$3,745.42
|
| Rate for Payer: United Healthcare All Payer |
$3,433.30
|
|
|
PLATE VOL DOR DIS RD 2.4*57 6H
|
Facility
|
OP
|
$4,001.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.51 |
| Max. Negotiated Rate |
$3,841.64 |
| Rate for Payer: Aetna Commercial |
$3,081.32
|
| Rate for Payer: Anthem Medicaid |
$1,376.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,121.33
|
| Rate for Payer: Cash Price |
$2,000.86
|
| Rate for Payer: Cigna Commercial |
$3,321.42
|
| Rate for Payer: First Health Commercial |
$3,801.62
|
| Rate for Payer: Humana Commercial |
$3,401.45
|
| Rate for Payer: Humana KY Medicaid |
$1,376.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,390.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,281.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,953.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,403.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,521.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,001.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,201.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,481.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,761.18
|
| Rate for Payer: PHCS Commercial |
$3,841.64
|
| Rate for Payer: United Healthcare All Payer |
$3,521.50
|
|
|
PLATE VOL DOR DIS RD 2.4*57 6H
|
Facility
|
IP
|
$4,001.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.51 |
| Max. Negotiated Rate |
$3,841.64 |
| Rate for Payer: Aetna Commercial |
$3,081.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,121.33
|
| Rate for Payer: Cash Price |
$2,000.86
|
| Rate for Payer: Cigna Commercial |
$3,321.42
|
| Rate for Payer: First Health Commercial |
$3,801.62
|
| Rate for Payer: Humana Commercial |
$3,401.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,281.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,953.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,521.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,001.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,201.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,481.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,761.18
|
| Rate for Payer: PHCS Commercial |
$3,841.64
|
| Rate for Payer: United Healthcare All Payer |
$3,521.50
|
|
|
PLATE VOL DOR DS RD 2.4*41 +90
|
Facility
|
IP
|
$4,492.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,347.65 |
| Max. Negotiated Rate |
$4,312.49 |
| Rate for Payer: Aetna Commercial |
$3,458.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,503.90
|
| Rate for Payer: Cash Price |
$2,246.09
|
| Rate for Payer: Cigna Commercial |
$3,728.51
|
| Rate for Payer: First Health Commercial |
$4,267.57
|
| Rate for Payer: Humana Commercial |
$3,818.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,683.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,315.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,347.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,953.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,369.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,593.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,908.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,099.60
|
| Rate for Payer: PHCS Commercial |
$4,312.49
|
| Rate for Payer: United Healthcare All Payer |
$3,953.12
|
|
|
PLATE VOL DOR DS RD 2.4*41 +90
|
Facility
|
OP
|
$4,492.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,347.65 |
| Max. Negotiated Rate |
$4,312.49 |
| Rate for Payer: Aetna Commercial |
$3,458.98
|
| Rate for Payer: Anthem Medicaid |
$1,544.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,503.90
|
| Rate for Payer: Cash Price |
$2,246.09
|
| Rate for Payer: Cigna Commercial |
$3,728.51
|
| Rate for Payer: First Health Commercial |
$4,267.57
|
| Rate for Payer: Humana Commercial |
$3,818.35
|
| Rate for Payer: Humana KY Medicaid |
$1,544.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,560.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,683.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,315.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,347.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,575.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,953.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,369.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,593.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,908.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,099.60
|
| Rate for Payer: PHCS Commercial |
$4,312.49
|
| Rate for Payer: United Healthcare All Payer |
$3,953.12
|
|
|
PLATE VOL DOR DS RD 2.4*41 -90
|
Facility
|
OP
|
$4,492.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,347.65 |
| Max. Negotiated Rate |
$4,312.49 |
| Rate for Payer: Aetna Commercial |
$3,458.98
|
| Rate for Payer: Anthem Medicaid |
$1,544.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,503.90
|
| Rate for Payer: Cash Price |
$2,246.09
|
| Rate for Payer: Cigna Commercial |
$3,728.51
|
| Rate for Payer: First Health Commercial |
$4,267.57
|
| Rate for Payer: Humana Commercial |
$3,818.35
|
| Rate for Payer: Humana KY Medicaid |
$1,544.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,560.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,683.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,315.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,347.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,575.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,953.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,369.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,593.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,908.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,099.60
|
| Rate for Payer: PHCS Commercial |
$4,312.49
|
| Rate for Payer: United Healthcare All Payer |
$3,953.12
|
|
|
PLATE VOL DOR DS RD 2.4*41 -90
|
Facility
|
IP
|
$4,492.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,347.65 |
| Max. Negotiated Rate |
$4,312.49 |
| Rate for Payer: Aetna Commercial |
$3,458.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,503.90
|
| Rate for Payer: Cash Price |
$2,246.09
|
| Rate for Payer: Cigna Commercial |
$3,728.51
|
| Rate for Payer: First Health Commercial |
$4,267.57
|
| Rate for Payer: Humana Commercial |
$3,818.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,683.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,315.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,347.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,953.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,369.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,593.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,908.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,099.60
|
| Rate for Payer: PHCS Commercial |
$4,312.49
|
| Rate for Payer: United Healthcare All Payer |
$3,953.12
|
|
|
PLATE VOL DOR DS RD 2.4*49 +90
|
Facility
|
IP
|
$4,165.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,249.72 |
| Max. Negotiated Rate |
$3,999.11 |
| Rate for Payer: Aetna Commercial |
$3,207.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,249.28
|
| Rate for Payer: Cash Price |
$2,082.87
|
| Rate for Payer: Cigna Commercial |
$3,457.56
|
| Rate for Payer: First Health Commercial |
$3,957.45
|
| Rate for Payer: Humana Commercial |
$3,540.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,415.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,074.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,249.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,665.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,124.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,332.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,874.36
|
| Rate for Payer: PHCS Commercial |
$3,999.11
|
| Rate for Payer: United Healthcare All Payer |
$3,665.85
|
|
|
PLATE VOL DOR DS RD 2.4*49 +90
|
Facility
|
OP
|
$4,165.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,249.72 |
| Max. Negotiated Rate |
$3,999.11 |
| Rate for Payer: Aetna Commercial |
$3,207.62
|
| Rate for Payer: Anthem Medicaid |
$1,432.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,249.28
|
| Rate for Payer: Cash Price |
$2,082.87
|
| Rate for Payer: Cigna Commercial |
$3,457.56
|
| Rate for Payer: First Health Commercial |
$3,957.45
|
| Rate for Payer: Humana Commercial |
$3,540.88
|
| Rate for Payer: Humana KY Medicaid |
$1,432.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,447.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,415.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,074.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,249.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,461.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,665.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,124.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,332.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,874.36
|
| Rate for Payer: PHCS Commercial |
$3,999.11
|
| Rate for Payer: United Healthcare All Payer |
$3,665.85
|
|
|
PLATE VOL DOR DS RD 2.4*49 -90
|
Facility
|
OP
|
$4,582.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,374.81 |
| Max. Negotiated Rate |
$4,399.39 |
| Rate for Payer: Aetna Commercial |
$3,528.68
|
| Rate for Payer: Anthem Medicaid |
$1,575.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,574.51
|
| Rate for Payer: Cash Price |
$2,291.35
|
| Rate for Payer: Cigna Commercial |
$3,803.64
|
| Rate for Payer: First Health Commercial |
$4,353.56
|
| Rate for Payer: Humana Commercial |
$3,895.30
|
| Rate for Payer: Humana KY Medicaid |
$1,575.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,592.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,757.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,382.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,374.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,607.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,032.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,437.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,666.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,986.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,162.06
|
| Rate for Payer: PHCS Commercial |
$4,399.39
|
| Rate for Payer: United Healthcare All Payer |
$4,032.78
|
|
|
PLATE VOL DOR DS RD 2.4*49 -90
|
Facility
|
IP
|
$4,582.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,374.81 |
| Max. Negotiated Rate |
$4,399.39 |
| Rate for Payer: Aetna Commercial |
$3,528.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,574.51
|
| Rate for Payer: Cash Price |
$2,291.35
|
| Rate for Payer: Cigna Commercial |
$3,803.64
|
| Rate for Payer: First Health Commercial |
$4,353.56
|
| Rate for Payer: Humana Commercial |
$3,895.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,757.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,382.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,374.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,032.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,437.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,666.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,986.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,162.06
|
| Rate for Payer: PHCS Commercial |
$4,399.39
|
| Rate for Payer: United Healthcare All Payer |
$4,032.78
|
|
|
PLATE VOL DST RD 5H 2.4*66 R
|
Facility
|
OP
|
$6,984.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,095.20 |
| Max. Negotiated Rate |
$6,704.65 |
| Rate for Payer: Aetna Commercial |
$5,377.69
|
| Rate for Payer: Anthem Medicaid |
$2,401.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,447.53
|
| Rate for Payer: Cash Price |
$3,492.01
|
| Rate for Payer: Cigna Commercial |
$5,796.73
|
| Rate for Payer: First Health Commercial |
$6,634.81
|
| Rate for Payer: Humana Commercial |
$5,936.41
|
| Rate for Payer: Humana KY Medicaid |
$2,401.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,426.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,726.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,154.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,095.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,449.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,145.93
|
| Rate for Payer: Ohio Health Group HMO |
$5,238.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,587.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,076.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,818.97
|
| Rate for Payer: PHCS Commercial |
$6,704.65
|
| Rate for Payer: United Healthcare All Payer |
$6,145.93
|
|
|
PLATE VOL DST RD 5H 2.4*66 R
|
Facility
|
IP
|
$6,984.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,095.20 |
| Max. Negotiated Rate |
$6,704.65 |
| Rate for Payer: Aetna Commercial |
$5,377.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,447.53
|
| Rate for Payer: Cash Price |
$3,492.01
|
| Rate for Payer: Cigna Commercial |
$5,796.73
|
| Rate for Payer: First Health Commercial |
$6,634.81
|
| Rate for Payer: Humana Commercial |
$5,936.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,726.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,154.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,095.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,145.93
|
| Rate for Payer: Ohio Health Group HMO |
$5,238.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,587.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,076.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,818.97
|
| Rate for Payer: PHCS Commercial |
$6,704.65
|
| Rate for Payer: United Healthcare All Payer |
$6,145.93
|
|
|
PLATE V PROFL LCK 2.3 LE MC 5H
|
Facility
|
IP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
