|
PLATE TI VA-LCP 4H 2.4*66 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*66 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 3.5*87 L
|
Facility
|
OP
|
$9,238.97
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.07 |
| Max. Negotiated Rate |
$8,869.41 |
| Rate for Payer: Aetna Commercial |
$7,114.01
|
| Rate for Payer: Anthem Medicaid |
$3,177.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,206.40
|
| Rate for Payer: Cash Price |
$4,619.48
|
| Rate for Payer: Cigna Commercial |
$7,668.35
|
| Rate for Payer: First Health Commercial |
$8,777.02
|
| Rate for Payer: Humana Commercial |
$7,853.12
|
| Rate for Payer: Humana KY Medicaid |
$3,177.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3,209.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,575.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,818.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,771.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,130.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,929.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,847.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.08
|
| Rate for Payer: PHCS Commercial |
$8,869.41
|
| Rate for Payer: United Healthcare All Payer |
$8,130.29
|
|
|
PLATE TI VA-LCP 4H 3.5*87 L
|
Facility
|
IP
|
$9,238.97
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.07 |
| Max. Negotiated Rate |
$8,869.41 |
| Rate for Payer: Aetna Commercial |
$7,114.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,206.40
|
| Rate for Payer: Cash Price |
$4,619.48
|
| Rate for Payer: Cigna Commercial |
$7,668.35
|
| Rate for Payer: First Health Commercial |
$8,777.02
|
| Rate for Payer: Humana Commercial |
$7,853.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,575.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,818.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,771.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,130.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,929.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,847.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,201.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,864.08
|
| Rate for Payer: PHCS Commercial |
$8,869.41
|
| Rate for Payer: United Healthcare All Payer |
$8,130.29
|
|
|
PLATE TI VA-LCP 5H 2.4*48 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 5H 2.4*48 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 5H 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 5H 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 5H 2.4*51 +90
|
Facility
|
OP
|
$4,345.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.91 |
| Max. Negotiated Rate |
$4,171.64 |
| Rate for Payer: Aetna Commercial |
$3,346.00
|
| Rate for Payer: Anthem Medicaid |
$1,494.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,389.46
|
| Rate for Payer: Cash Price |
$2,172.73
|
| Rate for Payer: Cigna Commercial |
$3,606.73
|
| Rate for Payer: First Health Commercial |
$4,128.19
|
| Rate for Payer: Humana Commercial |
$3,693.64
|
| Rate for Payer: Humana KY Medicaid |
$1,494.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,509.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,563.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,206.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,303.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,524.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,824.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,259.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$869.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.09
|
| Rate for Payer: PHCS Commercial |
$4,171.64
|
| Rate for Payer: United Healthcare All Payer |
$3,824.00
|
|
|
PLATE TI VA-LCP 5H 2.4*51 +90
|
Facility
|
IP
|
$4,345.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.91 |
| Max. Negotiated Rate |
$4,171.64 |
| Rate for Payer: Aetna Commercial |
$3,346.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,389.46
|
| Rate for Payer: Cash Price |
$2,172.73
|
| Rate for Payer: Cigna Commercial |
$3,606.73
|
| Rate for Payer: First Health Commercial |
$4,128.19
|
| Rate for Payer: Humana Commercial |
$3,693.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,563.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,206.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,303.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,824.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,259.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$869.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.09
|
| Rate for Payer: PHCS Commercial |
$4,171.64
|
| Rate for Payer: United Healthcare All Payer |
$3,824.00
|
|
|
PLATE TI VA-LCP 5H 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
|
|
|
PLATE TI VA-LCP 5H 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: 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
|
| 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
|
|
|
PLATE TI VA-LCP 5H 2.4*66 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 5H 2.4*66 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 6H 2.4*42 L
|
Facility
|
OP
|
$5,467.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.78 |
| Max. Negotiated Rate |
$5,248.83 |
| Rate for Payer: Aetna Commercial |
$4,210.00
|
| Rate for Payer: Anthem Medicaid |
$1,880.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,264.67
|
| Rate for Payer: Cash Price |
$2,733.76
|
| Rate for Payer: Cigna Commercial |
$4,538.05
|
| Rate for Payer: First Health Commercial |
$5,194.15
|
| Rate for Payer: Humana Commercial |
$4,647.40
|
| Rate for Payer: Humana KY Medicaid |
$1,880.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,899.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,483.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,035.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,918.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,811.43
|
| Rate for Payer: Ohio Health Group HMO |
$4,100.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,093.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$710.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,694.93
|
| Rate for Payer: PHCS Commercial |
$5,248.83
|
| Rate for Payer: United Healthcare All Payer |
$4,811.43
|
|
|
PLATE TI VA-LCP 6H 2.4*42 L
|
Facility
|
IP
|
$5,467.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.78 |
| Max. Negotiated Rate |
$5,248.83 |
| Rate for Payer: Aetna Commercial |
$4,210.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,264.67
|
| Rate for Payer: Cash Price |
$2,733.76
|
| Rate for Payer: Cigna Commercial |
$4,538.05
|
| Rate for Payer: First Health Commercial |
$5,194.15
|
| Rate for Payer: Humana Commercial |
$4,647.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,483.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,035.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,811.43
|
| Rate for Payer: Ohio Health Group HMO |
$4,100.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,093.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$710.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,694.93
|
| Rate for Payer: PHCS Commercial |
$5,248.83
|
| Rate for Payer: United Healthcare All Payer |
$4,811.43
|
|
|
PLATE TI VA-LCP 6H 2.4*42 R
|
Facility
|
OP
|
$5,467.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.78 |
| Max. Negotiated Rate |
$5,248.83 |
| Rate for Payer: Aetna Commercial |
$4,210.00
|
| Rate for Payer: Anthem Medicaid |
$1,880.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,264.67
|
| Rate for Payer: Cash Price |
$2,733.76
|
| Rate for Payer: Cigna Commercial |
$4,538.05
|
| Rate for Payer: First Health Commercial |
$5,194.15
|
| Rate for Payer: Humana Commercial |
$4,647.40
|
| Rate for Payer: Humana KY Medicaid |
$1,880.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,899.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,483.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,035.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,918.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,811.43
|
| Rate for Payer: Ohio Health Group HMO |
$4,100.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,093.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$710.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,694.93
|
| Rate for Payer: PHCS Commercial |
$5,248.83
|
| Rate for Payer: United Healthcare All Payer |
$4,811.43
|
|
|
PLATE TI VA-LCP 6H 2.4*42 R
|
Facility
|
IP
|
$5,467.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.78 |
| Max. Negotiated Rate |
$5,248.83 |
| Rate for Payer: Aetna Commercial |
$4,210.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,264.67
|
| Rate for Payer: Cash Price |
$2,733.76
|
| Rate for Payer: Cigna Commercial |
$4,538.05
|
| Rate for Payer: First Health Commercial |
$5,194.15
|
| Rate for Payer: Humana Commercial |
$4,647.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,483.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,035.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,811.43
|
| Rate for Payer: Ohio Health Group HMO |
$4,100.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,093.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$710.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,694.93
|
| Rate for Payer: PHCS Commercial |
$5,248.83
|
| Rate for Payer: United Healthcare All Payer |
$4,811.43
|
|
|
PLATE TI VA-LCP 6H 2.4*45 L
|
Facility
|
IP
|
$6,612.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.62 |
| Max. Negotiated Rate |
$6,347.96 |
| Rate for Payer: Aetna Commercial |
$5,091.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,157.72
|
| Rate for Payer: Cash Price |
$3,306.23
|
| Rate for Payer: Cigna Commercial |
$5,488.34
|
| Rate for Payer: First Health Commercial |
$6,281.84
|
| Rate for Payer: Humana Commercial |
$5,620.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,422.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,880.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,983.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,818.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,959.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,322.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$859.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,049.86
|
| Rate for Payer: PHCS Commercial |
$6,347.96
|
| Rate for Payer: United Healthcare All Payer |
$5,818.96
|
|
|
PLATE TI VA-LCP 6H 2.4*45 L
|
Facility
|
OP
|
$6,612.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.62 |
| Max. Negotiated Rate |
$6,347.96 |
| Rate for Payer: Humana Commercial |
$5,620.59
|
| Rate for Payer: Humana KY Medicaid |
$2,274.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,297.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,422.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,880.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,983.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,319.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,818.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,959.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,322.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$859.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,049.86
|
| Rate for Payer: PHCS Commercial |
$6,347.96
|
| Rate for Payer: United Healthcare All Payer |
$5,818.96
|
| Rate for Payer: Aetna Commercial |
$5,091.59
|
| Rate for Payer: Anthem Medicaid |
$2,274.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,157.72
|
| Rate for Payer: Cash Price |
$3,306.23
|
| Rate for Payer: Cigna Commercial |
$5,488.34
|
| Rate for Payer: First Health Commercial |
$6,281.84
|
|
|
PLATE TI VA-LCP 6H 2.4*45 R
|
Facility
|
OP
|
$6,612.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.62 |
| Max. Negotiated Rate |
$6,347.96 |
| Rate for Payer: Aetna Commercial |
$5,091.59
|
| Rate for Payer: Anthem Medicaid |
$2,274.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,157.72
|
| Rate for Payer: Cash Price |
$3,306.23
|
| Rate for Payer: Cigna Commercial |
$5,488.34
|
| Rate for Payer: First Health Commercial |
$6,281.84
|
| Rate for Payer: Humana Commercial |
$5,620.59
|
| Rate for Payer: Humana KY Medicaid |
$2,274.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,297.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,422.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,880.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,983.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,319.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,818.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,959.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,322.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$859.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,049.86
|
| Rate for Payer: PHCS Commercial |
$6,347.96
|
| Rate for Payer: United Healthcare All Payer |
$5,818.96
|
|
|
PLATE TI VA-LCP 6H 2.4*45 R
|
Facility
|
IP
|
$6,612.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.62 |
| Max. Negotiated Rate |
$6,347.96 |
| Rate for Payer: Aetna Commercial |
$5,091.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,157.72
|
| Rate for Payer: Cash Price |
$3,306.23
|
| Rate for Payer: Cigna Commercial |
$5,488.34
|
| Rate for Payer: First Health Commercial |
$6,281.84
|
| Rate for Payer: Humana Commercial |
$5,620.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,422.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,880.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,983.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,818.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,959.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,322.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$859.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,049.86
|
| Rate for Payer: PHCS Commercial |
$6,347.96
|
| Rate for Payer: United Healthcare All Payer |
$5,818.96
|
|
|
PLATE TI VA-LCP 6H 2.4*51 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 6H 2.4*51 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 6H 2.4*51 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
|
|
