PLATE TI TUB W/COLLAR 5H 61MM
|
Facility
|
IP
|
$1,132.12
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$147.18 |
Max. Negotiated Rate |
$1,086.84 |
Rate for Payer: Aetna Commercial |
$871.73
|
Rate for Payer: Anthem POS/PPO/Traditional |
$883.05
|
Rate for Payer: Cash Price |
$566.06
|
Rate for Payer: Cigna Commercial |
$939.66
|
Rate for Payer: First Health Commercial |
$1,075.51
|
Rate for Payer: Humana Commercial |
$962.30
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$928.34
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$835.50
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$339.64
|
Rate for Payer: Ohio Health Choice Commercial |
$996.27
|
Rate for Payer: Ohio Health Group HMO |
$849.09
|
Rate for Payer: Ohio Health Group PPO Differential |
$226.42
|
Rate for Payer: Ohio Health Group PPO No Differential |
$147.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.96
|
Rate for Payer: PHCS Commercial |
$1,086.84
|
Rate for Payer: United Healthcare All Payer |
$996.27
|
|
PLATE TI TUB W/COLLAR 6H 73MM
|
Facility
|
IP
|
$1,142.57
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$148.53 |
Max. Negotiated Rate |
$1,096.87 |
Rate for Payer: Aetna Commercial |
$879.78
|
Rate for Payer: Anthem POS/PPO/Traditional |
$891.20
|
Rate for Payer: Cash Price |
$571.29
|
Rate for Payer: Cigna Commercial |
$948.33
|
Rate for Payer: First Health Commercial |
$1,085.44
|
Rate for Payer: Humana Commercial |
$971.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$936.91
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$843.22
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$342.77
|
Rate for Payer: Ohio Health Choice Commercial |
$1,005.46
|
Rate for Payer: Ohio Health Group HMO |
$856.93
|
Rate for Payer: Ohio Health Group PPO Differential |
$228.51
|
Rate for Payer: Ohio Health Group PPO No Differential |
$148.53
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.20
|
Rate for Payer: PHCS Commercial |
$1,096.87
|
Rate for Payer: United Healthcare All Payer |
$1,005.46
|
|
PLATE TI TUB W/COLLAR 6H 73MM
|
Facility
|
OP
|
$1,142.57
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$148.53 |
Max. Negotiated Rate |
$1,096.87 |
Rate for Payer: Aetna Commercial |
$879.78
|
Rate for Payer: Anthem Medicaid |
$392.93
|
Rate for Payer: Anthem POS/PPO/Traditional |
$891.20
|
Rate for Payer: Cash Price |
$571.29
|
Rate for Payer: Cigna Commercial |
$948.33
|
Rate for Payer: First Health Commercial |
$1,085.44
|
Rate for Payer: Humana Commercial |
$971.18
|
Rate for Payer: Humana KY Medicaid |
$392.93
|
Rate for Payer: Kentucky WC Medicaid |
$396.93
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$936.91
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$843.22
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$342.77
|
Rate for Payer: Molina Healthcare Medicaid |
$400.81
|
Rate for Payer: Ohio Health Choice Commercial |
$1,005.46
|
Rate for Payer: Ohio Health Group HMO |
$856.93
|
Rate for Payer: Ohio Health Group PPO Differential |
$228.51
|
Rate for Payer: Ohio Health Group PPO No Differential |
$148.53
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.20
|
Rate for Payer: PHCS Commercial |
$1,096.87
|
Rate for Payer: United Healthcare All Payer |
$1,005.46
|
|
PLATE TI TUB W/ COLLAR 7H 85MM
|
Facility
|
OP
|
$1,169.49
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$152.03 |
Max. Negotiated Rate |
$1,122.71 |
Rate for Payer: Humana Commercial |
$994.07
|
Rate for Payer: Humana KY Medicaid |
$402.19
|
Rate for Payer: Kentucky WC Medicaid |
$406.28
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$958.98
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.08
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$350.85
|
Rate for Payer: Molina Healthcare Medicaid |
$410.26
|
Rate for Payer: Ohio Health Choice Commercial |
$1,029.15
|
Rate for Payer: Ohio Health Group HMO |
$877.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$233.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$152.03
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.54
|
Rate for Payer: PHCS Commercial |
$1,122.71
|
Rate for Payer: United Healthcare All Payer |
$1,029.15
|
Rate for Payer: Aetna Commercial |
$900.51
|
Rate for Payer: Anthem Medicaid |
$402.19
|
Rate for Payer: Anthem POS/PPO/Traditional |
$912.20
|
Rate for Payer: Cash Price |
$584.74
|
Rate for Payer: Cigna Commercial |
$970.68
|
Rate for Payer: First Health Commercial |
$1,111.02
|
|
PLATE TI TUB W/ COLLAR 7H 85MM
|
Facility
|
IP
|
$1,169.49
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$152.03 |
Max. Negotiated Rate |
$1,122.71 |
Rate for Payer: Aetna Commercial |
$900.51
|
Rate for Payer: Anthem POS/PPO/Traditional |
$912.20
|
Rate for Payer: Cash Price |
$584.74
|
Rate for Payer: Cigna Commercial |
$970.68
|
Rate for Payer: First Health Commercial |
$1,111.02
|
Rate for Payer: Humana Commercial |
$994.07
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$958.98
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.08
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$350.85
|
Rate for Payer: Ohio Health Choice Commercial |
$1,029.15
|
Rate for Payer: Ohio Health Group HMO |
$877.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$233.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$152.03
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.54
|
Rate for Payer: PHCS Commercial |
$1,122.71
|
Rate for Payer: United Healthcare All Payer |
$1,029.15
|
|
PLATE TI TUB W/COLLAR 8H 97MM
|
Facility
|
OP
|
$1,166.65
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$151.66 |
Max. Negotiated Rate |
$1,119.98 |
Rate for Payer: Aetna Commercial |
$898.32
|
Rate for Payer: Anthem Medicaid |
$401.21
|
Rate for Payer: Anthem POS/PPO/Traditional |
$909.99
|
Rate for Payer: Cash Price |
$583.33
|
Rate for Payer: Cigna Commercial |
$968.32
|
Rate for Payer: First Health Commercial |
$1,108.32
|
Rate for Payer: Humana Commercial |
$991.65
|
Rate for Payer: Humana KY Medicaid |
$401.21
|
Rate for Payer: Kentucky WC Medicaid |
$405.29
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$956.65
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$860.99
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$350.00
|
Rate for Payer: Molina Healthcare Medicaid |
$409.26
|
Rate for Payer: Ohio Health Choice Commercial |
$1,026.65
|
Rate for Payer: Ohio Health Group HMO |
$874.99
|
Rate for Payer: Ohio Health Group PPO Differential |
$233.33
|
Rate for Payer: Ohio Health Group PPO No Differential |
$151.66
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$361.66
|
Rate for Payer: PHCS Commercial |
$1,119.98
|
Rate for Payer: United Healthcare All Payer |
$1,026.65
|
|
PLATE TI TUB W/COLLAR 8H 97MM
|
Facility
|
IP
|
$1,166.65
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$151.66 |
Max. Negotiated Rate |
$1,119.98 |
Rate for Payer: Aetna Commercial |
$898.32
|
Rate for Payer: Anthem POS/PPO/Traditional |
$909.99
|
Rate for Payer: Cash Price |
$583.33
|
Rate for Payer: Cigna Commercial |
$968.32
|
Rate for Payer: First Health Commercial |
$1,108.32
|
Rate for Payer: Humana Commercial |
$991.65
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$956.65
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$860.99
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$350.00
|
Rate for Payer: Ohio Health Choice Commercial |
$1,026.65
|
Rate for Payer: Ohio Health Group HMO |
$874.99
|
Rate for Payer: Ohio Health Group PPO Differential |
$233.33
|
Rate for Payer: Ohio Health Group PPO No Differential |
$151.66
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$361.66
|
Rate for Payer: PHCS Commercial |
$1,119.98
|
Rate for Payer: United Healthcare All Payer |
$1,026.65
|
|
PLATE TI VA-LCP 3H 2.4*37 -90
|
Facility
|
IP
|
$4,249.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$552.44 |
Max. Negotiated Rate |
$4,079.52 |
Rate for Payer: Aetna Commercial |
$3,272.12
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,314.61
|
Rate for Payer: Cash Price |
$2,124.75
|
Rate for Payer: Cigna Commercial |
$3,527.08
|
Rate for Payer: First Health Commercial |
$4,037.02
|
Rate for Payer: Humana Commercial |
$3,612.08
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,484.59
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.13
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.85
|
Rate for Payer: Ohio Health Choice Commercial |
$3,739.56
|
Rate for Payer: Ohio Health Group HMO |
$3,187.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$849.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$552.44
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,317.34
|
Rate for Payer: PHCS Commercial |
$4,079.52
|
Rate for Payer: United Healthcare All Payer |
$3,739.56
|
|
PLATE TI VA-LCP 3H 2.4*37 -90
|
Facility
|
OP
|
$4,249.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$552.44 |
Max. Negotiated Rate |
$4,079.52 |
Rate for Payer: Aetna Commercial |
$3,272.12
|
Rate for Payer: Anthem Medicaid |
$1,461.40
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,314.61
|
Rate for Payer: Cash Price |
$2,124.75
|
Rate for Payer: Cigna Commercial |
$3,527.08
|
Rate for Payer: First Health Commercial |
$4,037.02
|
Rate for Payer: Humana Commercial |
$3,612.08
|
Rate for Payer: Humana KY Medicaid |
$1,461.40
|
Rate for Payer: Kentucky WC Medicaid |
$1,476.28
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,484.59
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.13
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.85
|
Rate for Payer: Molina Healthcare Medicaid |
$1,490.72
|
Rate for Payer: Ohio Health Choice Commercial |
$3,739.56
|
Rate for Payer: Ohio Health Group HMO |
$3,187.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$849.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$552.44
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,317.34
|
Rate for Payer: PHCS Commercial |
$4,079.52
|
Rate for Payer: United Healthcare All Payer |
$3,739.56
|
|
PLATE TI VA-LCP 3H 2.4*41 +90
|
Facility
|
IP
|
$4,398.07
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$571.75 |
Max. Negotiated Rate |
$4,222.15 |
Rate for Payer: Aetna Commercial |
$3,386.51
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,430.49
|
Rate for Payer: Cash Price |
$2,199.03
|
Rate for Payer: Cigna Commercial |
$3,650.40
|
Rate for Payer: First Health Commercial |
$4,178.17
|
Rate for Payer: Humana Commercial |
$3,738.36
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,606.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,245.78
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,319.42
|
Rate for Payer: Ohio Health Choice Commercial |
$3,870.30
|
Rate for Payer: Ohio Health Group HMO |
$3,298.55
|
Rate for Payer: Ohio Health Group PPO Differential |
$879.61
|
Rate for Payer: Ohio Health Group PPO No Differential |
$571.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,363.40
|
Rate for Payer: PHCS Commercial |
$4,222.15
|
Rate for Payer: United Healthcare All Payer |
$3,870.30
|
|
PLATE TI VA-LCP 3H 2.4*41 +90
|
Facility
|
OP
|
$4,398.07
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$571.75 |
Max. Negotiated Rate |
$4,222.15 |
Rate for Payer: Aetna Commercial |
$3,386.51
|
Rate for Payer: Anthem Medicaid |
$1,512.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,430.49
|
Rate for Payer: Cash Price |
$2,199.03
|
Rate for Payer: Cigna Commercial |
$3,650.40
|
Rate for Payer: First Health Commercial |
$4,178.17
|
Rate for Payer: Humana Commercial |
$3,738.36
|
Rate for Payer: Humana KY Medicaid |
$1,512.50
|
Rate for Payer: Kentucky WC Medicaid |
$1,527.89
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,606.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,245.78
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,319.42
|
Rate for Payer: Molina Healthcare Medicaid |
$1,542.84
|
Rate for Payer: Ohio Health Choice Commercial |
$3,870.30
|
Rate for Payer: Ohio Health Group HMO |
$3,298.55
|
Rate for Payer: Ohio Health Group PPO Differential |
$879.61
|
Rate for Payer: Ohio Health Group PPO No Differential |
$571.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,363.40
|
Rate for Payer: PHCS Commercial |
$4,222.15
|
Rate for Payer: United Healthcare All Payer |
$3,870.30
|
|
PLATE TI VA-LCP 3H 2.4*41 -90
|
Facility
|
IP
|
$4,398.07
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$571.75 |
Max. Negotiated Rate |
$4,222.15 |
Rate for Payer: Aetna Commercial |
$3,386.51
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,430.49
|
Rate for Payer: Cash Price |
$2,199.03
|
Rate for Payer: Cigna Commercial |
$3,650.40
|
Rate for Payer: First Health Commercial |
$4,178.17
|
Rate for Payer: Humana Commercial |
$3,738.36
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,606.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,245.78
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,319.42
|
Rate for Payer: Ohio Health Choice Commercial |
$3,870.30
|
Rate for Payer: Ohio Health Group HMO |
$3,298.55
|
Rate for Payer: Ohio Health Group PPO Differential |
$879.61
|
Rate for Payer: Ohio Health Group PPO No Differential |
$571.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,363.40
|
Rate for Payer: PHCS Commercial |
$4,222.15
|
Rate for Payer: United Healthcare All Payer |
$3,870.30
|
|
PLATE TI VA-LCP 3H 2.4*41 -90
|
Facility
|
OP
|
$4,398.07
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$571.75 |
Max. Negotiated Rate |
$4,222.15 |
Rate for Payer: Aetna Commercial |
$3,386.51
|
Rate for Payer: Anthem Medicaid |
$1,512.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,430.49
|
Rate for Payer: Cash Price |
$2,199.03
|
Rate for Payer: Cigna Commercial |
$3,650.40
|
Rate for Payer: First Health Commercial |
$4,178.17
|
Rate for Payer: Humana Commercial |
$3,738.36
|
Rate for Payer: Humana KY Medicaid |
$1,512.50
|
Rate for Payer: Kentucky WC Medicaid |
$1,527.89
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,606.42
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,245.78
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,319.42
|
Rate for Payer: Molina Healthcare Medicaid |
$1,542.84
|
Rate for Payer: Ohio Health Choice Commercial |
$3,870.30
|
Rate for Payer: Ohio Health Group HMO |
$3,298.55
|
Rate for Payer: Ohio Health Group PPO Differential |
$879.61
|
Rate for Payer: Ohio Health Group PPO No Differential |
$571.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,363.40
|
Rate for Payer: PHCS Commercial |
$4,222.15
|
Rate for Payer: United Healthcare All Payer |
$3,870.30
|
|
PLATE TI VA-LCP 3H 2.4*54 L
|
Facility
|
IP
|
$5,596.92
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$727.60 |
Max. Negotiated Rate |
$5,373.04 |
Rate for Payer: Aetna Commercial |
$4,309.63
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,365.60
|
Rate for Payer: Cash Price |
$2,798.46
|
Rate for Payer: Cigna Commercial |
$4,645.44
|
Rate for Payer: First Health Commercial |
$5,317.07
|
Rate for Payer: Humana Commercial |
$4,757.38
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,589.47
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,130.53
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,679.08
|
Rate for Payer: Ohio Health Choice Commercial |
$4,925.29
|
Rate for Payer: Ohio Health Group HMO |
$4,197.69
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,119.38
|
Rate for Payer: Ohio Health Group PPO No Differential |
$727.60
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.05
|
Rate for Payer: PHCS Commercial |
$5,373.04
|
Rate for Payer: United Healthcare All Payer |
$4,925.29
|
|
PLATE TI VA-LCP 3H 2.4*54 L
|
Facility
|
OP
|
$5,596.92
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$727.60 |
Max. Negotiated Rate |
$5,373.04 |
Rate for Payer: Aetna Commercial |
$4,309.63
|
Rate for Payer: Anthem Medicaid |
$1,924.78
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,365.60
|
Rate for Payer: Cash Price |
$2,798.46
|
Rate for Payer: Cigna Commercial |
$4,645.44
|
Rate for Payer: First Health Commercial |
$5,317.07
|
Rate for Payer: Humana Commercial |
$4,757.38
|
Rate for Payer: Humana KY Medicaid |
$1,924.78
|
Rate for Payer: Kentucky WC Medicaid |
$1,944.37
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,589.47
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,130.53
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,679.08
|
Rate for Payer: Molina Healthcare Medicaid |
$1,963.40
|
Rate for Payer: Ohio Health Choice Commercial |
$4,925.29
|
Rate for Payer: Ohio Health Group HMO |
$4,197.69
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,119.38
|
Rate for Payer: Ohio Health Group PPO No Differential |
$727.60
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.05
|
Rate for Payer: PHCS Commercial |
$5,373.04
|
Rate for Payer: United Healthcare All Payer |
$4,925.29
|
|
PLATE TI VA-LCP 4H 2.4*48 L
|
Facility
|
IP
|
$7,177.44
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$933.07 |
Max. Negotiated Rate |
$6,890.34 |
Rate for Payer: Aetna Commercial |
$5,526.63
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,598.40
|
Rate for Payer: Cash Price |
$3,588.72
|
Rate for Payer: Cigna Commercial |
$5,957.28
|
Rate for Payer: First Health Commercial |
$6,818.57
|
Rate for Payer: Humana Commercial |
$6,100.82
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,885.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,296.95
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,153.23
|
Rate for Payer: Ohio Health Choice Commercial |
$6,316.15
|
Rate for Payer: Ohio Health Group HMO |
$5,383.08
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,435.49
|
Rate for Payer: Ohio Health Group PPO No Differential |
$933.07
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.01
|
Rate for Payer: PHCS Commercial |
$6,890.34
|
Rate for Payer: United Healthcare All Payer |
$6,316.15
|
|
PLATE TI VA-LCP 4H 2.4*48 L
|
Facility
|
OP
|
$7,177.44
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$933.07 |
Max. Negotiated Rate |
$6,890.34 |
Rate for Payer: Aetna Commercial |
$5,526.63
|
Rate for Payer: Anthem Medicaid |
$2,468.32
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,598.40
|
Rate for Payer: Cash Price |
$3,588.72
|
Rate for Payer: Cigna Commercial |
$5,957.28
|
Rate for Payer: First Health Commercial |
$6,818.57
|
Rate for Payer: Humana Commercial |
$6,100.82
|
Rate for Payer: Humana KY Medicaid |
$2,468.32
|
Rate for Payer: Kentucky WC Medicaid |
$2,493.44
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,885.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,296.95
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,153.23
|
Rate for Payer: Molina Healthcare Medicaid |
$2,517.85
|
Rate for Payer: Ohio Health Choice Commercial |
$6,316.15
|
Rate for Payer: Ohio Health Group HMO |
$5,383.08
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,435.49
|
Rate for Payer: Ohio Health Group PPO No Differential |
$933.07
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.01
|
Rate for Payer: PHCS Commercial |
$6,890.34
|
Rate for Payer: United Healthcare All Payer |
$6,316.15
|
|
PLATE TI VA-LCP 4H 2.4*48 R
|
Facility
|
OP
|
$5,596.92
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$727.60 |
Max. Negotiated Rate |
$5,373.04 |
Rate for Payer: Aetna Commercial |
$4,309.63
|
Rate for Payer: Anthem Medicaid |
$1,924.78
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,365.60
|
Rate for Payer: Cash Price |
$2,798.46
|
Rate for Payer: Cigna Commercial |
$4,645.44
|
Rate for Payer: First Health Commercial |
$5,317.07
|
Rate for Payer: Humana Commercial |
$4,757.38
|
Rate for Payer: Humana KY Medicaid |
$1,924.78
|
Rate for Payer: Kentucky WC Medicaid |
$1,944.37
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,589.47
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,130.53
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,679.08
|
Rate for Payer: Molina Healthcare Medicaid |
$1,963.40
|
Rate for Payer: Ohio Health Choice Commercial |
$4,925.29
|
Rate for Payer: Ohio Health Group HMO |
$4,197.69
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,119.38
|
Rate for Payer: Ohio Health Group PPO No Differential |
$727.60
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.05
|
Rate for Payer: PHCS Commercial |
$5,373.04
|
Rate for Payer: United Healthcare All Payer |
$4,925.29
|
|
PLATE TI VA-LCP 4H 2.4*48 R
|
Facility
|
IP
|
$5,596.92
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$727.60 |
Max. Negotiated Rate |
$5,373.04 |
Rate for Payer: Aetna Commercial |
$4,309.63
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,365.60
|
Rate for Payer: Cash Price |
$2,798.46
|
Rate for Payer: Cigna Commercial |
$4,645.44
|
Rate for Payer: First Health Commercial |
$5,317.07
|
Rate for Payer: Humana Commercial |
$4,757.38
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,589.47
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,130.53
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,679.08
|
Rate for Payer: Ohio Health Choice Commercial |
$4,925.29
|
Rate for Payer: Ohio Health Group HMO |
$4,197.69
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,119.38
|
Rate for Payer: Ohio Health Group PPO No Differential |
$727.60
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.05
|
Rate for Payer: PHCS Commercial |
$5,373.04
|
Rate for Payer: United Healthcare All Payer |
$4,925.29
|
|
PLATE TI VA-LCP 4H 2.4*49 +90
|
Facility
|
IP
|
$4,472.38
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$581.41 |
Max. Negotiated Rate |
$4,293.48 |
Rate for Payer: Aetna Commercial |
$3,443.73
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,488.46
|
Rate for Payer: Cash Price |
$2,236.19
|
Rate for Payer: Cigna Commercial |
$3,712.08
|
Rate for Payer: First Health Commercial |
$4,248.76
|
Rate for Payer: Humana Commercial |
$3,801.52
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,667.35
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,300.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,341.71
|
Rate for Payer: Ohio Health Choice Commercial |
$3,935.69
|
Rate for Payer: Ohio Health Group HMO |
$3,354.28
|
Rate for Payer: Ohio Health Group PPO Differential |
$894.48
|
Rate for Payer: Ohio Health Group PPO No Differential |
$581.41
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.44
|
Rate for Payer: PHCS Commercial |
$4,293.48
|
Rate for Payer: United Healthcare All Payer |
$3,935.69
|
|
PLATE TI VA-LCP 4H 2.4*49 +90
|
Facility
|
OP
|
$4,472.38
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$581.41 |
Max. Negotiated Rate |
$4,293.48 |
Rate for Payer: Anthem Medicaid |
$1,538.05
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,488.46
|
Rate for Payer: Cash Price |
$2,236.19
|
Rate for Payer: Cigna Commercial |
$3,712.08
|
Rate for Payer: First Health Commercial |
$4,248.76
|
Rate for Payer: Humana Commercial |
$3,801.52
|
Rate for Payer: Humana KY Medicaid |
$1,538.05
|
Rate for Payer: Kentucky WC Medicaid |
$1,553.70
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,667.35
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,300.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,341.71
|
Rate for Payer: Molina Healthcare Medicaid |
$1,568.91
|
Rate for Payer: Ohio Health Choice Commercial |
$3,935.69
|
Rate for Payer: Ohio Health Group HMO |
$3,354.28
|
Rate for Payer: Ohio Health Group PPO Differential |
$894.48
|
Rate for Payer: Ohio Health Group PPO No Differential |
$581.41
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.44
|
Rate for Payer: PHCS Commercial |
$4,293.48
|
Rate for Payer: United Healthcare All Payer |
$3,935.69
|
Rate for Payer: Aetna Commercial |
$3,443.73
|
|
PLATE TI VA-LCP 4H 2.4*49 -90
|
Facility
|
IP
|
$4,472.38
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$581.41 |
Max. Negotiated Rate |
$4,293.48 |
Rate for Payer: Aetna Commercial |
$3,443.73
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,488.46
|
Rate for Payer: Cash Price |
$2,236.19
|
Rate for Payer: Cigna Commercial |
$3,712.08
|
Rate for Payer: First Health Commercial |
$4,248.76
|
Rate for Payer: Humana Commercial |
$3,801.52
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,667.35
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,300.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,341.71
|
Rate for Payer: Ohio Health Choice Commercial |
$3,935.69
|
Rate for Payer: Ohio Health Group HMO |
$3,354.28
|
Rate for Payer: Ohio Health Group PPO Differential |
$894.48
|
Rate for Payer: Ohio Health Group PPO No Differential |
$581.41
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.44
|
Rate for Payer: PHCS Commercial |
$4,293.48
|
Rate for Payer: United Healthcare All Payer |
$3,935.69
|
|
PLATE TI VA-LCP 4H 2.4*49 -90
|
Facility
|
OP
|
$4,472.38
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$581.41 |
Max. Negotiated Rate |
$4,293.48 |
Rate for Payer: Aetna Commercial |
$3,443.73
|
Rate for Payer: Anthem Medicaid |
$1,538.05
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,488.46
|
Rate for Payer: Cash Price |
$2,236.19
|
Rate for Payer: Cigna Commercial |
$3,712.08
|
Rate for Payer: First Health Commercial |
$4,248.76
|
Rate for Payer: Humana Commercial |
$3,801.52
|
Rate for Payer: Humana KY Medicaid |
$1,538.05
|
Rate for Payer: Kentucky WC Medicaid |
$1,553.70
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,667.35
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,300.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,341.71
|
Rate for Payer: Molina Healthcare Medicaid |
$1,568.91
|
Rate for Payer: Ohio Health Choice Commercial |
$3,935.69
|
Rate for Payer: Ohio Health Group HMO |
$3,354.28
|
Rate for Payer: Ohio Health Group PPO Differential |
$894.48
|
Rate for Payer: Ohio Health Group PPO No Differential |
$581.41
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.44
|
Rate for Payer: PHCS Commercial |
$4,293.48
|
Rate for Payer: United Healthcare All Payer |
$3,935.69
|
|
PLATE TI VA-LCP 4H 2.4*66 L
|
Facility
|
IP
|
$5,596.92
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$727.60 |
Max. Negotiated Rate |
$5,373.04 |
Rate for Payer: Aetna Commercial |
$4,309.63
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,365.60
|
Rate for Payer: Cash Price |
$2,798.46
|
Rate for Payer: Cigna Commercial |
$4,645.44
|
Rate for Payer: First Health Commercial |
$5,317.07
|
Rate for Payer: Humana Commercial |
$4,757.38
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,589.47
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,130.53
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,679.08
|
Rate for Payer: Ohio Health Choice Commercial |
$4,925.29
|
Rate for Payer: Ohio Health Group HMO |
$4,197.69
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,119.38
|
Rate for Payer: Ohio Health Group PPO No Differential |
$727.60
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.05
|
Rate for Payer: PHCS Commercial |
$5,373.04
|
Rate for Payer: United Healthcare All Payer |
$4,925.29
|
|
PLATE TI VA-LCP 4H 2.4*66 L
|
Facility
|
OP
|
$5,596.92
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$727.60 |
Max. Negotiated Rate |
$5,373.04 |
Rate for Payer: Aetna Commercial |
$4,309.63
|
Rate for Payer: Anthem Medicaid |
$1,924.78
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,365.60
|
Rate for Payer: Cash Price |
$2,798.46
|
Rate for Payer: Cigna Commercial |
$4,645.44
|
Rate for Payer: First Health Commercial |
$5,317.07
|
Rate for Payer: Humana Commercial |
$4,757.38
|
Rate for Payer: Humana KY Medicaid |
$1,924.78
|
Rate for Payer: Kentucky WC Medicaid |
$1,944.37
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,589.47
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,130.53
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,679.08
|
Rate for Payer: Molina Healthcare Medicaid |
$1,963.40
|
Rate for Payer: Ohio Health Choice Commercial |
$4,925.29
|
Rate for Payer: Ohio Health Group HMO |
$4,197.69
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,119.38
|
Rate for Payer: Ohio Health Group PPO No Differential |
$727.60
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.05
|
Rate for Payer: PHCS Commercial |
$5,373.04
|
Rate for Payer: United Healthcare All Payer |
$4,925.29
|
|