|
PLATE VOL DIS RAD TI WDE 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 WDE 3H R
|
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 WDE 3H R
|
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
|
|
|
PLATE VOL DIS RAD TI WDE 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 WDE 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
|
|
|
PLATE VOL DIS RAD TI WDE 5H R
|
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
|
|
|
PLATE VOL DIS RAD TI WDE 5H R
|
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 WDE 7H 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
|
|
|
PLATE VOL DIS RAD TI WDE 7H 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 WDE 7H R
|
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
|
|
|
PLATE VOL DIS RAD TI WDE 7H R
|
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 WDE 9H 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 WDE 9H 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
|
|
|
PLATE VOL DIS RAD TI WDE 9H R
|
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
|
|
|
PLATE VOL DIS RAD TI WDE 9H R
|
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 RD NAR 2.4*42 R
|
Facility
|
OP
|
$5,350.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,605.05 |
| Max. Negotiated Rate |
$5,136.17 |
| Rate for Payer: Aetna Commercial |
$4,119.64
|
| Rate for Payer: Anthem Medicaid |
$1,839.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.14
|
| Rate for Payer: Cash Price |
$2,675.09
|
| Rate for Payer: Cigna Commercial |
$4,440.65
|
| Rate for Payer: First Health Commercial |
$5,082.67
|
| Rate for Payer: Humana Commercial |
$4,547.65
|
| Rate for Payer: Humana KY Medicaid |
$1,839.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,280.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,654.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,691.62
|
| Rate for Payer: PHCS Commercial |
$5,136.17
|
| Rate for Payer: United Healthcare All Payer |
$4,708.16
|
|
|
PLATE VOL DIS RD NAR 2.4*42 R
|
Facility
|
IP
|
$5,350.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,605.05 |
| Max. Negotiated Rate |
$5,136.17 |
| Rate for Payer: Aetna Commercial |
$4,119.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.14
|
| Rate for Payer: Cash Price |
$2,675.09
|
| Rate for Payer: Cigna Commercial |
$4,440.65
|
| Rate for Payer: First Health Commercial |
$5,082.67
|
| Rate for Payer: Humana Commercial |
$4,547.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,280.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,654.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,691.62
|
| Rate for Payer: PHCS Commercial |
$5,136.17
|
| Rate for Payer: United Healthcare All Payer |
$4,708.16
|
|
|
PLATE VOL DIS RD NAR 2.4*51 R
|
Facility
|
OP
|
$6,868.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,060.55 |
| Max. Negotiated Rate |
$6,593.75 |
| Rate for Payer: Aetna Commercial |
$5,288.74
|
| Rate for Payer: Anthem Medicaid |
$2,362.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,357.42
|
| Rate for Payer: Cash Price |
$3,434.24
|
| Rate for Payer: Cigna Commercial |
$5,700.85
|
| Rate for Payer: First Health Commercial |
$6,525.07
|
| Rate for Payer: Humana Commercial |
$5,838.22
|
| Rate for Payer: Humana KY Medicaid |
$2,362.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,386.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,632.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,068.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,060.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,409.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,044.27
|
| Rate for Payer: Ohio Health Group HMO |
$5,151.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,494.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,975.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,739.26
|
| Rate for Payer: PHCS Commercial |
$6,593.75
|
| Rate for Payer: United Healthcare All Payer |
$6,044.27
|
|
|
PLATE VOL DIS RD NAR 2.4*51 R
|
Facility
|
IP
|
$6,868.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,060.55 |
| Max. Negotiated Rate |
$6,593.75 |
| Rate for Payer: Aetna Commercial |
$5,288.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,357.42
|
| Rate for Payer: Cash Price |
$3,434.24
|
| Rate for Payer: Cigna Commercial |
$5,700.85
|
| Rate for Payer: First Health Commercial |
$6,525.07
|
| Rate for Payer: Humana Commercial |
$5,838.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,632.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,068.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,060.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,044.27
|
| Rate for Payer: Ohio Health Group HMO |
$5,151.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,494.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,975.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,739.26
|
| Rate for Payer: PHCS Commercial |
$6,593.75
|
| Rate for Payer: United Healthcare All Payer |
$6,044.27
|
|
|
PLATE VOL DIS RD NAR 2.4*63 R
|
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 RD NAR 2.4*63 R
|
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 RD NAR 2.4*72 R
|
Facility
|
OP
|
$5,748.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,724.47 |
| Max. Negotiated Rate |
$5,518.31 |
| Rate for Payer: Aetna Commercial |
$4,426.14
|
| Rate for Payer: Anthem Medicaid |
$1,976.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,483.63
|
| Rate for Payer: Cash Price |
$2,874.12
|
| Rate for Payer: Cigna Commercial |
$4,771.04
|
| Rate for Payer: First Health Commercial |
$5,460.83
|
| Rate for Payer: Humana Commercial |
$4,886.00
|
| Rate for Payer: Humana KY Medicaid |
$1,976.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,996.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,713.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,242.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,724.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,016.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,058.45
|
| Rate for Payer: Ohio Health Group HMO |
$4,311.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,598.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,000.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,966.29
|
| Rate for Payer: PHCS Commercial |
$5,518.31
|
| Rate for Payer: United Healthcare All Payer |
$5,058.45
|
|
|
PLATE VOL DIS RD NAR 2.4*72 R
|
Facility
|
IP
|
$5,748.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,724.47 |
| Max. Negotiated Rate |
$5,518.31 |
| Rate for Payer: Aetna Commercial |
$4,426.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,483.63
|
| Rate for Payer: Cash Price |
$2,874.12
|
| Rate for Payer: Cigna Commercial |
$4,771.04
|
| Rate for Payer: First Health Commercial |
$5,460.83
|
| Rate for Payer: Humana Commercial |
$4,886.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,713.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,242.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,724.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,058.45
|
| Rate for Payer: Ohio Health Group HMO |
$4,311.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,598.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,000.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,966.29
|
| Rate for Payer: PHCS Commercial |
$5,518.31
|
| Rate for Payer: United Healthcare All Payer |
$5,058.45
|
|
|
PLATE VOL DIST RAD 4H 2.4*48 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 DIST RAD 4H 2.4*48 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
|
|
