|
PLATE TI VA-LP 3H 2.4*41+20 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 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: 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
|
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 5H2.4*51 -90 2H
|
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-LP 5H2.4*51 -90 2H
|
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-LP 5H 2.4*51+90 3H
|
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-LP 5H 2.4*51+90 3H
|
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-LP 5H 2.4*51-90 3H
|
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-LP 5H 2.4*51-90 3H
|
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-LP 5H 2.4*55+20 3H
|
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-LP 5H 2.4*55+20 3H
|
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-LP 5H 2.4*55-20 3H
|
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-LP 5H 2.4*55-20 3H
|
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-LP 5HS 2.4*57 L 6H
|
Facility
|
OP
|
$5,678.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.15 |
| Max. Negotiated Rate |
$5,450.94 |
| Rate for Payer: Aetna Commercial |
$4,372.11
|
| Rate for Payer: Anthem Medicaid |
$1,952.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,428.89
|
| Rate for Payer: Cash Price |
$2,839.03
|
| Rate for Payer: Cigna Commercial |
$4,712.79
|
| Rate for Payer: First Health Commercial |
$5,394.16
|
| Rate for Payer: Humana Commercial |
$4,826.35
|
| Rate for Payer: Humana KY Medicaid |
$1,952.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,972.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,656.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,190.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,703.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,991.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,996.69
|
| Rate for Payer: Ohio Health Group HMO |
$4,258.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,135.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,760.20
|
| Rate for Payer: PHCS Commercial |
$5,450.94
|
| Rate for Payer: United Healthcare All Payer |
$4,996.69
|
|
|
PLATE TI VA-LP 5HS 2.4*57 L 6H
|
Facility
|
IP
|
$5,678.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.15 |
| Max. Negotiated Rate |
$5,450.94 |
| Rate for Payer: Aetna Commercial |
$4,372.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,428.89
|
| Rate for Payer: Cash Price |
$2,839.03
|
| Rate for Payer: Cigna Commercial |
$4,712.79
|
| Rate for Payer: First Health Commercial |
$5,394.16
|
| Rate for Payer: Humana Commercial |
$4,826.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,656.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,190.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,703.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,996.69
|
| Rate for Payer: Ohio Health Group HMO |
$4,258.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,135.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,760.20
|
| Rate for Payer: PHCS Commercial |
$5,450.94
|
| Rate for Payer: United Healthcare All Payer |
$4,996.69
|
|
|
PLATE TI VA-LP 5HS 2.4*57 L 7H
|
Facility
|
OP
|
$5,678.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.15 |
| Max. Negotiated Rate |
$5,450.94 |
| Rate for Payer: Aetna Commercial |
$4,372.11
|
| Rate for Payer: Anthem Medicaid |
$1,952.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,428.89
|
| Rate for Payer: Cash Price |
$2,839.03
|
| Rate for Payer: Cigna Commercial |
$4,712.79
|
| Rate for Payer: First Health Commercial |
$5,394.16
|
| Rate for Payer: Humana Commercial |
$4,826.35
|
| Rate for Payer: Humana KY Medicaid |
$1,952.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,972.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,656.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,190.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,703.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,991.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,996.69
|
| Rate for Payer: Ohio Health Group HMO |
$4,258.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,135.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,760.20
|
| Rate for Payer: PHCS Commercial |
$5,450.94
|
| Rate for Payer: United Healthcare All Payer |
$4,996.69
|
|
|
PLATE TI VA-LP 5HS 2.4*57 L 7H
|
Facility
|
IP
|
$5,678.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.15 |
| Max. Negotiated Rate |
$5,450.94 |
| Rate for Payer: Humana Commercial |
$4,826.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,656.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,190.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,703.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,996.69
|
| Rate for Payer: Ohio Health Group HMO |
$4,258.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,135.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,760.20
|
| Rate for Payer: PHCS Commercial |
$5,450.94
|
| Rate for Payer: United Healthcare All Payer |
$4,996.69
|
| Rate for Payer: Aetna Commercial |
$4,372.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,428.89
|
| Rate for Payer: Cash Price |
$2,839.03
|
| Rate for Payer: Cigna Commercial |
$4,712.79
|
| Rate for Payer: First Health Commercial |
$5,394.16
|
|
|
PLATE TI VA-LP 5HS 2.4*57 R 6H
|
Facility
|
IP
|
$5,678.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.15 |
| Max. Negotiated Rate |
$5,450.94 |
| Rate for Payer: Aetna Commercial |
$4,372.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,428.89
|
| Rate for Payer: Cash Price |
$2,839.03
|
| Rate for Payer: Cigna Commercial |
$4,712.79
|
| Rate for Payer: First Health Commercial |
$5,394.16
|
| Rate for Payer: Humana Commercial |
$4,826.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,656.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,190.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,703.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,996.69
|
| Rate for Payer: Ohio Health Group HMO |
$4,258.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,135.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,760.20
|
| Rate for Payer: PHCS Commercial |
$5,450.94
|
| Rate for Payer: United Healthcare All Payer |
$4,996.69
|
|
|
PLATE TI VA-LP 5HS 2.4*57 R 6H
|
Facility
|
OP
|
$5,678.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.15 |
| Max. Negotiated Rate |
$5,450.94 |
| Rate for Payer: Aetna Commercial |
$4,372.11
|
| Rate for Payer: Anthem Medicaid |
$1,952.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,428.89
|
| Rate for Payer: Cash Price |
$2,839.03
|
| Rate for Payer: Cigna Commercial |
$4,712.79
|
| Rate for Payer: First Health Commercial |
$5,394.16
|
| Rate for Payer: Humana Commercial |
$4,826.35
|
| Rate for Payer: Humana KY Medicaid |
$1,952.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,972.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,656.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,190.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,703.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,991.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,996.69
|
| Rate for Payer: Ohio Health Group HMO |
$4,258.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,135.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,760.20
|
| Rate for Payer: PHCS Commercial |
$5,450.94
|
| Rate for Payer: United Healthcare All Payer |
$4,996.69
|
|
|
PLATE TI VA-LP 5HS 2.4*57 R 7H
|
Facility
|
IP
|
$5,678.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.15 |
| Max. Negotiated Rate |
$5,450.94 |
| Rate for Payer: Aetna Commercial |
$4,372.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,428.89
|
| Rate for Payer: Cash Price |
$2,839.03
|
| Rate for Payer: Cigna Commercial |
$4,712.79
|
| Rate for Payer: First Health Commercial |
$5,394.16
|
| Rate for Payer: Humana Commercial |
$4,826.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,656.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,190.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,703.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,996.69
|
| Rate for Payer: Ohio Health Group HMO |
$4,258.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,135.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,760.20
|
| Rate for Payer: PHCS Commercial |
$5,450.94
|
| Rate for Payer: United Healthcare All Payer |
$4,996.69
|
|
|
PLATE TI VA-LP 5HS 2.4*57 R 7H
|
Facility
|
OP
|
$5,678.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.15 |
| Max. Negotiated Rate |
$5,450.94 |
| Rate for Payer: Aetna Commercial |
$4,372.11
|
| Rate for Payer: Anthem Medicaid |
$1,952.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,428.89
|
| Rate for Payer: Cash Price |
$2,839.03
|
| Rate for Payer: Cigna Commercial |
$4,712.79
|
| Rate for Payer: First Health Commercial |
$5,394.16
|
| Rate for Payer: Humana Commercial |
$4,826.35
|
| Rate for Payer: Humana KY Medicaid |
$1,952.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,972.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,656.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,190.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,703.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,991.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,996.69
|
| Rate for Payer: Ohio Health Group HMO |
$4,258.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,135.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,760.20
|
| Rate for Payer: PHCS Commercial |
$5,450.94
|
| Rate for Payer: United Healthcare All Payer |
$4,996.69
|
|
|
PLATE TI WRIST FUSION 8 HOLE
|
Facility
|
OP
|
$4,314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.82 |
| Max. Negotiated Rate |
$4,141.44 |
| Rate for Payer: Aetna Commercial |
$3,321.78
|
| Rate for Payer: Anthem Medicaid |
$1,483.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,364.92
|
| Rate for Payer: Cash Price |
$2,157.00
|
| Rate for Payer: Cigna Commercial |
$3,580.62
|
| Rate for Payer: First Health Commercial |
$4,098.30
|
| Rate for Payer: Humana Commercial |
$3,666.90
|
| Rate for Payer: Humana KY Medicaid |
$1,483.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,498.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,537.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,183.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,513.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,796.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,235.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$862.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,337.34
|
| Rate for Payer: PHCS Commercial |
$4,141.44
|
| Rate for Payer: United Healthcare All Payer |
$3,796.32
|
|
|
PLATE TI WRIST FUSION 8 HOLE
|
Facility
|
IP
|
$4,314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.82 |
| Max. Negotiated Rate |
$4,141.44 |
| Rate for Payer: Aetna Commercial |
$3,321.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,364.92
|
| Rate for Payer: Cash Price |
$2,157.00
|
| Rate for Payer: Cigna Commercial |
$3,580.62
|
| Rate for Payer: First Health Commercial |
$4,098.30
|
| Rate for Payer: Humana Commercial |
$3,666.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,537.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,183.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,796.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,235.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$862.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,337.34
|
| Rate for Payer: PHCS Commercial |
$4,141.44
|
| Rate for Payer: United Healthcare All Payer |
$3,796.32
|
|
|
PLATE TI WRIST FUSION 9 HOLE
|
Facility
|
IP
|
$4,398.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.74 |
| Max. Negotiated Rate |
$4,222.08 |
| Rate for Payer: Aetna Commercial |
$3,386.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,430.44
|
| Rate for Payer: Cash Price |
$2,199.00
|
| Rate for Payer: Cigna Commercial |
$3,650.34
|
| Rate for Payer: First Health Commercial |
$4,178.10
|
| Rate for Payer: Humana Commercial |
$3,738.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,606.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,245.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,319.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,870.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,298.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$879.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$571.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,363.38
|
| Rate for Payer: PHCS Commercial |
$4,222.08
|
| Rate for Payer: United Healthcare All Payer |
$3,870.24
|
|
|
PLATE TI WRIST FUSION 9 HOLE
|
Facility
|
OP
|
$4,398.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.74 |
| Max. Negotiated Rate |
$4,222.08 |
| Rate for Payer: Humana Commercial |
$3,738.30
|
| Rate for Payer: Humana KY Medicaid |
$1,512.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,527.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,606.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,245.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,319.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,542.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,870.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,298.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$879.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$571.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,363.38
|
| Rate for Payer: PHCS Commercial |
$4,222.08
|
| Rate for Payer: United Healthcare All Payer |
$3,870.24
|
| Rate for Payer: Aetna Commercial |
$3,386.46
|
| Rate for Payer: Anthem Medicaid |
$1,512.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,430.44
|
| Rate for Payer: Cash Price |
$2,199.00
|
| Rate for Payer: Cigna Commercial |
$3,650.34
|
| Rate for Payer: First Health Commercial |
$4,178.10
|
|
