|
PLATE TI VA-LCP 7H 2.4*55 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 7H 2.4*55 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: 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 7H 2.4*68 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 7H 2.4*68 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 7H 2.4*68 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 7H 2.4*68 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 7H 2.4*77 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 7H 2.4*77 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 7H 2.4*77 R
|
Facility
|
IP
|
$6,466.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.64 |
| Max. Negotiated Rate |
$6,207.80 |
| Rate for Payer: Aetna Commercial |
$4,979.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,043.84
|
| Rate for Payer: Cash Price |
$3,233.23
|
| Rate for Payer: Cigna Commercial |
$5,367.16
|
| Rate for Payer: First Health Commercial |
$6,143.14
|
| Rate for Payer: Humana Commercial |
$5,496.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,302.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,772.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,939.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,690.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,849.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,293.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$840.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,004.60
|
| Rate for Payer: PHCS Commercial |
$6,207.80
|
| Rate for Payer: United Healthcare All Payer |
$5,690.48
|
|
|
PLATE TI VA-LCP 7H 2.4*77 R
|
Facility
|
OP
|
$6,466.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.64 |
| Max. Negotiated Rate |
$6,207.80 |
| Rate for Payer: Humana Commercial |
$5,496.49
|
| Rate for Payer: Humana KY Medicaid |
$2,223.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,246.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,302.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,772.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,939.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,268.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,690.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,849.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,293.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$840.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,004.60
|
| Rate for Payer: PHCS Commercial |
$6,207.80
|
| Rate for Payer: United Healthcare All Payer |
$5,690.48
|
| Rate for Payer: Aetna Commercial |
$4,979.17
|
| Rate for Payer: Anthem Medicaid |
$2,223.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,043.84
|
| Rate for Payer: Cash Price |
$3,233.23
|
| Rate for Payer: Cigna Commercial |
$5,367.16
|
| Rate for Payer: First Health Commercial |
$6,143.14
|
|
|
PLATE TI VA-LCP DOR 5H 2.4*46
|
Facility
|
IP
|
$4,311.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.48 |
| Max. Negotiated Rate |
$4,138.95 |
| Rate for Payer: Aetna Commercial |
$3,319.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,362.90
|
| Rate for Payer: Cash Price |
$2,155.70
|
| Rate for Payer: Cigna Commercial |
$3,578.47
|
| Rate for Payer: First Health Commercial |
$4,095.84
|
| Rate for Payer: Humana Commercial |
$3,664.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,535.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,181.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,794.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,233.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$862.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,336.54
|
| Rate for Payer: PHCS Commercial |
$4,138.95
|
| Rate for Payer: United Healthcare All Payer |
$3,794.04
|
|
|
PLATE TI VA-LCP DOR 5H 2.4*46
|
Facility
|
OP
|
$4,311.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.48 |
| Max. Negotiated Rate |
$4,138.95 |
| Rate for Payer: Aetna Commercial |
$3,319.79
|
| Rate for Payer: Anthem Medicaid |
$1,482.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,362.90
|
| Rate for Payer: Cash Price |
$2,155.70
|
| Rate for Payer: Cigna Commercial |
$3,578.47
|
| Rate for Payer: First Health Commercial |
$4,095.84
|
| Rate for Payer: Humana Commercial |
$3,664.70
|
| Rate for Payer: Humana KY Medicaid |
$1,482.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,497.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,535.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,181.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,512.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,794.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,233.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$862.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,336.54
|
| Rate for Payer: PHCS Commercial |
$4,138.95
|
| Rate for Payer: United Healthcare All Payer |
$3,794.04
|
|
|
PLATE TI VA-LCP DOR 6H 2.4*57
|
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 DOR 6H 2.4*57
|
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 T 3H 2.4*37 3H
|
Facility
|
IP
|
$4,311.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.48 |
| Max. Negotiated Rate |
$4,138.95 |
| Rate for Payer: Aetna Commercial |
$3,319.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,362.90
|
| Rate for Payer: Cash Price |
$2,155.70
|
| Rate for Payer: Cigna Commercial |
$3,578.47
|
| Rate for Payer: First Health Commercial |
$4,095.84
|
| Rate for Payer: Humana Commercial |
$3,664.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,535.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,181.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,794.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,233.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$862.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,336.54
|
| Rate for Payer: PHCS Commercial |
$4,138.95
|
| Rate for Payer: United Healthcare All Payer |
$3,794.04
|
|
|
PLATE TI VA-LCP T 3H 2.4*37 3H
|
Facility
|
OP
|
$4,311.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.48 |
| Max. Negotiated Rate |
$4,138.95 |
| Rate for Payer: Aetna Commercial |
$3,319.79
|
| Rate for Payer: Anthem Medicaid |
$1,482.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,362.90
|
| Rate for Payer: Cash Price |
$2,155.70
|
| Rate for Payer: Cigna Commercial |
$3,578.47
|
| Rate for Payer: First Health Commercial |
$4,095.84
|
| Rate for Payer: Humana Commercial |
$3,664.70
|
| Rate for Payer: Humana KY Medicaid |
$1,482.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,497.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,535.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,181.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,512.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,794.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,233.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$862.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,336.54
|
| Rate for Payer: PHCS Commercial |
$4,138.95
|
| Rate for Payer: United Healthcare All Payer |
$3,794.04
|
|
|
PLATE TI VA-LCP T 3H 2.4*51 5H
|
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 T 3H 2.4*51 5H
|
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-LP 3H 2.4*37+90 2H
|
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-LP 3H 2.4*37+90 2H
|
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-LP 3H 2.4*37+90 3H
|
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-LP 3H 2.4*37+90 3H
|
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-LP 3H2.4*37 -90 3H
|
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-LP 3H2.4*37 -90 3H
|
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-LP 3H 2.4*41+20 3H
|
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: 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
|
| Rate for Payer: Aetna Commercial |
$3,272.12
|
|
