|
PLATE GEMINUS VOL DSRD N 4H L
|
Facility
|
IP
|
$8,970.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.14 |
| Max. Negotiated Rate |
$8,611.52 |
| Rate for Payer: Aetna Commercial |
$6,907.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,996.86
|
| Rate for Payer: Cash Price |
$4,485.16
|
| Rate for Payer: Cigna Commercial |
$7,445.37
|
| Rate for Payer: First Health Commercial |
$8,521.81
|
| Rate for Payer: Humana Commercial |
$7,624.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,355.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,620.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,691.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,893.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,727.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,794.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,166.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,780.80
|
| Rate for Payer: PHCS Commercial |
$8,611.52
|
| Rate for Payer: United Healthcare All Payer |
$7,893.89
|
|
|
PLATE GEMI VOL DIS RAD N 3H L
|
Facility
|
IP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE GEMI VOL DIS RAD N 3H L
|
Facility
|
OP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Anthem Medicaid |
$1,654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Humana KY Medicaid |
$1,654.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,687.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE GEMI VOL DIS RAD N 3H R
|
Facility
|
OP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Anthem Medicaid |
$1,654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Humana KY Medicaid |
$1,654.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,687.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE GEMI VOL DIS RAD N 3H R
|
Facility
|
IP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE GEMI VOL DIS RAD N 4H R
|
Facility
|
IP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE GEMI VOL DIS RAD N 4H R
|
Facility
|
OP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Anthem Medicaid |
$1,654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Humana KY Medicaid |
$1,654.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,687.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE GEMI VOL DISRAD SD 3H L
|
Facility
|
OP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Anthem Medicaid |
$1,654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Humana KY Medicaid |
$1,654.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,687.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE GEMI VOL DISRAD SD 3H L
|
Facility
|
IP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE GEMI VOL DIS RAD SD 3H R
|
Facility
|
IP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE GEMI VOL DIS RAD SD 3H R
|
Facility
|
OP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Anthem Medicaid |
$1,654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Humana KY Medicaid |
$1,654.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,687.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE GEMI VOL DISRAD SD 4H L
|
Facility
|
IP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE GEMI VOL DISRAD SD 4H L
|
Facility
|
OP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Anthem Medicaid |
$1,654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Humana KY Medicaid |
$1,654.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,687.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE GEMI VOL DISRAD SD 4H R
|
Facility
|
OP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Anthem Medicaid |
$1,654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Humana KY Medicaid |
$1,654.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,687.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE GEMI VOL DISRAD SD 4H R
|
Facility
|
IP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE GEMI VOL DISRAD SD 7H L
|
Facility
|
IP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE GEMI VOL DISRAD SD 7H L
|
Facility
|
OP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Anthem Medicaid |
$1,654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Humana KY Medicaid |
$1,654.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,687.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE GEMI VOL DISRAD SD 7H R
|
Facility
|
OP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Anthem Medicaid |
$1,654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Humana KY Medicaid |
$1,654.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,687.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE GEMI VOL DISRAD SD 7H R
|
Facility
|
IP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE GEMI VOL DIS RAD WD 4H L
|
Facility
|
IP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE GEMI VOL DIS RAD WD 4H L
|
Facility
|
OP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Anthem Medicaid |
$1,654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Humana KY Medicaid |
$1,654.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,687.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE GEMI VOL DISRAD WD 4H R
|
Facility
|
OP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Anthem Medicaid |
$1,654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Humana KY Medicaid |
$1,654.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,687.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE GEMI VOL DISRAD WD 4H R
|
Facility
|
IP
|
$4,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$4,618.56 |
| Rate for Payer: Aetna Commercial |
$3,704.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,752.58
|
| Rate for Payer: Cash Price |
$2,405.50
|
| Rate for Payer: Cigna Commercial |
$3,993.13
|
| Rate for Payer: First Health Commercial |
$4,570.45
|
| Rate for Payer: Humana Commercial |
$4,089.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,550.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,233.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.41
|
| Rate for Payer: PHCS Commercial |
$4,618.56
|
| Rate for Payer: United Healthcare All Payer |
$4,233.68
|
|
|
PLATE H 2.0MM 4H
|
Facility
|
IP
|
$1,959.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.78 |
| Max. Negotiated Rate |
$1,881.48 |
| Rate for Payer: Aetna Commercial |
$1,509.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,528.71
|
| Rate for Payer: Cash Price |
$979.94
|
| Rate for Payer: Cigna Commercial |
$1,626.70
|
| Rate for Payer: First Health Commercial |
$1,861.89
|
| Rate for Payer: Humana Commercial |
$1,665.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,607.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,446.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$587.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,724.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,469.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$391.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$607.56
|
| Rate for Payer: PHCS Commercial |
$1,881.48
|
| Rate for Payer: United Healthcare All Payer |
$1,724.69
|
|
|
PLATE H 2.0MM 4H
|
Facility
|
OP
|
$1,959.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.78 |
| Max. Negotiated Rate |
$1,881.48 |
| Rate for Payer: Aetna Commercial |
$1,509.11
|
| Rate for Payer: Anthem Medicaid |
$674.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,528.71
|
| Rate for Payer: Cash Price |
$979.94
|
| Rate for Payer: Cigna Commercial |
$1,626.70
|
| Rate for Payer: First Health Commercial |
$1,861.89
|
| Rate for Payer: Humana Commercial |
$1,665.90
|
| Rate for Payer: Humana KY Medicaid |
$674.00
|
| Rate for Payer: Kentucky WC Medicaid |
$680.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,607.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,446.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$587.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$687.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,724.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,469.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$391.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$607.56
|
| Rate for Payer: PHCS Commercial |
$1,881.48
|
| Rate for Payer: United Healthcare All Payer |
$1,724.69
|
|
