|
PLATE MINI-MOD 2.0 STOUT 6H
|
Facility
|
IP
|
$4,261.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.38 |
| Max. Negotiated Rate |
$4,090.80 |
| Rate for Payer: Aetna Commercial |
$3,281.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,323.78
|
| Rate for Payer: Cash Price |
$2,130.62
|
| Rate for Payer: Cigna Commercial |
$3,536.84
|
| Rate for Payer: First Health Commercial |
$4,048.19
|
| Rate for Payer: Humana Commercial |
$3,622.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,494.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,144.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,749.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,409.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,707.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,940.26
|
| Rate for Payer: PHCS Commercial |
$4,090.80
|
| Rate for Payer: United Healthcare All Payer |
$3,749.90
|
|
|
PLATE MINI-MOD 2.4 MESH 12*3H
|
Facility
|
OP
|
$7,732.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,319.61 |
| Max. Negotiated Rate |
$7,422.76 |
| Rate for Payer: Aetna Commercial |
$5,953.67
|
| Rate for Payer: Anthem Medicaid |
$2,659.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,030.99
|
| Rate for Payer: Cash Price |
$3,866.02
|
| Rate for Payer: Cigna Commercial |
$6,417.59
|
| Rate for Payer: First Health Commercial |
$7,345.44
|
| Rate for Payer: Humana Commercial |
$6,572.23
|
| Rate for Payer: Humana KY Medicaid |
$2,659.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,686.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,340.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,706.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,319.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,712.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,804.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,799.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,185.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,726.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,335.11
|
| Rate for Payer: PHCS Commercial |
$7,422.76
|
| Rate for Payer: United Healthcare All Payer |
$6,804.20
|
|
|
PLATE MINI-MOD 2.4 MESH 12*3H
|
Facility
|
IP
|
$7,732.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,319.61 |
| Max. Negotiated Rate |
$7,422.76 |
| Rate for Payer: Aetna Commercial |
$5,953.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,030.99
|
| Rate for Payer: Cash Price |
$3,866.02
|
| Rate for Payer: Cigna Commercial |
$6,417.59
|
| Rate for Payer: First Health Commercial |
$7,345.44
|
| Rate for Payer: Humana Commercial |
$6,572.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,340.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,706.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,319.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,804.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,799.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,185.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,726.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,335.11
|
| Rate for Payer: PHCS Commercial |
$7,422.76
|
| Rate for Payer: United Healthcare All Payer |
$6,804.20
|
|
|
PLATE MINI-MOD 2.4 STOUT 12H
|
Facility
|
OP
|
$5,567.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,670.33 |
| Max. Negotiated Rate |
$5,345.04 |
| Rate for Payer: Aetna Commercial |
$4,287.17
|
| Rate for Payer: Anthem Medicaid |
$1,914.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,342.85
|
| Rate for Payer: Cash Price |
$2,783.88
|
| Rate for Payer: Cigna Commercial |
$4,621.23
|
| Rate for Payer: First Health Commercial |
$5,289.36
|
| Rate for Payer: Humana Commercial |
$4,732.59
|
| Rate for Payer: Humana KY Medicaid |
$1,914.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,934.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,565.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,109.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,670.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,953.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,899.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,175.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,454.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,843.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,841.75
|
| Rate for Payer: PHCS Commercial |
$5,345.04
|
| Rate for Payer: United Healthcare All Payer |
$4,899.62
|
|
|
PLATE MINI-MOD 2.4 STOUT 12H
|
Facility
|
IP
|
$5,567.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,670.33 |
| Max. Negotiated Rate |
$5,345.04 |
| Rate for Payer: Aetna Commercial |
$4,287.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,342.85
|
| Rate for Payer: Cash Price |
$2,783.88
|
| Rate for Payer: Cigna Commercial |
$4,621.23
|
| Rate for Payer: First Health Commercial |
$5,289.36
|
| Rate for Payer: Humana Commercial |
$4,732.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,565.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,109.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,670.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,899.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,175.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,454.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,843.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,841.75
|
| Rate for Payer: PHCS Commercial |
$5,345.04
|
| Rate for Payer: United Healthcare All Payer |
$4,899.62
|
|
|
PLATE MINI-MOD 2.4 STOUT 6H
|
Facility
|
OP
|
$4,261.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.38 |
| Max. Negotiated Rate |
$4,090.80 |
| Rate for Payer: Aetna Commercial |
$3,281.16
|
| Rate for Payer: Anthem Medicaid |
$1,465.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,323.78
|
| Rate for Payer: Cash Price |
$2,130.62
|
| Rate for Payer: Cigna Commercial |
$3,536.84
|
| Rate for Payer: First Health Commercial |
$4,048.19
|
| Rate for Payer: Humana Commercial |
$3,622.06
|
| Rate for Payer: Humana KY Medicaid |
$1,465.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,480.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,494.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,144.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,494.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,749.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,409.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,707.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,940.26
|
| Rate for Payer: PHCS Commercial |
$4,090.80
|
| Rate for Payer: United Healthcare All Payer |
$3,749.90
|
|
|
PLATE MINI-MOD 2.4 STOUT 6H
|
Facility
|
IP
|
$4,261.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.38 |
| Max. Negotiated Rate |
$4,090.80 |
| Rate for Payer: Aetna Commercial |
$3,281.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,323.78
|
| Rate for Payer: Cash Price |
$2,130.62
|
| Rate for Payer: Cigna Commercial |
$3,536.84
|
| Rate for Payer: First Health Commercial |
$4,048.19
|
| Rate for Payer: Humana Commercial |
$3,622.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,494.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,144.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,749.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,409.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,707.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,940.26
|
| Rate for Payer: PHCS Commercial |
$4,090.80
|
| Rate for Payer: United Healthcare All Payer |
$3,749.90
|
|
|
PLATE MINI-MOD 2.4 STOUT 8H
|
Facility
|
OP
|
$4,914.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,474.35 |
| Max. Negotiated Rate |
$4,717.92 |
| Rate for Payer: Aetna Commercial |
$3,784.16
|
| Rate for Payer: Anthem Medicaid |
$1,690.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,833.31
|
| Rate for Payer: Cash Price |
$2,457.25
|
| Rate for Payer: Cigna Commercial |
$4,079.03
|
| Rate for Payer: First Health Commercial |
$4,668.77
|
| Rate for Payer: Humana Commercial |
$4,177.32
|
| Rate for Payer: Humana KY Medicaid |
$1,690.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,707.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,029.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,626.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,474.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,724.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,324.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,685.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,931.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,275.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,391.01
|
| Rate for Payer: PHCS Commercial |
$4,717.92
|
| Rate for Payer: United Healthcare All Payer |
$4,324.76
|
|
|
PLATE MINI-MOD 2.4 STOUT 8H
|
Facility
|
IP
|
$4,914.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,474.35 |
| Max. Negotiated Rate |
$4,717.92 |
| Rate for Payer: Aetna Commercial |
$3,784.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,833.31
|
| Rate for Payer: Cash Price |
$2,457.25
|
| Rate for Payer: Cigna Commercial |
$4,079.03
|
| Rate for Payer: First Health Commercial |
$4,668.77
|
| Rate for Payer: Humana Commercial |
$4,177.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,029.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,626.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,474.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,324.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,685.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,931.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,275.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,391.01
|
| Rate for Payer: PHCS Commercial |
$4,717.92
|
| Rate for Payer: United Healthcare All Payer |
$4,324.76
|
|
|
PLATE MINIMOD 2.4 TALS LL 3H L
|
Facility
|
OP
|
$5,050.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,515.24 |
| Max. Negotiated Rate |
$4,848.78 |
| Rate for Payer: Aetna Commercial |
$3,889.12
|
| Rate for Payer: Anthem Medicaid |
$1,736.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.63
|
| Rate for Payer: Cash Price |
$2,525.41
|
| Rate for Payer: Cigna Commercial |
$4,192.17
|
| Rate for Payer: First Health Commercial |
$4,798.27
|
| Rate for Payer: Humana Commercial |
$4,293.19
|
| Rate for Payer: Humana KY Medicaid |
$1,736.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,754.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,771.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,444.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,040.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,394.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,485.06
|
| Rate for Payer: PHCS Commercial |
$4,848.78
|
| Rate for Payer: United Healthcare All Payer |
$4,444.71
|
|
|
PLATE MINIMOD 2.4 TALS LL 3H L
|
Facility
|
IP
|
$5,050.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,515.24 |
| Max. Negotiated Rate |
$4,848.78 |
| Rate for Payer: Aetna Commercial |
$3,889.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.63
|
| Rate for Payer: Cash Price |
$2,525.41
|
| Rate for Payer: Cigna Commercial |
$4,192.17
|
| Rate for Payer: First Health Commercial |
$4,798.27
|
| Rate for Payer: Humana Commercial |
$4,293.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,444.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,040.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,394.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,485.06
|
| Rate for Payer: PHCS Commercial |
$4,848.78
|
| Rate for Payer: United Healthcare All Payer |
$4,444.71
|
|
|
PLATE MINIMOD 2.4 TALS LL 3H R
|
Facility
|
IP
|
$5,050.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,515.24 |
| Max. Negotiated Rate |
$4,848.78 |
| Rate for Payer: Aetna Commercial |
$3,889.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.63
|
| Rate for Payer: Cash Price |
$2,525.41
|
| Rate for Payer: Cigna Commercial |
$4,192.17
|
| Rate for Payer: First Health Commercial |
$4,798.27
|
| Rate for Payer: Humana Commercial |
$4,293.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,444.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,040.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,394.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,485.06
|
| Rate for Payer: PHCS Commercial |
$4,848.78
|
| Rate for Payer: United Healthcare All Payer |
$4,444.71
|
|
|
PLATE MINIMOD 2.4 TALS LL 3H R
|
Facility
|
OP
|
$5,050.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,515.24 |
| Max. Negotiated Rate |
$4,848.78 |
| Rate for Payer: Aetna Commercial |
$3,889.12
|
| Rate for Payer: Anthem Medicaid |
$1,736.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.63
|
| Rate for Payer: Cash Price |
$2,525.41
|
| Rate for Payer: Cigna Commercial |
$4,192.17
|
| Rate for Payer: First Health Commercial |
$4,798.27
|
| Rate for Payer: Humana Commercial |
$4,293.19
|
| Rate for Payer: Humana KY Medicaid |
$1,736.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,754.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,771.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,444.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,040.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,394.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,485.06
|
| Rate for Payer: PHCS Commercial |
$4,848.78
|
| Rate for Payer: United Healthcare All Payer |
$4,444.71
|
|
|
PLATE MINIMOD 2.4 TALS LL 4H L
|
Facility
|
OP
|
$5,050.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,515.24 |
| Max. Negotiated Rate |
$4,848.78 |
| Rate for Payer: Aetna Commercial |
$3,889.12
|
| Rate for Payer: Anthem Medicaid |
$1,736.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.63
|
| Rate for Payer: Cash Price |
$2,525.41
|
| Rate for Payer: Cigna Commercial |
$4,192.17
|
| Rate for Payer: First Health Commercial |
$4,798.27
|
| Rate for Payer: Humana Commercial |
$4,293.19
|
| Rate for Payer: Humana KY Medicaid |
$1,736.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,754.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,771.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,444.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,040.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,394.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,485.06
|
| Rate for Payer: PHCS Commercial |
$4,848.78
|
| Rate for Payer: United Healthcare All Payer |
$4,444.71
|
|
|
PLATE MINIMOD 2.4 TALS LL 4H L
|
Facility
|
IP
|
$5,050.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,515.24 |
| Max. Negotiated Rate |
$4,848.78 |
| Rate for Payer: Aetna Commercial |
$3,889.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.63
|
| Rate for Payer: Cash Price |
$2,525.41
|
| Rate for Payer: Cigna Commercial |
$4,192.17
|
| Rate for Payer: First Health Commercial |
$4,798.27
|
| Rate for Payer: Humana Commercial |
$4,293.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,444.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,040.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,394.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,485.06
|
| Rate for Payer: PHCS Commercial |
$4,848.78
|
| Rate for Payer: United Healthcare All Payer |
$4,444.71
|
|
|
PLATE MINIMOD 2.4 TALS LL 4H R
|
Facility
|
IP
|
$5,050.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,515.24 |
| Max. Negotiated Rate |
$4,848.78 |
| Rate for Payer: Aetna Commercial |
$3,889.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.63
|
| Rate for Payer: Cash Price |
$2,525.41
|
| Rate for Payer: Cigna Commercial |
$4,192.17
|
| Rate for Payer: First Health Commercial |
$4,798.27
|
| Rate for Payer: Humana Commercial |
$4,293.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,444.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,040.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,394.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,485.06
|
| Rate for Payer: PHCS Commercial |
$4,848.78
|
| Rate for Payer: United Healthcare All Payer |
$4,444.71
|
|
|
PLATE MINIMOD 2.4 TALS LL 4H R
|
Facility
|
OP
|
$5,050.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,515.24 |
| Max. Negotiated Rate |
$4,848.78 |
| Rate for Payer: Aetna Commercial |
$3,889.12
|
| Rate for Payer: Anthem Medicaid |
$1,736.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.63
|
| Rate for Payer: Cash Price |
$2,525.41
|
| Rate for Payer: Cigna Commercial |
$4,192.17
|
| Rate for Payer: First Health Commercial |
$4,798.27
|
| Rate for Payer: Humana Commercial |
$4,293.19
|
| Rate for Payer: Humana KY Medicaid |
$1,736.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,754.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,771.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,444.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,040.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,394.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,485.06
|
| Rate for Payer: PHCS Commercial |
$4,848.78
|
| Rate for Payer: United Healthcare All Payer |
$4,444.71
|
|
|
PLATE MINIMOD 2.4 TALS MDL L L
|
Facility
|
OP
|
$4,544.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,363.20 |
| Max. Negotiated Rate |
$4,362.24 |
| Rate for Payer: Aetna Commercial |
$3,498.88
|
| Rate for Payer: Anthem Medicaid |
$1,562.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,544.32
|
| Rate for Payer: Cash Price |
$2,272.00
|
| Rate for Payer: Cigna Commercial |
$3,771.52
|
| Rate for Payer: First Health Commercial |
$4,316.80
|
| Rate for Payer: Humana Commercial |
$3,862.40
|
| Rate for Payer: Humana KY Medicaid |
$1,562.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,578.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,726.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,353.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,363.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,594.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,998.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,408.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,635.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,953.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,135.36
|
| Rate for Payer: PHCS Commercial |
$4,362.24
|
| Rate for Payer: United Healthcare All Payer |
$3,998.72
|
|
|
PLATE MINIMOD 2.4 TALS MDL L L
|
Facility
|
IP
|
$4,544.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,363.20 |
| Max. Negotiated Rate |
$4,362.24 |
| Rate for Payer: Aetna Commercial |
$3,498.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,544.32
|
| Rate for Payer: Cash Price |
$2,272.00
|
| Rate for Payer: Cigna Commercial |
$3,771.52
|
| Rate for Payer: First Health Commercial |
$4,316.80
|
| Rate for Payer: Humana Commercial |
$3,862.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,726.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,353.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,363.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,998.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,408.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,635.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,953.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,135.36
|
| Rate for Payer: PHCS Commercial |
$4,362.24
|
| Rate for Payer: United Healthcare All Payer |
$3,998.72
|
|
|
PLATE MINIMOD 2.4 TALS MDL L R
|
Facility
|
OP
|
$4,544.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,363.20 |
| Max. Negotiated Rate |
$4,362.24 |
| Rate for Payer: Aetna Commercial |
$3,498.88
|
| Rate for Payer: Anthem Medicaid |
$1,562.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,544.32
|
| Rate for Payer: Cash Price |
$2,272.00
|
| Rate for Payer: Cigna Commercial |
$3,771.52
|
| Rate for Payer: First Health Commercial |
$4,316.80
|
| Rate for Payer: Humana Commercial |
$3,862.40
|
| Rate for Payer: Humana KY Medicaid |
$1,562.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,578.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,726.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,353.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,363.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,594.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,998.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,408.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,635.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,953.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,135.36
|
| Rate for Payer: PHCS Commercial |
$4,362.24
|
| Rate for Payer: United Healthcare All Payer |
$3,998.72
|
|
|
PLATE MINIMOD 2.4 TALS MDL L R
|
Facility
|
IP
|
$4,544.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,363.20 |
| Max. Negotiated Rate |
$4,362.24 |
| Rate for Payer: Aetna Commercial |
$3,498.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,544.32
|
| Rate for Payer: Cash Price |
$2,272.00
|
| Rate for Payer: Cigna Commercial |
$3,771.52
|
| Rate for Payer: First Health Commercial |
$4,316.80
|
| Rate for Payer: Humana Commercial |
$3,862.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,726.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,353.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,363.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,998.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,408.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,635.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,953.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,135.36
|
| Rate for Payer: PHCS Commercial |
$4,362.24
|
| Rate for Payer: United Healthcare All Payer |
$3,998.72
|
|
|
PLATE MINIMOD 2.4 TALS MDL T L
|
Facility
|
OP
|
$4,544.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,363.20 |
| Max. Negotiated Rate |
$4,362.24 |
| Rate for Payer: Aetna Commercial |
$3,498.88
|
| Rate for Payer: Anthem Medicaid |
$1,562.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,544.32
|
| Rate for Payer: Cash Price |
$2,272.00
|
| Rate for Payer: Cigna Commercial |
$3,771.52
|
| Rate for Payer: First Health Commercial |
$4,316.80
|
| Rate for Payer: Humana Commercial |
$3,862.40
|
| Rate for Payer: Humana KY Medicaid |
$1,562.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,578.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,726.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,353.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,363.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,594.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,998.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,408.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,635.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,953.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,135.36
|
| Rate for Payer: PHCS Commercial |
$4,362.24
|
| Rate for Payer: United Healthcare All Payer |
$3,998.72
|
|
|
PLATE MINIMOD 2.4 TALS MDL T L
|
Facility
|
IP
|
$4,544.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,363.20 |
| Max. Negotiated Rate |
$4,362.24 |
| Rate for Payer: Aetna Commercial |
$3,498.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,544.32
|
| Rate for Payer: Cash Price |
$2,272.00
|
| Rate for Payer: Cigna Commercial |
$3,771.52
|
| Rate for Payer: First Health Commercial |
$4,316.80
|
| Rate for Payer: Humana Commercial |
$3,862.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,726.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,353.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,363.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,998.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,408.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,635.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,953.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,135.36
|
| Rate for Payer: PHCS Commercial |
$4,362.24
|
| Rate for Payer: United Healthcare All Payer |
$3,998.72
|
|
|
PLATE MINIMOD 2.4 TALS MDL T R
|
Facility
|
OP
|
$4,544.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,363.20 |
| Max. Negotiated Rate |
$4,362.24 |
| Rate for Payer: Aetna Commercial |
$3,498.88
|
| Rate for Payer: Anthem Medicaid |
$1,562.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,544.32
|
| Rate for Payer: Cash Price |
$2,272.00
|
| Rate for Payer: Cigna Commercial |
$3,771.52
|
| Rate for Payer: First Health Commercial |
$4,316.80
|
| Rate for Payer: Humana Commercial |
$3,862.40
|
| Rate for Payer: Humana KY Medicaid |
$1,562.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,578.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,726.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,353.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,363.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,594.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,998.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,408.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,635.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,953.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,135.36
|
| Rate for Payer: PHCS Commercial |
$4,362.24
|
| Rate for Payer: United Healthcare All Payer |
$3,998.72
|
|
|
PLATE MINIMOD 2.4 TALS MDL T R
|
Facility
|
IP
|
$4,544.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,363.20 |
| Max. Negotiated Rate |
$4,362.24 |
| Rate for Payer: Aetna Commercial |
$3,498.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,544.32
|
| Rate for Payer: Cash Price |
$2,272.00
|
| Rate for Payer: Cigna Commercial |
$3,771.52
|
| Rate for Payer: First Health Commercial |
$4,316.80
|
| Rate for Payer: Humana Commercial |
$3,862.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,726.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,353.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,363.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,998.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,408.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,635.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,953.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,135.36
|
| Rate for Payer: PHCS Commercial |
$4,362.24
|
| Rate for Payer: United Healthcare All Payer |
$3,998.72
|
|
