|
PLATE VOL DIS RAD 7H 2.4*47 L
|
Facility
|
OP
|
$7,042.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,112.77 |
| Max. Negotiated Rate |
$6,760.86 |
| Rate for Payer: Aetna Commercial |
$5,422.77
|
| Rate for Payer: Anthem Medicaid |
$2,421.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.20
|
| Rate for Payer: Cash Price |
$3,521.28
|
| Rate for Payer: Cigna Commercial |
$5,845.32
|
| Rate for Payer: First Health Commercial |
$6,690.43
|
| Rate for Payer: Humana Commercial |
$5,986.18
|
| Rate for Payer: Humana KY Medicaid |
$2,421.94
|
| Rate for Payer: Kentucky WC Medicaid |
$2,446.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,470.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,281.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,634.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,127.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,859.37
|
| Rate for Payer: PHCS Commercial |
$6,760.86
|
| Rate for Payer: United Healthcare All Payer |
$6,197.45
|
|
|
PLATE VOL DIS RAD 7H 2.4*47 R
|
Facility
|
IP
|
$5,658.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,697.54 |
| Max. Negotiated Rate |
$5,432.12 |
| Rate for Payer: Aetna Commercial |
$4,357.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,413.60
|
| Rate for Payer: Cash Price |
$2,829.23
|
| Rate for Payer: Cigna Commercial |
$4,696.52
|
| Rate for Payer: First Health Commercial |
$5,375.54
|
| Rate for Payer: Humana Commercial |
$4,809.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,639.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,175.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,697.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,979.44
|
| Rate for Payer: Ohio Health Group HMO |
$4,243.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,526.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,922.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,904.34
|
| Rate for Payer: PHCS Commercial |
$5,432.12
|
| Rate for Payer: United Healthcare All Payer |
$4,979.44
|
|
|
PLATE VOL DIS RAD 7H 2.4*47 R
|
Facility
|
OP
|
$5,658.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,697.54 |
| Max. Negotiated Rate |
$5,432.12 |
| Rate for Payer: Aetna Commercial |
$4,357.01
|
| Rate for Payer: Anthem Medicaid |
$1,945.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,413.60
|
| Rate for Payer: Cash Price |
$2,829.23
|
| Rate for Payer: Cigna Commercial |
$4,696.52
|
| Rate for Payer: First Health Commercial |
$5,375.54
|
| Rate for Payer: Humana Commercial |
$4,809.69
|
| Rate for Payer: Humana KY Medicaid |
$1,945.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,965.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,639.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,175.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,697.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,984.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,979.44
|
| Rate for Payer: Ohio Health Group HMO |
$4,243.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,526.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,922.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,904.34
|
| Rate for Payer: PHCS Commercial |
$5,432.12
|
| Rate for Payer: United Healthcare All Payer |
$4,979.44
|
|
|
PLATE VOL DIS RAD 7H 2.4*55 L
|
Facility
|
IP
|
$7,042.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,112.77 |
| Max. Negotiated Rate |
$6,760.86 |
| Rate for Payer: Aetna Commercial |
$5,422.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.20
|
| Rate for Payer: Cash Price |
$3,521.28
|
| Rate for Payer: Cigna Commercial |
$5,845.32
|
| Rate for Payer: First Health Commercial |
$6,690.43
|
| Rate for Payer: Humana Commercial |
$5,986.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,281.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,634.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,127.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,859.37
|
| Rate for Payer: PHCS Commercial |
$6,760.86
|
| Rate for Payer: United Healthcare All Payer |
$6,197.45
|
|
|
PLATE VOL DIS RAD 7H 2.4*55 L
|
Facility
|
OP
|
$7,042.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,112.77 |
| Max. Negotiated Rate |
$6,760.86 |
| Rate for Payer: Aetna Commercial |
$5,422.77
|
| Rate for Payer: Anthem Medicaid |
$2,421.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.20
|
| Rate for Payer: Cash Price |
$3,521.28
|
| Rate for Payer: Cigna Commercial |
$5,845.32
|
| Rate for Payer: First Health Commercial |
$6,690.43
|
| Rate for Payer: Humana Commercial |
$5,986.18
|
| Rate for Payer: Humana KY Medicaid |
$2,421.94
|
| Rate for Payer: Kentucky WC Medicaid |
$2,446.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,470.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,281.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,634.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,127.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,859.37
|
| Rate for Payer: PHCS Commercial |
$6,760.86
|
| Rate for Payer: United Healthcare All Payer |
$6,197.45
|
|
|
PLATE VOL DIS RAD 7H 2.4*55 R
|
Facility
|
IP
|
$7,042.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,112.77 |
| Max. Negotiated Rate |
$6,760.86 |
| Rate for Payer: Aetna Commercial |
$5,422.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.20
|
| Rate for Payer: Cash Price |
$3,521.28
|
| Rate for Payer: Cigna Commercial |
$5,845.32
|
| Rate for Payer: First Health Commercial |
$6,690.43
|
| Rate for Payer: Humana Commercial |
$5,986.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,281.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,634.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,127.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,859.37
|
| Rate for Payer: PHCS Commercial |
$6,760.86
|
| Rate for Payer: United Healthcare All Payer |
$6,197.45
|
|
|
PLATE VOL DIS RAD 7H 2.4*55 R
|
Facility
|
OP
|
$7,042.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,112.77 |
| Max. Negotiated Rate |
$6,760.86 |
| Rate for Payer: Aetna Commercial |
$5,422.77
|
| Rate for Payer: Anthem Medicaid |
$2,421.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.20
|
| Rate for Payer: Cash Price |
$3,521.28
|
| Rate for Payer: Cigna Commercial |
$5,845.32
|
| Rate for Payer: First Health Commercial |
$6,690.43
|
| Rate for Payer: Humana Commercial |
$5,986.18
|
| Rate for Payer: Humana KY Medicaid |
$2,421.94
|
| Rate for Payer: Kentucky WC Medicaid |
$2,446.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,470.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,281.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,634.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,127.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,859.37
|
| Rate for Payer: PHCS Commercial |
$6,760.86
|
| Rate for Payer: United Healthcare All Payer |
$6,197.45
|
|
|
PLATE VOL DIS RAD 7H 2.4*68 L
|
Facility
|
IP
|
$7,015.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,104.78 |
| Max. Negotiated Rate |
$6,735.31 |
| Rate for Payer: Aetna Commercial |
$5,402.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.44
|
| Rate for Payer: Cash Price |
$3,507.97
|
| Rate for Payer: Cigna Commercial |
$5,823.24
|
| Rate for Payer: First Health Commercial |
$6,665.15
|
| Rate for Payer: Humana Commercial |
$5,963.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,753.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,174.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,612.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,103.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,841.01
|
| Rate for Payer: PHCS Commercial |
$6,735.31
|
| Rate for Payer: United Healthcare All Payer |
$6,174.04
|
|
|
PLATE VOL DIS RAD 7H 2.4*68 L
|
Facility
|
OP
|
$7,015.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,104.78 |
| Max. Negotiated Rate |
$6,735.31 |
| Rate for Payer: Aetna Commercial |
$5,402.28
|
| Rate for Payer: Anthem Medicaid |
$2,412.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.44
|
| Rate for Payer: Cash Price |
$3,507.97
|
| Rate for Payer: Cigna Commercial |
$5,823.24
|
| Rate for Payer: First Health Commercial |
$6,665.15
|
| Rate for Payer: Humana Commercial |
$5,963.56
|
| Rate for Payer: Humana KY Medicaid |
$2,412.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,437.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,753.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,461.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,174.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,612.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,103.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,841.01
|
| Rate for Payer: PHCS Commercial |
$6,735.31
|
| Rate for Payer: United Healthcare All Payer |
$6,174.04
|
|
|
PLATE VOL DIS RAD 7H 2.4*68 R
|
Facility
|
IP
|
$7,196.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,159.00 |
| Max. Negotiated Rate |
$6,908.79 |
| Rate for Payer: Aetna Commercial |
$5,541.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,613.39
|
| Rate for Payer: Cash Price |
$3,598.33
|
| Rate for Payer: Cigna Commercial |
$5,973.23
|
| Rate for Payer: First Health Commercial |
$6,836.83
|
| Rate for Payer: Humana Commercial |
$6,117.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,901.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,311.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,159.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,333.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,397.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,757.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,261.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,965.70
|
| Rate for Payer: PHCS Commercial |
$6,908.79
|
| Rate for Payer: United Healthcare All Payer |
$6,333.06
|
|
|
PLATE VOL DIS RAD 7H 2.4*68 R
|
Facility
|
OP
|
$7,196.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,159.00 |
| Max. Negotiated Rate |
$6,908.79 |
| Rate for Payer: Aetna Commercial |
$5,541.43
|
| Rate for Payer: Anthem Medicaid |
$2,474.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,613.39
|
| Rate for Payer: Cash Price |
$3,598.33
|
| Rate for Payer: Cigna Commercial |
$5,973.23
|
| Rate for Payer: First Health Commercial |
$6,836.83
|
| Rate for Payer: Humana Commercial |
$6,117.16
|
| Rate for Payer: Humana KY Medicaid |
$2,474.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,500.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,901.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,311.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,159.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,524.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,333.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,397.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,757.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,261.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,965.70
|
| Rate for Payer: PHCS Commercial |
$6,908.79
|
| Rate for Payer: United Healthcare All Payer |
$6,333.06
|
|
|
PLATE VOL DIS RAD 7H 2.4*77 L
|
Facility
|
IP
|
$7,042.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,112.77 |
| Max. Negotiated Rate |
$6,760.86 |
| Rate for Payer: Aetna Commercial |
$5,422.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.20
|
| Rate for Payer: Cash Price |
$3,521.28
|
| Rate for Payer: Cigna Commercial |
$5,845.32
|
| Rate for Payer: First Health Commercial |
$6,690.43
|
| Rate for Payer: Humana Commercial |
$5,986.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,281.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,634.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,127.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,859.37
|
| Rate for Payer: PHCS Commercial |
$6,760.86
|
| Rate for Payer: United Healthcare All Payer |
$6,197.45
|
|
|
PLATE VOL DIS RAD 7H 2.4*77 L
|
Facility
|
OP
|
$7,042.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,112.77 |
| Max. Negotiated Rate |
$6,760.86 |
| Rate for Payer: Aetna Commercial |
$5,422.77
|
| Rate for Payer: Anthem Medicaid |
$2,421.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.20
|
| Rate for Payer: Cash Price |
$3,521.28
|
| Rate for Payer: Cigna Commercial |
$5,845.32
|
| Rate for Payer: First Health Commercial |
$6,690.43
|
| Rate for Payer: Humana Commercial |
$5,986.18
|
| Rate for Payer: Humana KY Medicaid |
$2,421.94
|
| Rate for Payer: Kentucky WC Medicaid |
$2,446.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,470.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,281.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,634.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,127.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,859.37
|
| Rate for Payer: PHCS Commercial |
$6,760.86
|
| Rate for Payer: United Healthcare All Payer |
$6,197.45
|
|
|
PLATE VOL DIS RAD 7H 2.4*77 R
|
Facility
|
OP
|
$7,042.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,112.77 |
| Max. Negotiated Rate |
$6,760.86 |
| Rate for Payer: Aetna Commercial |
$5,422.77
|
| Rate for Payer: Anthem Medicaid |
$2,421.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.20
|
| Rate for Payer: Cash Price |
$3,521.28
|
| Rate for Payer: Cigna Commercial |
$5,845.32
|
| Rate for Payer: First Health Commercial |
$6,690.43
|
| Rate for Payer: Humana Commercial |
$5,986.18
|
| Rate for Payer: Humana KY Medicaid |
$2,421.94
|
| Rate for Payer: Kentucky WC Medicaid |
$2,446.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,470.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,281.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,634.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,127.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,859.37
|
| Rate for Payer: PHCS Commercial |
$6,760.86
|
| Rate for Payer: United Healthcare All Payer |
$6,197.45
|
|
|
PLATE VOL DIS RAD 7H 2.4*77 R
|
Facility
|
IP
|
$7,042.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,112.77 |
| Max. Negotiated Rate |
$6,760.86 |
| Rate for Payer: Aetna Commercial |
$5,422.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.20
|
| Rate for Payer: Cash Price |
$3,521.28
|
| Rate for Payer: Cigna Commercial |
$5,845.32
|
| Rate for Payer: First Health Commercial |
$6,690.43
|
| Rate for Payer: Humana Commercial |
$5,986.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,281.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,634.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,127.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,859.37
|
| Rate for Payer: PHCS Commercial |
$6,760.86
|
| Rate for Payer: United Healthcare All Payer |
$6,197.45
|
|
|
PLATE VOL DIS RAD NAR 2.4*51 L
|
Facility
|
OP
|
$7,042.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,112.77 |
| Max. Negotiated Rate |
$6,760.86 |
| Rate for Payer: Aetna Commercial |
$5,422.77
|
| Rate for Payer: Anthem Medicaid |
$2,421.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.20
|
| Rate for Payer: Cash Price |
$3,521.28
|
| Rate for Payer: Cigna Commercial |
$5,845.32
|
| Rate for Payer: First Health Commercial |
$6,690.43
|
| Rate for Payer: Humana Commercial |
$5,986.18
|
| Rate for Payer: Humana KY Medicaid |
$2,421.94
|
| Rate for Payer: Kentucky WC Medicaid |
$2,446.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,470.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,281.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,634.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,127.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,859.37
|
| Rate for Payer: PHCS Commercial |
$6,760.86
|
| Rate for Payer: United Healthcare All Payer |
$6,197.45
|
|
|
PLATE VOL DIS RAD NAR 2.4*51 L
|
Facility
|
IP
|
$7,042.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,112.77 |
| Max. Negotiated Rate |
$6,760.86 |
| Rate for Payer: Aetna Commercial |
$5,422.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.20
|
| Rate for Payer: Cash Price |
$3,521.28
|
| Rate for Payer: Cigna Commercial |
$5,845.32
|
| Rate for Payer: First Health Commercial |
$6,690.43
|
| Rate for Payer: Humana Commercial |
$5,986.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,281.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,634.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,127.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,859.37
|
| Rate for Payer: PHCS Commercial |
$6,760.86
|
| Rate for Payer: United Healthcare All Payer |
$6,197.45
|
|
|
PLATE VOL DIS RAD NAR 2.4*63 L
|
Facility
|
IP
|
$6,843.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,052.90 |
| Max. Negotiated Rate |
$6,569.29 |
| Rate for Payer: Aetna Commercial |
$5,269.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,337.55
|
| Rate for Payer: Cash Price |
$3,421.51
|
| Rate for Payer: Cigna Commercial |
$5,679.70
|
| Rate for Payer: First Health Commercial |
$6,500.86
|
| Rate for Payer: Humana Commercial |
$5,816.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,611.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,050.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,052.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,021.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,132.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,474.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,953.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,721.68
|
| Rate for Payer: PHCS Commercial |
$6,569.29
|
| Rate for Payer: United Healthcare All Payer |
$6,021.85
|
|
|
PLATE VOL DIS RAD NAR 2.4*63 L
|
Facility
|
OP
|
$6,843.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,052.90 |
| Max. Negotiated Rate |
$6,569.29 |
| Rate for Payer: Aetna Commercial |
$5,269.12
|
| Rate for Payer: Anthem Medicaid |
$2,353.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,337.55
|
| Rate for Payer: Cash Price |
$3,421.51
|
| Rate for Payer: Cigna Commercial |
$5,679.70
|
| Rate for Payer: First Health Commercial |
$6,500.86
|
| Rate for Payer: Humana Commercial |
$5,816.56
|
| Rate for Payer: Humana KY Medicaid |
$2,353.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,377.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,611.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,050.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,052.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,400.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,021.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,132.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,474.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,953.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,721.68
|
| Rate for Payer: PHCS Commercial |
$6,569.29
|
| Rate for Payer: United Healthcare All Payer |
$6,021.85
|
|
|
PLATE VOL DIS RAD NAR 2.4*72 L
|
Facility
|
IP
|
$5,658.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,697.54 |
| Max. Negotiated Rate |
$5,432.12 |
| Rate for Payer: Aetna Commercial |
$4,357.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,413.60
|
| Rate for Payer: Cash Price |
$2,829.23
|
| Rate for Payer: Cigna Commercial |
$4,696.52
|
| Rate for Payer: First Health Commercial |
$5,375.54
|
| Rate for Payer: Humana Commercial |
$4,809.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,639.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,175.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,697.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,979.44
|
| Rate for Payer: Ohio Health Group HMO |
$4,243.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,526.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,922.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,904.34
|
| Rate for Payer: PHCS Commercial |
$5,432.12
|
| Rate for Payer: United Healthcare All Payer |
$4,979.44
|
|
|
PLATE VOL DIS RAD NAR 2.4*72 L
|
Facility
|
OP
|
$5,658.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,697.54 |
| Max. Negotiated Rate |
$5,432.12 |
| Rate for Payer: Aetna Commercial |
$4,357.01
|
| Rate for Payer: Anthem Medicaid |
$1,945.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,413.60
|
| Rate for Payer: Cash Price |
$2,829.23
|
| Rate for Payer: Cigna Commercial |
$4,696.52
|
| Rate for Payer: First Health Commercial |
$5,375.54
|
| Rate for Payer: Humana Commercial |
$4,809.69
|
| Rate for Payer: Humana KY Medicaid |
$1,945.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,965.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,639.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,175.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,697.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,984.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,979.44
|
| Rate for Payer: Ohio Health Group HMO |
$4,243.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,526.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,922.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,904.34
|
| Rate for Payer: PHCS Commercial |
$5,432.12
|
| Rate for Payer: United Healthcare All Payer |
$4,979.44
|
|
|
PLATE VOL DIS RAD TI NAR 3H L
|
Facility
|
IP
|
$5,130.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,539.09 |
| Max. Negotiated Rate |
$4,925.10 |
| Rate for Payer: Aetna Commercial |
$3,950.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,001.64
|
| Rate for Payer: Cash Price |
$2,565.16
|
| Rate for Payer: Cigna Commercial |
$4,258.16
|
| Rate for Payer: First Health Commercial |
$4,873.79
|
| Rate for Payer: Humana Commercial |
$4,360.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,206.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,786.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,539.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,514.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,847.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,104.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,463.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,539.91
|
| Rate for Payer: PHCS Commercial |
$4,925.10
|
| Rate for Payer: United Healthcare All Payer |
$4,514.67
|
|
|
PLATE VOL DIS RAD TI NAR 3H L
|
Facility
|
OP
|
$5,130.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,539.09 |
| Max. Negotiated Rate |
$4,925.10 |
| Rate for Payer: Aetna Commercial |
$3,950.34
|
| Rate for Payer: Anthem Medicaid |
$1,764.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,001.64
|
| Rate for Payer: Cash Price |
$2,565.16
|
| Rate for Payer: Cigna Commercial |
$4,258.16
|
| Rate for Payer: First Health Commercial |
$4,873.79
|
| Rate for Payer: Humana Commercial |
$4,360.76
|
| Rate for Payer: Humana KY Medicaid |
$1,764.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,782.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,206.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,786.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,539.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,799.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,514.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,847.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,104.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,463.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,539.91
|
| Rate for Payer: PHCS Commercial |
$4,925.10
|
| Rate for Payer: United Healthcare All Payer |
$4,514.67
|
|
|
PLATE VOL DIS RAD TI NAR 5H L
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
PLATE VOL DIS RAD TI NAR 5H L
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
