|
PLATE TI VA-LCP 6H 2.4*51 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*54 R
|
Facility
|
OP
|
$6,501.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.25 |
| Max. Negotiated Rate |
$6,241.82 |
| Rate for Payer: Aetna Commercial |
$5,006.46
|
| Rate for Payer: Anthem Medicaid |
$2,236.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,071.48
|
| Rate for Payer: Cash Price |
$3,250.95
|
| Rate for Payer: Cigna Commercial |
$5,396.58
|
| Rate for Payer: First Health Commercial |
$6,176.80
|
| Rate for Payer: Humana Commercial |
$5,526.62
|
| Rate for Payer: Humana KY Medicaid |
$2,236.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,258.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,331.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,798.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,950.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,280.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,721.67
|
| Rate for Payer: Ohio Health Group HMO |
$4,876.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,015.59
|
| Rate for Payer: PHCS Commercial |
$6,241.82
|
| Rate for Payer: United Healthcare All Payer |
$5,721.67
|
|
|
PLATE TI VA-LCP 6H 2.4*54 R
|
Facility
|
IP
|
$6,501.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.25 |
| Max. Negotiated Rate |
$6,241.82 |
| Rate for Payer: Aetna Commercial |
$5,006.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,071.48
|
| Rate for Payer: Cash Price |
$3,250.95
|
| Rate for Payer: Cigna Commercial |
$5,396.58
|
| Rate for Payer: First Health Commercial |
$6,176.80
|
| Rate for Payer: Humana Commercial |
$5,526.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,331.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,798.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,950.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,721.67
|
| Rate for Payer: Ohio Health Group HMO |
$4,876.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,015.59
|
| Rate for Payer: PHCS Commercial |
$6,241.82
|
| Rate for Payer: United Healthcare All Payer |
$5,721.67
|
|
|
PLATE TI VA-LCP 6H 2.4*63 L
|
Facility
|
OP
|
$6,477.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$842.08 |
| Max. Negotiated Rate |
$6,218.42 |
| Rate for Payer: Aetna Commercial |
$4,987.69
|
| Rate for Payer: Anthem Medicaid |
$2,227.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,052.47
|
| Rate for Payer: Cash Price |
$3,238.76
|
| Rate for Payer: Cigna Commercial |
$5,376.34
|
| Rate for Payer: First Health Commercial |
$6,153.64
|
| Rate for Payer: Humana Commercial |
$5,505.89
|
| Rate for Payer: Humana KY Medicaid |
$2,227.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,250.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,311.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,780.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,943.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,272.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,700.22
|
| Rate for Payer: Ohio Health Group HMO |
$4,858.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,295.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$842.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,008.03
|
| Rate for Payer: PHCS Commercial |
$6,218.42
|
| Rate for Payer: United Healthcare All Payer |
$5,700.22
|
|
|
PLATE TI VA-LCP 6H 2.4*63 L
|
Facility
|
IP
|
$6,477.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$842.08 |
| Max. Negotiated Rate |
$6,218.42 |
| Rate for Payer: Aetna Commercial |
$4,987.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,052.47
|
| Rate for Payer: Cash Price |
$3,238.76
|
| Rate for Payer: Cigna Commercial |
$5,376.34
|
| Rate for Payer: First Health Commercial |
$6,153.64
|
| Rate for Payer: Humana Commercial |
$5,505.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,311.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,780.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,943.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,700.22
|
| Rate for Payer: Ohio Health Group HMO |
$4,858.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,295.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$842.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,008.03
|
| Rate for Payer: PHCS Commercial |
$6,218.42
|
| Rate for Payer: United Healthcare All Payer |
$5,700.22
|
|
|
PLATE TI VA-LCP 6H 2.4*63 R
|
Facility
|
IP
|
$6,477.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$842.08 |
| Max. Negotiated Rate |
$6,218.42 |
| Rate for Payer: Aetna Commercial |
$4,987.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,052.47
|
| Rate for Payer: Cash Price |
$3,238.76
|
| Rate for Payer: Cigna Commercial |
$5,376.34
|
| Rate for Payer: First Health Commercial |
$6,153.64
|
| Rate for Payer: Humana Commercial |
$5,505.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,311.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,780.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,943.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,700.22
|
| Rate for Payer: Ohio Health Group HMO |
$4,858.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,295.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$842.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,008.03
|
| Rate for Payer: PHCS Commercial |
$6,218.42
|
| Rate for Payer: United Healthcare All Payer |
$5,700.22
|
|
|
PLATE TI VA-LCP 6H 2.4*63 R
|
Facility
|
OP
|
$6,477.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$842.08 |
| Max. Negotiated Rate |
$6,218.42 |
| Rate for Payer: Aetna Commercial |
$4,987.69
|
| Rate for Payer: Anthem Medicaid |
$2,227.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,052.47
|
| Rate for Payer: Cash Price |
$3,238.76
|
| Rate for Payer: Cigna Commercial |
$5,376.34
|
| Rate for Payer: First Health Commercial |
$6,153.64
|
| Rate for Payer: Humana Commercial |
$5,505.89
|
| Rate for Payer: Humana KY Medicaid |
$2,227.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,250.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,311.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,780.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,943.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,272.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,700.22
|
| Rate for Payer: Ohio Health Group HMO |
$4,858.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,295.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$842.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,008.03
|
| Rate for Payer: PHCS Commercial |
$6,218.42
|
| Rate for Payer: United Healthcare All Payer |
$5,700.22
|
|
|
PLATE TI VA-LCP 6H 2.4*66 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*66 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: 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*66 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*66 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*72 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*72 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: 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
|
| Rate for Payer: Aetna Commercial |
$5,091.59
|
|
|
PLATE TI VA-LCP 6H 2.4*72 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*72 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*75 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*75 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: 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*75 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*75 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 7H 2.4*47 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 7H 2.4*47 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 7H 2.4*47 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 7H 2.4*47 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 7H 2.4*55 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 7H 2.4*55 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
|
|
