|
PLATE VOLAR WO LIP RT 7H SHAFT
|
Facility
|
OP
|
$4,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.26 |
| Max. Negotiated Rate |
$4,705.92 |
| Rate for Payer: Aetna Commercial |
$3,774.54
|
| Rate for Payer: Anthem Medicaid |
$1,685.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,823.56
|
| Rate for Payer: Cash Price |
$2,451.00
|
| Rate for Payer: Cigna Commercial |
$4,068.66
|
| Rate for Payer: First Health Commercial |
$4,656.90
|
| Rate for Payer: Humana Commercial |
$4,166.70
|
| Rate for Payer: Humana KY Medicaid |
$1,685.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,702.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,019.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,617.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,470.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,719.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,313.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,676.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,519.62
|
| Rate for Payer: PHCS Commercial |
$4,705.92
|
| Rate for Payer: United Healthcare All Payer |
$4,313.76
|
|
|
PLATE VOLAR WO LIP RT 7H SHAFT
|
Facility
|
IP
|
$4,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.26 |
| Max. Negotiated Rate |
$4,705.92 |
| Rate for Payer: Humana Commercial |
$4,166.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,019.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,617.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,470.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,313.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,676.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,519.62
|
| Rate for Payer: PHCS Commercial |
$4,705.92
|
| Rate for Payer: United Healthcare All Payer |
$4,313.76
|
| Rate for Payer: Aetna Commercial |
$3,774.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,823.56
|
| Rate for Payer: Cash Price |
$2,451.00
|
| Rate for Payer: Cigna Commercial |
$4,068.66
|
| Rate for Payer: First Health Commercial |
$4,656.90
|
|
|
PLATE VOL DIS RAD 6H 2.4*54 L
|
Facility
|
IP
|
$6,842.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.53 |
| Max. Negotiated Rate |
$6,568.86 |
| Rate for Payer: Aetna Commercial |
$5,268.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,337.20
|
| Rate for Payer: Cash Price |
$3,421.28
|
| Rate for Payer: Cigna Commercial |
$5,679.32
|
| Rate for Payer: First Health Commercial |
$6,500.43
|
| Rate for Payer: Humana Commercial |
$5,816.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,610.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,049.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,052.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,021.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,131.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,368.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$889.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,121.19
|
| Rate for Payer: PHCS Commercial |
$6,568.86
|
| Rate for Payer: United Healthcare All Payer |
$6,021.45
|
|
|
PLATE VOL DIS RAD 6H 2.4*54 L
|
Facility
|
OP
|
$6,842.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.53 |
| Max. Negotiated Rate |
$6,568.86 |
| Rate for Payer: Aetna Commercial |
$5,268.77
|
| Rate for Payer: Anthem Medicaid |
$2,353.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,337.20
|
| Rate for Payer: Cash Price |
$3,421.28
|
| Rate for Payer: Cigna Commercial |
$5,679.32
|
| Rate for Payer: First Health Commercial |
$6,500.43
|
| Rate for Payer: Humana Commercial |
$5,816.18
|
| Rate for Payer: Humana KY Medicaid |
$2,353.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,377.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,610.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,049.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,052.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,400.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,021.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,131.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,368.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$889.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,121.19
|
| Rate for Payer: PHCS Commercial |
$6,568.86
|
| Rate for Payer: United Healthcare All Payer |
$6,021.45
|
|
|
PLATE VOL DIS RAD 6H 2.4*66 L
|
Facility
|
OP
|
$5,574.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.69 |
| Max. Negotiated Rate |
$5,351.54 |
| Rate for Payer: Aetna Commercial |
$4,292.38
|
| Rate for Payer: Anthem Medicaid |
$1,917.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,348.13
|
| Rate for Payer: Cash Price |
$2,787.26
|
| Rate for Payer: Cigna Commercial |
$4,626.85
|
| Rate for Payer: First Health Commercial |
$5,295.79
|
| Rate for Payer: Humana Commercial |
$4,738.34
|
| Rate for Payer: Humana KY Medicaid |
$1,917.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,936.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,571.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,114.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,955.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,905.58
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,728.10
|
| Rate for Payer: PHCS Commercial |
$5,351.54
|
| Rate for Payer: United Healthcare All Payer |
$4,905.58
|
|
|
PLATE VOL DIS RAD 6H 2.4*66 L
|
Facility
|
IP
|
$5,574.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.69 |
| Max. Negotiated Rate |
$5,351.54 |
| Rate for Payer: Aetna Commercial |
$4,292.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,348.13
|
| Rate for Payer: Cash Price |
$2,787.26
|
| Rate for Payer: Cigna Commercial |
$4,626.85
|
| Rate for Payer: First Health Commercial |
$5,295.79
|
| Rate for Payer: Humana Commercial |
$4,738.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,571.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,114.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,905.58
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,728.10
|
| Rate for Payer: PHCS Commercial |
$5,351.54
|
| Rate for Payer: United Healthcare All Payer |
$4,905.58
|
|
|
PLATE VOL DIS RAD 6H 2.4*75 L
|
Facility
|
IP
|
$5,698.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$740.79 |
| Max. Negotiated Rate |
$5,470.42 |
| Rate for Payer: Aetna Commercial |
$4,387.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,444.71
|
| Rate for Payer: Cash Price |
$2,849.18
|
| Rate for Payer: Cigna Commercial |
$4,729.63
|
| Rate for Payer: First Health Commercial |
$5,413.43
|
| Rate for Payer: Humana Commercial |
$4,843.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,672.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,205.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,709.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,014.55
|
| Rate for Payer: Ohio Health Group HMO |
$4,273.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,139.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$740.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,766.49
|
| Rate for Payer: PHCS Commercial |
$5,470.42
|
| Rate for Payer: United Healthcare All Payer |
$5,014.55
|
|
|
PLATE VOL DIS RAD 6H 2.4*75 L
|
Facility
|
OP
|
$5,698.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$740.79 |
| Max. Negotiated Rate |
$5,470.42 |
| Rate for Payer: Aetna Commercial |
$4,387.73
|
| Rate for Payer: Anthem Medicaid |
$1,959.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,444.71
|
| Rate for Payer: Cash Price |
$2,849.18
|
| Rate for Payer: Cigna Commercial |
$4,729.63
|
| Rate for Payer: First Health Commercial |
$5,413.43
|
| Rate for Payer: Humana Commercial |
$4,843.60
|
| Rate for Payer: Humana KY Medicaid |
$1,959.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,979.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,672.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,205.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,709.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,998.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,014.55
|
| Rate for Payer: Ohio Health Group HMO |
$4,273.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,139.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$740.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,766.49
|
| Rate for Payer: PHCS Commercial |
$5,470.42
|
| Rate for Payer: United Healthcare All Payer |
$5,014.55
|
|
|
PLATE VOL DIS RAD 6H 2.4*75 R
|
Facility
|
IP
|
$5,698.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$740.79 |
| Max. Negotiated Rate |
$5,470.42 |
| Rate for Payer: Aetna Commercial |
$4,387.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,444.71
|
| Rate for Payer: Cash Price |
$2,849.18
|
| Rate for Payer: Cigna Commercial |
$4,729.63
|
| Rate for Payer: First Health Commercial |
$5,413.43
|
| Rate for Payer: Humana Commercial |
$4,843.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,672.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,205.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,709.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,014.55
|
| Rate for Payer: Ohio Health Group HMO |
$4,273.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,139.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$740.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,766.49
|
| Rate for Payer: PHCS Commercial |
$5,470.42
|
| Rate for Payer: United Healthcare All Payer |
$5,014.55
|
|
|
PLATE VOL DIS RAD 6H 2.4*75 R
|
Facility
|
OP
|
$5,698.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$740.79 |
| Max. Negotiated Rate |
$5,470.42 |
| Rate for Payer: Humana Commercial |
$4,843.60
|
| Rate for Payer: Humana KY Medicaid |
$1,959.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,979.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,672.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,205.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,709.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,998.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,014.55
|
| Rate for Payer: Ohio Health Group HMO |
$4,273.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,139.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$740.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,766.49
|
| Rate for Payer: PHCS Commercial |
$5,470.42
|
| Rate for Payer: United Healthcare All Payer |
$5,014.55
|
| Rate for Payer: Aetna Commercial |
$4,387.73
|
| Rate for Payer: Anthem Medicaid |
$1,959.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,444.71
|
| Rate for Payer: Cash Price |
$2,849.18
|
| Rate for Payer: Cigna Commercial |
$4,729.63
|
| Rate for Payer: First Health Commercial |
$5,413.43
|
|
|
PLATE VOL DIS RAD 7H 2.4*47 L
|
Facility
|
IP
|
$6,842.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.53 |
| Max. Negotiated Rate |
$6,568.86 |
| Rate for Payer: Aetna Commercial |
$5,268.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,337.20
|
| Rate for Payer: Cash Price |
$3,421.28
|
| Rate for Payer: Cigna Commercial |
$5,679.32
|
| Rate for Payer: First Health Commercial |
$6,500.43
|
| Rate for Payer: Humana Commercial |
$5,816.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,610.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,049.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,052.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,021.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,131.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,368.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$889.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,121.19
|
| Rate for Payer: PHCS Commercial |
$6,568.86
|
| Rate for Payer: United Healthcare All Payer |
$6,021.45
|
|
|
PLATE VOL DIS RAD 7H 2.4*47 L
|
Facility
|
OP
|
$6,842.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.53 |
| Max. Negotiated Rate |
$6,568.86 |
| Rate for Payer: Aetna Commercial |
$5,268.77
|
| Rate for Payer: Anthem Medicaid |
$2,353.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,337.20
|
| Rate for Payer: Cash Price |
$3,421.28
|
| Rate for Payer: Cigna Commercial |
$5,679.32
|
| Rate for Payer: First Health Commercial |
$6,500.43
|
| Rate for Payer: Humana Commercial |
$5,816.18
|
| Rate for Payer: Humana KY Medicaid |
$2,353.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,377.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,610.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,049.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,052.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,400.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,021.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,131.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,368.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$889.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,121.19
|
| Rate for Payer: PHCS Commercial |
$6,568.86
|
| Rate for Payer: United Healthcare All Payer |
$6,021.45
|
|
|
PLATE VOL DIS RAD 7H 2.4*47 R
|
Facility
|
IP
|
$5,614.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$729.89 |
| Max. Negotiated Rate |
$5,389.98 |
| Rate for Payer: Aetna Commercial |
$4,323.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.36
|
| Rate for Payer: Cash Price |
$2,807.28
|
| Rate for Payer: Cigna Commercial |
$4,660.08
|
| Rate for Payer: First Health Commercial |
$5,333.83
|
| Rate for Payer: Humana Commercial |
$4,772.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,122.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$729.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,740.51
|
| Rate for Payer: PHCS Commercial |
$5,389.98
|
| Rate for Payer: United Healthcare All Payer |
$4,940.81
|
|
|
PLATE VOL DIS RAD 7H 2.4*47 R
|
Facility
|
OP
|
$5,614.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$729.89 |
| Max. Negotiated Rate |
$5,389.98 |
| Rate for Payer: Aetna Commercial |
$4,323.21
|
| Rate for Payer: Anthem Medicaid |
$1,930.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.36
|
| Rate for Payer: Cash Price |
$2,807.28
|
| Rate for Payer: Cigna Commercial |
$4,660.08
|
| Rate for Payer: First Health Commercial |
$5,333.83
|
| Rate for Payer: Humana Commercial |
$4,772.38
|
| Rate for Payer: Humana KY Medicaid |
$1,930.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,950.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,122.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$729.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,740.51
|
| Rate for Payer: PHCS Commercial |
$5,389.98
|
| Rate for Payer: United Healthcare All Payer |
$4,940.81
|
|
|
PLATE VOL DIS RAD 7H 2.4*55 L
|
Facility
|
IP
|
$6,842.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.53 |
| Max. Negotiated Rate |
$6,568.86 |
| Rate for Payer: Aetna Commercial |
$5,268.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,337.20
|
| Rate for Payer: Cash Price |
$3,421.28
|
| Rate for Payer: Cigna Commercial |
$5,679.32
|
| Rate for Payer: First Health Commercial |
$6,500.43
|
| Rate for Payer: Humana Commercial |
$5,816.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,610.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,049.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,052.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,021.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,131.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,368.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$889.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,121.19
|
| Rate for Payer: PHCS Commercial |
$6,568.86
|
| Rate for Payer: United Healthcare All Payer |
$6,021.45
|
|
|
PLATE VOL DIS RAD 7H 2.4*55 L
|
Facility
|
OP
|
$6,842.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.53 |
| Max. Negotiated Rate |
$6,568.86 |
| Rate for Payer: Aetna Commercial |
$5,268.77
|
| Rate for Payer: Anthem Medicaid |
$2,353.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,337.20
|
| Rate for Payer: Cash Price |
$3,421.28
|
| Rate for Payer: Cigna Commercial |
$5,679.32
|
| Rate for Payer: First Health Commercial |
$6,500.43
|
| Rate for Payer: Humana Commercial |
$5,816.18
|
| Rate for Payer: Humana KY Medicaid |
$2,353.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,377.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,610.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,049.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,052.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,400.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,021.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,131.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,368.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$889.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,121.19
|
| Rate for Payer: PHCS Commercial |
$6,568.86
|
| Rate for Payer: United Healthcare All Payer |
$6,021.45
|
|
|
PLATE VOL DIS RAD 7H 2.4*55 R
|
Facility
|
IP
|
$6,842.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.53 |
| Max. Negotiated Rate |
$6,568.86 |
| Rate for Payer: Aetna Commercial |
$5,268.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,337.20
|
| Rate for Payer: Cash Price |
$3,421.28
|
| Rate for Payer: Cigna Commercial |
$5,679.32
|
| Rate for Payer: First Health Commercial |
$6,500.43
|
| Rate for Payer: Humana Commercial |
$5,816.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,610.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,049.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,052.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,021.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,131.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,368.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$889.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,121.19
|
| Rate for Payer: PHCS Commercial |
$6,568.86
|
| Rate for Payer: United Healthcare All Payer |
$6,021.45
|
|
|
PLATE VOL DIS RAD 7H 2.4*55 R
|
Facility
|
OP
|
$6,842.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.53 |
| Max. Negotiated Rate |
$6,568.86 |
| Rate for Payer: Aetna Commercial |
$5,268.77
|
| Rate for Payer: Anthem Medicaid |
$2,353.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,337.20
|
| Rate for Payer: Cash Price |
$3,421.28
|
| Rate for Payer: Cigna Commercial |
$5,679.32
|
| Rate for Payer: First Health Commercial |
$6,500.43
|
| Rate for Payer: Humana Commercial |
$5,816.18
|
| Rate for Payer: Humana KY Medicaid |
$2,353.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,377.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,610.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,049.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,052.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,400.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,021.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,131.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,368.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$889.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,121.19
|
| Rate for Payer: PHCS Commercial |
$6,568.86
|
| Rate for Payer: United Healthcare All Payer |
$6,021.45
|
|
|
PLATE VOL DIS RAD 7H 2.4*68 L
|
Facility
|
OP
|
$6,815.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$886.07 |
| Max. Negotiated Rate |
$6,543.31 |
| Rate for Payer: Aetna Commercial |
$5,248.28
|
| Rate for Payer: Anthem Medicaid |
$2,344.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,316.44
|
| Rate for Payer: Cash Price |
$3,407.97
|
| Rate for Payer: Cigna Commercial |
$5,657.24
|
| Rate for Payer: First Health Commercial |
$6,475.15
|
| Rate for Payer: Humana Commercial |
$5,793.56
|
| Rate for Payer: Humana KY Medicaid |
$2,344.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,589.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,030.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,391.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,998.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,111.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$886.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.94
|
| Rate for Payer: PHCS Commercial |
$6,543.31
|
| Rate for Payer: United Healthcare All Payer |
$5,998.04
|
|
|
PLATE VOL DIS RAD 7H 2.4*68 L
|
Facility
|
IP
|
$6,815.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$886.07 |
| Max. Negotiated Rate |
$6,543.31 |
| Rate for Payer: Aetna Commercial |
$5,248.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,316.44
|
| Rate for Payer: Cash Price |
$3,407.97
|
| Rate for Payer: Cigna Commercial |
$5,657.24
|
| Rate for Payer: First Health Commercial |
$6,475.15
|
| Rate for Payer: Humana Commercial |
$5,793.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,589.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,030.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,998.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,111.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$886.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.94
|
| Rate for Payer: PHCS Commercial |
$6,543.31
|
| Rate for Payer: United Healthcare All Payer |
$5,998.04
|
|
|
PLATE VOL DIS RAD 7H 2.4*68 R
|
Facility
|
OP
|
$6,996.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.57 |
| Max. Negotiated Rate |
$6,716.79 |
| Rate for Payer: Aetna Commercial |
$5,387.43
|
| Rate for Payer: Anthem Medicaid |
$2,406.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,457.39
|
| Rate for Payer: Cash Price |
$3,498.33
|
| Rate for Payer: Cigna Commercial |
$5,807.23
|
| Rate for Payer: First Health Commercial |
$6,646.83
|
| Rate for Payer: Humana Commercial |
$5,947.16
|
| Rate for Payer: Humana KY Medicaid |
$2,406.15
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,163.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,247.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,168.96
|
| Rate for Payer: PHCS Commercial |
$6,716.79
|
| Rate for Payer: United Healthcare All Payer |
$6,157.06
|
|
|
PLATE VOL DIS RAD 7H 2.4*68 R
|
Facility
|
IP
|
$6,996.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.57 |
| Max. Negotiated Rate |
$6,716.79 |
| Rate for Payer: Aetna Commercial |
$5,387.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,457.39
|
| Rate for Payer: Cash Price |
$3,498.33
|
| Rate for Payer: Cigna Commercial |
$5,807.23
|
| Rate for Payer: First Health Commercial |
$6,646.83
|
| Rate for Payer: Humana Commercial |
$5,947.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,163.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,247.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,168.96
|
| Rate for Payer: PHCS Commercial |
$6,716.79
|
| Rate for Payer: United Healthcare All Payer |
$6,157.06
|
|
|
PLATE VOL DIS RAD 7H 2.4*77 L
|
Facility
|
OP
|
$6,842.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.53 |
| Max. Negotiated Rate |
$6,568.86 |
| Rate for Payer: Aetna Commercial |
$5,268.77
|
| Rate for Payer: Anthem Medicaid |
$2,353.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,337.20
|
| Rate for Payer: Cash Price |
$3,421.28
|
| Rate for Payer: Cigna Commercial |
$5,679.32
|
| Rate for Payer: First Health Commercial |
$6,500.43
|
| Rate for Payer: Humana Commercial |
$5,816.18
|
| Rate for Payer: Humana KY Medicaid |
$2,353.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,377.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,610.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,049.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,052.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,400.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,021.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,131.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,368.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$889.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,121.19
|
| Rate for Payer: PHCS Commercial |
$6,568.86
|
| Rate for Payer: United Healthcare All Payer |
$6,021.45
|
|
|
PLATE VOL DIS RAD 7H 2.4*77 L
|
Facility
|
IP
|
$6,842.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.53 |
| Max. Negotiated Rate |
$6,568.86 |
| Rate for Payer: Aetna Commercial |
$5,268.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,337.20
|
| Rate for Payer: Cash Price |
$3,421.28
|
| Rate for Payer: Cigna Commercial |
$5,679.32
|
| Rate for Payer: First Health Commercial |
$6,500.43
|
| Rate for Payer: Humana Commercial |
$5,816.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,610.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,049.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,052.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,021.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,131.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,368.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$889.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,121.19
|
| Rate for Payer: PHCS Commercial |
$6,568.86
|
| Rate for Payer: United Healthcare All Payer |
$6,021.45
|
|
|
PLATE VOL DIS RAD 7H 2.4*77 R
|
Facility
|
IP
|
$6,842.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.53 |
| Max. Negotiated Rate |
$6,568.86 |
| Rate for Payer: Aetna Commercial |
$5,268.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,337.20
|
| Rate for Payer: Cash Price |
$3,421.28
|
| Rate for Payer: Cigna Commercial |
$5,679.32
|
| Rate for Payer: First Health Commercial |
$6,500.43
|
| Rate for Payer: Humana Commercial |
$5,816.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,610.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,049.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,052.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,021.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,131.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,368.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$889.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,121.19
|
| Rate for Payer: PHCS Commercial |
$6,568.86
|
| Rate for Payer: United Healthcare All Payer |
$6,021.45
|
|
