|
PLATE VOL DIS RAD 7H 2.4*77 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 NAR 2.4*51 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: 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
|
| Rate for Payer: Aetna Commercial |
$5,268.77
|
|
|
PLATE VOL DIS RAD NAR 2.4*51 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 NAR 2.4*63 L
|
Facility
|
IP
|
$6,643.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$863.59 |
| Max. Negotiated Rate |
$6,377.29 |
| Rate for Payer: Aetna Commercial |
$5,115.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,181.55
|
| Rate for Payer: Cash Price |
$3,321.51
|
| Rate for Payer: Cigna Commercial |
$5,513.70
|
| Rate for Payer: First Health Commercial |
$6,310.86
|
| Rate for Payer: Humana Commercial |
$5,646.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,447.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,902.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,992.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,845.85
|
| Rate for Payer: Ohio Health Group HMO |
$4,982.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,328.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$863.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,059.33
|
| Rate for Payer: PHCS Commercial |
$6,377.29
|
| Rate for Payer: United Healthcare All Payer |
$5,845.85
|
|
|
PLATE VOL DIS RAD NAR 2.4*63 L
|
Facility
|
OP
|
$6,643.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$863.59 |
| Max. Negotiated Rate |
$6,377.29 |
| Rate for Payer: Aetna Commercial |
$5,115.12
|
| Rate for Payer: Anthem Medicaid |
$2,284.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,181.55
|
| Rate for Payer: Cash Price |
$3,321.51
|
| Rate for Payer: Cigna Commercial |
$5,513.70
|
| Rate for Payer: First Health Commercial |
$6,310.86
|
| Rate for Payer: Humana Commercial |
$5,646.56
|
| Rate for Payer: Humana KY Medicaid |
$2,284.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,307.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,447.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,902.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,992.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,330.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,845.85
|
| Rate for Payer: Ohio Health Group HMO |
$4,982.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,328.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$863.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,059.33
|
| Rate for Payer: PHCS Commercial |
$6,377.29
|
| Rate for Payer: United Healthcare All Payer |
$5,845.85
|
|
|
PLATE VOL DIS RAD NAR 2.4*72 L
|
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 NAR 2.4*72 L
|
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 TI NAR 3H L
|
Facility
|
IP
|
$5,121.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.81 |
| Max. Negotiated Rate |
$4,916.76 |
| Rate for Payer: Aetna Commercial |
$3,943.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,994.86
|
| Rate for Payer: Cash Price |
$2,560.81
|
| Rate for Payer: Cigna Commercial |
$4,250.94
|
| Rate for Payer: First Health Commercial |
$4,865.54
|
| Rate for Payer: Humana Commercial |
$4,353.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,199.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,779.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,507.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,841.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.70
|
| Rate for Payer: PHCS Commercial |
$4,916.76
|
| Rate for Payer: United Healthcare All Payer |
$4,507.03
|
|
|
PLATE VOL DIS RAD TI NAR 3H L
|
Facility
|
OP
|
$5,121.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.81 |
| Max. Negotiated Rate |
$4,916.76 |
| Rate for Payer: Aetna Commercial |
$3,943.65
|
| Rate for Payer: Anthem Medicaid |
$1,761.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,994.86
|
| Rate for Payer: Cash Price |
$2,560.81
|
| Rate for Payer: Cigna Commercial |
$4,250.94
|
| Rate for Payer: First Health Commercial |
$4,865.54
|
| Rate for Payer: Humana Commercial |
$4,353.38
|
| Rate for Payer: Humana KY Medicaid |
$1,761.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,779.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,199.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,779.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,796.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,507.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,841.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.70
|
| Rate for Payer: PHCS Commercial |
$4,916.76
|
| Rate for Payer: United Healthcare All Payer |
$4,507.03
|
|
|
PLATE VOL DIS RAD TI NAR 5H L
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
PLATE VOL DIS RAD TI NAR 5H L
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
PLATE VOL DIS RAD TI NAR 5H R
|
Facility
|
IP
|
$5,121.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.81 |
| Max. Negotiated Rate |
$4,916.76 |
| Rate for Payer: Aetna Commercial |
$3,943.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,994.86
|
| Rate for Payer: Cash Price |
$2,560.81
|
| Rate for Payer: Cigna Commercial |
$4,250.94
|
| Rate for Payer: First Health Commercial |
$4,865.54
|
| Rate for Payer: Humana Commercial |
$4,353.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,199.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,779.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,507.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,841.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.70
|
| Rate for Payer: PHCS Commercial |
$4,916.76
|
| Rate for Payer: United Healthcare All Payer |
$4,507.03
|
|
|
PLATE VOL DIS RAD TI NAR 5H R
|
Facility
|
OP
|
$5,121.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.81 |
| Max. Negotiated Rate |
$4,916.76 |
| Rate for Payer: Aetna Commercial |
$3,943.65
|
| Rate for Payer: Anthem Medicaid |
$1,761.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,994.86
|
| Rate for Payer: Cash Price |
$2,560.81
|
| Rate for Payer: Cigna Commercial |
$4,250.94
|
| Rate for Payer: First Health Commercial |
$4,865.54
|
| Rate for Payer: Humana Commercial |
$4,353.38
|
| Rate for Payer: Humana KY Medicaid |
$1,761.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,779.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,199.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,779.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,796.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,507.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,841.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.70
|
| Rate for Payer: PHCS Commercial |
$4,916.76
|
| Rate for Payer: United Healthcare All Payer |
$4,507.03
|
|
|
PLATE VOL DIS RAD TI NAR 7H L
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
PLATE VOL DIS RAD TI NAR 7H L
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
PLATE VOL DIS RAD TI NAR 7H R
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
PLATE VOL DIS RAD TI NAR 7H R
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
|
|
PLATE VOL DIS RAD TI NAR 9H L
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
PLATE VOL DIS RAD TI NAR 9H L
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
PLATE VOL DIS RAD TI NAR 9H R
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
PLATE VOL DIS RAD TI NAR 9H R
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
PLATE VOL DIS RAD TI STD 3H L
|
Facility
|
OP
|
$5,121.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.81 |
| Max. Negotiated Rate |
$4,916.76 |
| Rate for Payer: Aetna Commercial |
$3,943.65
|
| Rate for Payer: Anthem Medicaid |
$1,761.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,994.86
|
| Rate for Payer: Cash Price |
$2,560.81
|
| Rate for Payer: Cigna Commercial |
$4,250.94
|
| Rate for Payer: First Health Commercial |
$4,865.54
|
| Rate for Payer: Humana Commercial |
$4,353.38
|
| Rate for Payer: Humana KY Medicaid |
$1,761.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,779.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,199.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,779.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,796.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,507.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,841.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.70
|
| Rate for Payer: PHCS Commercial |
$4,916.76
|
| Rate for Payer: United Healthcare All Payer |
$4,507.03
|
|
|
PLATE VOL DIS RAD TI STD 3H L
|
Facility
|
IP
|
$5,121.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.81 |
| Max. Negotiated Rate |
$4,916.76 |
| Rate for Payer: Aetna Commercial |
$3,943.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,994.86
|
| Rate for Payer: Cash Price |
$2,560.81
|
| Rate for Payer: Cigna Commercial |
$4,250.94
|
| Rate for Payer: First Health Commercial |
$4,865.54
|
| Rate for Payer: Humana Commercial |
$4,353.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,199.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,779.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,507.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,841.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.70
|
| Rate for Payer: PHCS Commercial |
$4,916.76
|
| Rate for Payer: United Healthcare All Payer |
$4,507.03
|
|
|
PLATE VOL DIS RAD TI STD 5H L
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
PLATE VOL DIS RAD TI STD 5H L
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
|
