|
PLATE UNIV RADIAL 6H
|
Facility
|
OP
|
$4,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.26 |
| Max. Negotiated Rate |
$4,705.92 |
| Rate for Payer: Aetna Commercial |
$3,774.54
|
| Rate for Payer: Anthem Medicaid |
$1,685.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,823.56
|
| Rate for Payer: Cash Price |
$2,451.00
|
| Rate for Payer: Cigna Commercial |
$4,068.66
|
| Rate for Payer: First Health Commercial |
$4,656.90
|
| Rate for Payer: Humana Commercial |
$4,166.70
|
| Rate for Payer: Humana KY Medicaid |
$1,685.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,702.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,019.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,617.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,470.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,719.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,313.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,676.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,519.62
|
| Rate for Payer: PHCS Commercial |
$4,705.92
|
| Rate for Payer: United Healthcare All Payer |
$4,313.76
|
|
|
PLATE UNIV RADIAL 6H
|
Facility
|
IP
|
$4,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.26 |
| Max. Negotiated Rate |
$4,705.92 |
| Rate for Payer: Aetna Commercial |
$3,774.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,823.56
|
| Rate for Payer: Cash Price |
$2,451.00
|
| Rate for Payer: Cigna Commercial |
$4,068.66
|
| Rate for Payer: First Health Commercial |
$4,656.90
|
| Rate for Payer: Humana Commercial |
$4,166.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,019.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,617.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,470.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,313.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,676.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,519.62
|
| Rate for Payer: PHCS Commercial |
$4,705.92
|
| Rate for Payer: United Healthcare All Payer |
$4,313.76
|
|
|
PLATE UNIV RADIAL 7H
|
Facility
|
IP
|
$4,709.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.24 |
| Max. Negotiated Rate |
$4,521.12 |
| Rate for Payer: Aetna Commercial |
$3,626.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,673.41
|
| Rate for Payer: Cash Price |
$2,354.75
|
| Rate for Payer: Cigna Commercial |
$3,908.88
|
| Rate for Payer: First Health Commercial |
$4,474.02
|
| Rate for Payer: Humana Commercial |
$4,003.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,861.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,475.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,412.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,144.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,532.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$941.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$612.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,459.94
|
| Rate for Payer: PHCS Commercial |
$4,521.12
|
| Rate for Payer: United Healthcare All Payer |
$4,144.36
|
|
|
PLATE UNIV RADIAL 7H
|
Facility
|
OP
|
$4,709.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.24 |
| Max. Negotiated Rate |
$4,521.12 |
| Rate for Payer: Aetna Commercial |
$3,626.32
|
| Rate for Payer: Anthem Medicaid |
$1,619.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,673.41
|
| Rate for Payer: Cash Price |
$2,354.75
|
| Rate for Payer: Cigna Commercial |
$3,908.88
|
| Rate for Payer: First Health Commercial |
$4,474.02
|
| Rate for Payer: Humana Commercial |
$4,003.08
|
| Rate for Payer: Humana KY Medicaid |
$1,619.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,636.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,861.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,475.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,412.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,652.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,144.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,532.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$941.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$612.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,459.94
|
| Rate for Payer: PHCS Commercial |
$4,521.12
|
| Rate for Payer: United Healthcare All Payer |
$4,144.36
|
|
|
PLATE UTL HD FSN 3.5M 104M 5 L
|
Facility
|
IP
|
$7,278.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.19 |
| Max. Negotiated Rate |
$6,987.24 |
| Rate for Payer: Aetna Commercial |
$5,604.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,677.13
|
| Rate for Payer: Cash Price |
$3,639.18
|
| Rate for Payer: Cigna Commercial |
$6,041.05
|
| Rate for Payer: First Health Commercial |
$6,914.45
|
| Rate for Payer: Humana Commercial |
$6,186.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,968.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,371.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,183.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,404.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,458.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,455.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$946.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,256.29
|
| Rate for Payer: PHCS Commercial |
$6,987.24
|
| Rate for Payer: United Healthcare All Payer |
$6,404.97
|
|
|
PLATE UTL HD FSN 3.5M 104M 5 L
|
Facility
|
OP
|
$7,278.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.19 |
| Max. Negotiated Rate |
$6,987.24 |
| Rate for Payer: Aetna Commercial |
$5,604.34
|
| Rate for Payer: Anthem Medicaid |
$2,503.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,677.13
|
| Rate for Payer: Cash Price |
$3,639.18
|
| Rate for Payer: Cigna Commercial |
$6,041.05
|
| Rate for Payer: First Health Commercial |
$6,914.45
|
| Rate for Payer: Humana Commercial |
$6,186.61
|
| Rate for Payer: Humana KY Medicaid |
$2,503.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,528.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,968.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,371.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,183.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,553.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,404.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,458.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,455.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$946.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,256.29
|
| Rate for Payer: PHCS Commercial |
$6,987.24
|
| Rate for Payer: United Healthcare All Payer |
$6,404.97
|
|
|
PLATE UTL HD FSN 3.5M 104M 5 R
|
Facility
|
OP
|
$7,278.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.19 |
| Max. Negotiated Rate |
$6,987.24 |
| Rate for Payer: Aetna Commercial |
$5,604.34
|
| Rate for Payer: Anthem Medicaid |
$2,503.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,677.13
|
| Rate for Payer: Cash Price |
$3,639.18
|
| Rate for Payer: Cigna Commercial |
$6,041.05
|
| Rate for Payer: First Health Commercial |
$6,914.45
|
| Rate for Payer: Humana Commercial |
$6,186.61
|
| Rate for Payer: Humana KY Medicaid |
$2,503.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,528.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,968.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,371.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,183.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,553.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,404.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,458.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,455.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$946.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,256.29
|
| Rate for Payer: PHCS Commercial |
$6,987.24
|
| Rate for Payer: United Healthcare All Payer |
$6,404.97
|
|
|
PLATE UTL HD FSN 3.5M 104M 5 R
|
Facility
|
IP
|
$7,278.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.19 |
| Max. Negotiated Rate |
$6,987.24 |
| Rate for Payer: Aetna Commercial |
$5,604.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,677.13
|
| Rate for Payer: Cash Price |
$3,639.18
|
| Rate for Payer: Cigna Commercial |
$6,041.05
|
| Rate for Payer: First Health Commercial |
$6,914.45
|
| Rate for Payer: Humana Commercial |
$6,186.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,968.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,371.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,183.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,404.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,458.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,455.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$946.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,256.29
|
| Rate for Payer: PHCS Commercial |
$6,987.24
|
| Rate for Payer: United Healthcare All Payer |
$6,404.97
|
|
|
PLATE UTL HND FSN 3.5M 79M 3 L
|
Facility
|
IP
|
$7,200.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$936.13 |
| Max. Negotiated Rate |
$6,912.95 |
| Rate for Payer: Aetna Commercial |
$5,544.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,616.77
|
| Rate for Payer: Cash Price |
$3,600.49
|
| Rate for Payer: Cigna Commercial |
$5,976.82
|
| Rate for Payer: First Health Commercial |
$6,840.94
|
| Rate for Payer: Humana Commercial |
$6,120.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,904.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,314.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,160.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,336.87
|
| Rate for Payer: Ohio Health Group HMO |
$5,400.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$936.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,232.31
|
| Rate for Payer: PHCS Commercial |
$6,912.95
|
| Rate for Payer: United Healthcare All Payer |
$6,336.87
|
|
|
PLATE UTL HND FSN 3.5M 79M 3 L
|
Facility
|
OP
|
$7,200.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$936.13 |
| Max. Negotiated Rate |
$6,912.95 |
| Rate for Payer: Aetna Commercial |
$5,544.76
|
| Rate for Payer: Anthem Medicaid |
$2,476.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,616.77
|
| Rate for Payer: Cash Price |
$3,600.49
|
| Rate for Payer: Cigna Commercial |
$5,976.82
|
| Rate for Payer: First Health Commercial |
$6,840.94
|
| Rate for Payer: Humana Commercial |
$6,120.84
|
| Rate for Payer: Humana KY Medicaid |
$2,476.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,501.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,904.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,314.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,160.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,526.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,336.87
|
| Rate for Payer: Ohio Health Group HMO |
$5,400.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$936.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,232.31
|
| Rate for Payer: PHCS Commercial |
$6,912.95
|
| Rate for Payer: United Healthcare All Payer |
$6,336.87
|
|
|
PLATE UTL HND FSN 3.5M 79M 3 R
|
Facility
|
OP
|
$7,239.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$941.16 |
| Max. Negotiated Rate |
$6,950.09 |
| Rate for Payer: Aetna Commercial |
$5,574.55
|
| Rate for Payer: Anthem Medicaid |
$2,489.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,646.95
|
| Rate for Payer: Cash Price |
$3,619.84
|
| Rate for Payer: Cigna Commercial |
$6,008.93
|
| Rate for Payer: First Health Commercial |
$6,877.70
|
| Rate for Payer: Humana Commercial |
$6,153.73
|
| Rate for Payer: Humana KY Medicaid |
$2,489.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,515.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,342.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,539.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,370.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,447.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$941.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,244.30
|
| Rate for Payer: PHCS Commercial |
$6,950.09
|
| Rate for Payer: United Healthcare All Payer |
$6,370.92
|
|
|
PLATE UTL HND FSN 3.5M 79M 3 R
|
Facility
|
IP
|
$7,239.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$941.16 |
| Max. Negotiated Rate |
$6,950.09 |
| Rate for Payer: Humana Commercial |
$6,153.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,342.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,370.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,447.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$941.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,244.30
|
| Rate for Payer: PHCS Commercial |
$6,950.09
|
| Rate for Payer: United Healthcare All Payer |
$6,370.92
|
| Rate for Payer: Aetna Commercial |
$5,574.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,646.95
|
| Rate for Payer: Cash Price |
$3,619.84
|
| Rate for Payer: Cigna Commercial |
$6,008.93
|
| Rate for Payer: First Health Commercial |
$6,877.70
|
|
|
PLATE VA LCP CVD 4.5*230 10H L
|
Facility
|
IP
|
$9,606.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.91 |
| Max. Negotiated Rate |
$9,222.71 |
| Rate for Payer: Aetna Commercial |
$7,397.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.45
|
| Rate for Payer: Cash Price |
$4,803.50
|
| Rate for Payer: Cigna Commercial |
$7,973.80
|
| Rate for Payer: First Health Commercial |
$9,126.64
|
| Rate for Payer: Humana Commercial |
$8,165.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,882.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,454.15
|
| Rate for Payer: Ohio Health Group HMO |
$7,205.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,921.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.17
|
| Rate for Payer: PHCS Commercial |
$9,222.71
|
| Rate for Payer: United Healthcare All Payer |
$8,454.15
|
|
|
PLATE VA LCP CVD 4.5*230 10H L
|
Facility
|
OP
|
$9,606.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.91 |
| Max. Negotiated Rate |
$9,222.71 |
| Rate for Payer: Aetna Commercial |
$7,397.38
|
| Rate for Payer: Anthem Medicaid |
$3,303.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.45
|
| Rate for Payer: Cash Price |
$4,803.50
|
| Rate for Payer: Cigna Commercial |
$7,973.80
|
| Rate for Payer: First Health Commercial |
$9,126.64
|
| Rate for Payer: Humana Commercial |
$8,165.94
|
| Rate for Payer: Humana KY Medicaid |
$3,303.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3,337.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,882.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,370.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,454.15
|
| Rate for Payer: Ohio Health Group HMO |
$7,205.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,921.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.17
|
| Rate for Payer: PHCS Commercial |
$9,222.71
|
| Rate for Payer: United Healthcare All Payer |
$8,454.15
|
|
|
PLATE VA LCP CVD 4.5*301 14H L
|
Facility
|
IP
|
$9,800.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,274.12 |
| Max. Negotiated Rate |
$9,408.88 |
| Rate for Payer: Aetna Commercial |
$7,546.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,644.72
|
| Rate for Payer: Cash Price |
$4,900.46
|
| Rate for Payer: Cigna Commercial |
$8,134.76
|
| Rate for Payer: First Health Commercial |
$9,310.87
|
| Rate for Payer: Humana Commercial |
$8,330.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,036.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,233.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,940.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,624.81
|
| Rate for Payer: Ohio Health Group HMO |
$7,350.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,960.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,038.29
|
| Rate for Payer: PHCS Commercial |
$9,408.88
|
| Rate for Payer: United Healthcare All Payer |
$8,624.81
|
|
|
PLATE VA LCP CVD 4.5*301 14H L
|
Facility
|
OP
|
$9,800.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,274.12 |
| Max. Negotiated Rate |
$9,408.88 |
| Rate for Payer: Aetna Commercial |
$7,546.71
|
| Rate for Payer: Anthem Medicaid |
$3,370.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,644.72
|
| Rate for Payer: Cash Price |
$4,900.46
|
| Rate for Payer: Cigna Commercial |
$8,134.76
|
| Rate for Payer: First Health Commercial |
$9,310.87
|
| Rate for Payer: Humana Commercial |
$8,330.78
|
| Rate for Payer: Humana KY Medicaid |
$3,370.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,404.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,036.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,233.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,940.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,438.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,624.81
|
| Rate for Payer: Ohio Health Group HMO |
$7,350.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,960.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,038.29
|
| Rate for Payer: PHCS Commercial |
$9,408.88
|
| Rate for Payer: United Healthcare All Payer |
$8,624.81
|
|
|
PLATE VA-LCP PRX TIB 3.5*117
|
Facility
|
OP
|
$15,817.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,056.24 |
| Max. Negotiated Rate |
$15,184.51 |
| Rate for Payer: Aetna Commercial |
$12,179.24
|
| Rate for Payer: Anthem Medicaid |
$5,439.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,337.42
|
| Rate for Payer: Cash Price |
$7,908.60
|
| Rate for Payer: Cigna Commercial |
$13,128.28
|
| Rate for Payer: First Health Commercial |
$15,026.34
|
| Rate for Payer: Humana Commercial |
$13,444.62
|
| Rate for Payer: Humana KY Medicaid |
$5,439.54
|
| Rate for Payer: Kentucky WC Medicaid |
$5,494.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,970.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,673.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,745.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,548.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,919.14
|
| Rate for Payer: Ohio Health Group HMO |
$11,862.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,163.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,056.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,903.33
|
| Rate for Payer: PHCS Commercial |
$15,184.51
|
| Rate for Payer: United Healthcare All Payer |
$13,919.14
|
|
|
PLATE VA-LCP PRX TIB 3.5*117
|
Facility
|
IP
|
$15,817.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,056.24 |
| Max. Negotiated Rate |
$15,184.51 |
| Rate for Payer: Aetna Commercial |
$12,179.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,337.42
|
| Rate for Payer: Cash Price |
$7,908.60
|
| Rate for Payer: Cigna Commercial |
$13,128.28
|
| Rate for Payer: First Health Commercial |
$15,026.34
|
| Rate for Payer: Humana Commercial |
$13,444.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,970.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,673.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,745.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,919.14
|
| Rate for Payer: Ohio Health Group HMO |
$11,862.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,163.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,056.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,903.33
|
| Rate for Payer: PHCS Commercial |
$15,184.51
|
| Rate for Payer: United Healthcare All Payer |
$13,919.14
|
|
|
PLATE VARIAX 2 META BRD STR 2H
|
Facility
|
IP
|
$9,450.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.54 |
| Max. Negotiated Rate |
$9,072.29 |
| Rate for Payer: Aetna Commercial |
$7,276.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,371.23
|
| Rate for Payer: Cash Price |
$4,725.15
|
| Rate for Payer: Cigna Commercial |
$7,843.75
|
| Rate for Payer: First Health Commercial |
$8,977.78
|
| Rate for Payer: Humana Commercial |
$8,032.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,749.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,974.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,835.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,316.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,087.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,890.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,228.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,929.59
|
| Rate for Payer: PHCS Commercial |
$9,072.29
|
| Rate for Payer: United Healthcare All Payer |
$8,316.26
|
|
|
PLATE VARIAX 2 META BRD STR 2H
|
Facility
|
OP
|
$9,450.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.54 |
| Max. Negotiated Rate |
$9,072.29 |
| Rate for Payer: Humana Commercial |
$8,032.76
|
| Rate for Payer: Humana KY Medicaid |
$3,249.96
|
| Rate for Payer: Kentucky WC Medicaid |
$3,283.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,749.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,974.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,835.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,315.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,316.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,087.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,890.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,228.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,929.59
|
| Rate for Payer: PHCS Commercial |
$9,072.29
|
| Rate for Payer: United Healthcare All Payer |
$8,316.26
|
| Rate for Payer: Aetna Commercial |
$7,276.73
|
| Rate for Payer: Anthem Medicaid |
$3,249.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,371.23
|
| Rate for Payer: Cash Price |
$4,725.15
|
| Rate for Payer: Cigna Commercial |
$7,843.75
|
| Rate for Payer: First Health Commercial |
$8,977.78
|
|
|
PLATE VARIAX 2 META BRD STR 3H
|
Facility
|
IP
|
$6,852.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.83 |
| Max. Negotiated Rate |
$6,578.46 |
| Rate for Payer: Aetna Commercial |
$5,276.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,345.00
|
| Rate for Payer: Cash Price |
$3,426.28
|
| Rate for Payer: Cigna Commercial |
$5,687.62
|
| Rate for Payer: First Health Commercial |
$6,509.93
|
| Rate for Payer: Humana Commercial |
$5,824.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,057.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,055.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,030.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,139.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,370.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$890.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,124.29
|
| Rate for Payer: PHCS Commercial |
$6,578.46
|
| Rate for Payer: United Healthcare All Payer |
$6,030.25
|
|
|
PLATE VARIAX 2 META BRD STR 3H
|
Facility
|
OP
|
$6,852.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.83 |
| Max. Negotiated Rate |
$6,578.46 |
| Rate for Payer: Aetna Commercial |
$5,276.47
|
| Rate for Payer: Anthem Medicaid |
$2,356.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,345.00
|
| Rate for Payer: Cash Price |
$3,426.28
|
| Rate for Payer: Cigna Commercial |
$5,687.62
|
| Rate for Payer: First Health Commercial |
$6,509.93
|
| Rate for Payer: Humana Commercial |
$5,824.68
|
| Rate for Payer: Humana KY Medicaid |
$2,356.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,380.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,057.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,055.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,403.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,030.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,139.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,370.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$890.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,124.29
|
| Rate for Payer: PHCS Commercial |
$6,578.46
|
| Rate for Payer: United Healthcare All Payer |
$6,030.25
|
|
|
PLATE VARIAX 2 META BRD STR 4H
|
Facility
|
IP
|
$9,450.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.54 |
| Max. Negotiated Rate |
$9,072.29 |
| Rate for Payer: Aetna Commercial |
$7,276.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,371.23
|
| Rate for Payer: Cash Price |
$4,725.15
|
| Rate for Payer: Cigna Commercial |
$7,843.75
|
| Rate for Payer: First Health Commercial |
$8,977.78
|
| Rate for Payer: Humana Commercial |
$8,032.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,749.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,974.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,835.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,316.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,087.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,890.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,228.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,929.59
|
| Rate for Payer: PHCS Commercial |
$9,072.29
|
| Rate for Payer: United Healthcare All Payer |
$8,316.26
|
|
|
PLATE VARIAX 2 META BRD STR 4H
|
Facility
|
OP
|
$9,450.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.54 |
| Max. Negotiated Rate |
$9,072.29 |
| Rate for Payer: Aetna Commercial |
$7,276.73
|
| Rate for Payer: Anthem Medicaid |
$3,249.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,371.23
|
| Rate for Payer: Cash Price |
$4,725.15
|
| Rate for Payer: Cigna Commercial |
$7,843.75
|
| Rate for Payer: First Health Commercial |
$8,977.78
|
| Rate for Payer: Humana Commercial |
$8,032.76
|
| Rate for Payer: Humana KY Medicaid |
$3,249.96
|
| Rate for Payer: Kentucky WC Medicaid |
$3,283.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,749.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,974.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,835.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,315.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,316.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,087.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,890.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,228.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,929.59
|
| Rate for Payer: PHCS Commercial |
$9,072.29
|
| Rate for Payer: United Healthcare All Payer |
$8,316.26
|
|
|
PLATE VARIAX 2 META BRD STR 5H
|
Facility
|
OP
|
$6,486.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$843.24 |
| Max. Negotiated Rate |
$6,227.00 |
| Rate for Payer: Aetna Commercial |
$4,994.57
|
| Rate for Payer: Anthem Medicaid |
$2,230.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,059.44
|
| Rate for Payer: Cash Price |
$3,243.23
|
| Rate for Payer: Cigna Commercial |
$5,383.76
|
| Rate for Payer: First Health Commercial |
$6,162.14
|
| Rate for Payer: Humana Commercial |
$5,513.49
|
| Rate for Payer: Humana KY Medicaid |
$2,230.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,253.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,318.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,787.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,945.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,275.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,708.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,864.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,297.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,010.80
|
| Rate for Payer: PHCS Commercial |
$6,227.00
|
| Rate for Payer: United Healthcare All Payer |
$5,708.08
|
|
