|
PLATE VOL DIS RAD TI WDE 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 RD NAR 2.4*42 R
|
Facility
|
OP
|
$5,326.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$692.49 |
| Max. Negotiated Rate |
$5,113.76 |
| Rate for Payer: Aetna Commercial |
$4,101.66
|
| Rate for Payer: Anthem Medicaid |
$1,831.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,154.93
|
| Rate for Payer: Cash Price |
$2,663.42
|
| Rate for Payer: Cigna Commercial |
$4,421.27
|
| Rate for Payer: First Health Commercial |
$5,060.49
|
| Rate for Payer: Humana Commercial |
$4,527.81
|
| Rate for Payer: Humana KY Medicaid |
$1,831.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,850.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,368.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,931.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,598.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,868.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,687.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,995.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,065.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,651.32
|
| Rate for Payer: PHCS Commercial |
$5,113.76
|
| Rate for Payer: United Healthcare All Payer |
$4,687.61
|
|
|
PLATE VOL DIS RD NAR 2.4*42 R
|
Facility
|
IP
|
$5,326.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$692.49 |
| Max. Negotiated Rate |
$5,113.76 |
| Rate for Payer: Aetna Commercial |
$4,101.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,154.93
|
| Rate for Payer: Cash Price |
$2,663.42
|
| Rate for Payer: Cigna Commercial |
$4,421.27
|
| Rate for Payer: First Health Commercial |
$5,060.49
|
| Rate for Payer: Humana Commercial |
$4,527.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,368.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,931.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,598.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,687.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,995.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,065.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,651.32
|
| Rate for Payer: PHCS Commercial |
$5,113.76
|
| Rate for Payer: United Healthcare All Payer |
$4,687.61
|
|
|
PLATE VOL DIS RD NAR 2.4*51 R
|
Facility
|
OP
|
$6,668.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.90 |
| Max. Negotiated Rate |
$6,401.75 |
| Rate for Payer: Aetna Commercial |
$5,134.74
|
| Rate for Payer: Anthem Medicaid |
$2,293.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.42
|
| Rate for Payer: Cash Price |
$3,334.24
|
| Rate for Payer: Cigna Commercial |
$5,534.85
|
| Rate for Payer: First Health Commercial |
$6,335.07
|
| Rate for Payer: Humana Commercial |
$5,668.22
|
| Rate for Payer: Humana KY Medicaid |
$2,293.29
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,339.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.27
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.23
|
| Rate for Payer: PHCS Commercial |
$6,401.75
|
| Rate for Payer: United Healthcare All Payer |
$5,868.27
|
|
|
PLATE VOL DIS RD NAR 2.4*51 R
|
Facility
|
IP
|
$6,668.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.90 |
| Max. Negotiated Rate |
$6,401.75 |
| Rate for Payer: Aetna Commercial |
$5,134.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.42
|
| Rate for Payer: Cash Price |
$3,334.24
|
| Rate for Payer: Cigna Commercial |
$5,534.85
|
| Rate for Payer: First Health Commercial |
$6,335.07
|
| Rate for Payer: Humana Commercial |
$5,668.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.27
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.23
|
| Rate for Payer: PHCS Commercial |
$6,401.75
|
| Rate for Payer: United Healthcare All Payer |
$5,868.27
|
|
|
PLATE VOL DIS RD NAR 2.4*63 R
|
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 RD NAR 2.4*63 R
|
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: 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
|
| 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
|
|
|
PLATE VOL DIS RD NAR 2.4*72 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: 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 RD NAR 2.4*72 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 DIST RAD 4H 2.4*48 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 DIST RAD 4H 2.4*48 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 DIST RAD 4H 2.4*66 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 DIST RAD 4H 2.4*66 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 DIST RD 4H 2.4*48 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 DIST RD 4H 2.4*48 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: 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
|
| 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
|
|
|
PLATE VOL DIST RD 4H 2.4*66 R
|
Facility
|
OP
|
$7,150.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.58 |
| Max. Negotiated Rate |
$6,864.62 |
| Rate for Payer: Aetna Commercial |
$5,506.00
|
| Rate for Payer: Anthem Medicaid |
$2,459.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,577.51
|
| Rate for Payer: Cash Price |
$3,575.33
|
| Rate for Payer: Cigna Commercial |
$5,935.04
|
| Rate for Payer: First Health Commercial |
$6,793.12
|
| Rate for Payer: Humana Commercial |
$6,078.05
|
| Rate for Payer: Humana KY Medicaid |
$2,459.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,484.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,863.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,277.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,145.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,508.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,292.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,362.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,430.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$929.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,216.70
|
| Rate for Payer: PHCS Commercial |
$6,864.62
|
| Rate for Payer: United Healthcare All Payer |
$6,292.57
|
|
|
PLATE VOL DIST RD 4H 2.4*66 R
|
Facility
|
IP
|
$7,150.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.58 |
| Max. Negotiated Rate |
$6,864.62 |
| Rate for Payer: Aetna Commercial |
$5,506.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,577.51
|
| Rate for Payer: Cash Price |
$3,575.33
|
| Rate for Payer: Cigna Commercial |
$5,935.04
|
| Rate for Payer: First Health Commercial |
$6,793.12
|
| Rate for Payer: Humana Commercial |
$6,078.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,863.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,277.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,145.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,292.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,362.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,430.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$929.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,216.70
|
| Rate for Payer: PHCS Commercial |
$6,864.62
|
| Rate for Payer: United Healthcare All Payer |
$6,292.57
|
|
|
PLATE VOL DIST RD 5H 2.4*48 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 DIST RD 5H 2.4*48 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 DIST RD NAR 2.4*42 L
|
Facility
|
OP
|
$6,688.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.52 |
| Max. Negotiated Rate |
$6,421.06 |
| Rate for Payer: Aetna Commercial |
$5,150.22
|
| Rate for Payer: Anthem Medicaid |
$2,300.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,217.11
|
| Rate for Payer: Cash Price |
$3,344.30
|
| Rate for Payer: Cigna Commercial |
$5,551.54
|
| Rate for Payer: First Health Commercial |
$6,354.17
|
| Rate for Payer: Humana Commercial |
$5,685.31
|
| Rate for Payer: Humana KY Medicaid |
$2,300.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,323.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,484.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,936.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,006.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,346.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,885.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,016.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,337.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$869.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,073.47
|
| Rate for Payer: PHCS Commercial |
$6,421.06
|
| Rate for Payer: United Healthcare All Payer |
$5,885.97
|
|
|
PLATE VOL DIST RD NAR 2.4*42 L
|
Facility
|
IP
|
$6,688.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.52 |
| Max. Negotiated Rate |
$6,421.06 |
| Rate for Payer: Aetna Commercial |
$5,150.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,217.11
|
| Rate for Payer: Cash Price |
$3,344.30
|
| Rate for Payer: Cigna Commercial |
$5,551.54
|
| Rate for Payer: First Health Commercial |
$6,354.17
|
| Rate for Payer: Humana Commercial |
$5,685.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,484.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,936.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,006.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,885.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,016.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,337.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$869.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,073.47
|
| Rate for Payer: PHCS Commercial |
$6,421.06
|
| Rate for Payer: United Healthcare All Payer |
$5,885.97
|
|
|
PLATE VOL DOR DIS RD 2.4*46 5H
|
Facility
|
OP
|
$3,974.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.71 |
| Max. Negotiated Rate |
$3,815.72 |
| Rate for Payer: Aetna Commercial |
$3,060.53
|
| Rate for Payer: Anthem Medicaid |
$1,366.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,100.27
|
| Rate for Payer: Cash Price |
$1,987.36
|
| Rate for Payer: Cigna Commercial |
$3,299.01
|
| Rate for Payer: First Health Commercial |
$3,775.97
|
| Rate for Payer: Humana Commercial |
$3,378.50
|
| Rate for Payer: Humana KY Medicaid |
$1,366.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,380.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,259.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,933.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,192.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,394.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,497.74
|
| Rate for Payer: Ohio Health Group HMO |
$2,981.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$794.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,232.16
|
| Rate for Payer: PHCS Commercial |
$3,815.72
|
| Rate for Payer: United Healthcare All Payer |
$3,497.74
|
|
|
PLATE VOL DOR DIS RD 2.4*46 5H
|
Facility
|
IP
|
$3,974.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.71 |
| Max. Negotiated Rate |
$3,815.72 |
| Rate for Payer: Aetna Commercial |
$3,060.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,100.27
|
| Rate for Payer: Cash Price |
$1,987.36
|
| Rate for Payer: Cigna Commercial |
$3,299.01
|
| Rate for Payer: First Health Commercial |
$3,775.97
|
| Rate for Payer: Humana Commercial |
$3,378.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,259.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,933.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,192.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,497.74
|
| Rate for Payer: Ohio Health Group HMO |
$2,981.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$794.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,232.16
|
| Rate for Payer: PHCS Commercial |
$3,815.72
|
| Rate for Payer: United Healthcare All Payer |
$3,497.74
|
|
|
PLATE VOL DOR DIS RD 2.4*57 6H
|
Facility
|
OP
|
$4,068.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$528.87 |
| Max. Negotiated Rate |
$3,905.53 |
| Rate for Payer: Aetna Commercial |
$3,132.56
|
| Rate for Payer: Anthem Medicaid |
$1,399.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,173.24
|
| Rate for Payer: Cash Price |
$2,034.13
|
| Rate for Payer: Cigna Commercial |
$3,376.66
|
| Rate for Payer: First Health Commercial |
$3,864.85
|
| Rate for Payer: Humana Commercial |
$3,458.02
|
| Rate for Payer: Humana KY Medicaid |
$1,399.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,413.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,335.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,002.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,220.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,427.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,580.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,051.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$813.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$528.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,261.16
|
| Rate for Payer: PHCS Commercial |
$3,905.53
|
| Rate for Payer: United Healthcare All Payer |
$3,580.07
|
|
|
PLATE VOL DOR DIS RD 2.4*57 6H
|
Facility
|
IP
|
$4,068.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$528.87 |
| Max. Negotiated Rate |
$3,905.53 |
| Rate for Payer: Aetna Commercial |
$3,132.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,173.24
|
| Rate for Payer: Cash Price |
$2,034.13
|
| Rate for Payer: Cigna Commercial |
$3,376.66
|
| Rate for Payer: First Health Commercial |
$3,864.85
|
| Rate for Payer: Humana Commercial |
$3,458.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,335.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,002.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,220.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,580.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,051.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$813.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$528.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,261.16
|
| Rate for Payer: PHCS Commercial |
$3,905.53
|
| Rate for Payer: United Healthcare All Payer |
$3,580.07
|
|
