PLATE VARIAX COMP NAR STR 6H
|
Facility
|
IP
|
$3,367.88
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$437.82 |
Max. Negotiated Rate |
$3,233.16 |
Rate for Payer: Aetna Commercial |
$2,593.27
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,626.95
|
Rate for Payer: Cash Price |
$1,683.94
|
Rate for Payer: Cigna Commercial |
$2,795.34
|
Rate for Payer: First Health Commercial |
$3,199.49
|
Rate for Payer: Humana Commercial |
$2,862.70
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,761.66
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,485.50
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.36
|
Rate for Payer: Ohio Health Choice Commercial |
$2,963.73
|
Rate for Payer: Ohio Health Group HMO |
$2,525.91
|
Rate for Payer: Ohio Health Group PPO Differential |
$673.58
|
Rate for Payer: Ohio Health Group PPO No Differential |
$437.82
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,044.04
|
Rate for Payer: PHCS Commercial |
$3,233.16
|
Rate for Payer: United Healthcare All Payer |
$2,963.73
|
|
PLATE VARIAX COMP NAR STR 8H
|
Facility
|
OP
|
$3,911.08
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$508.44 |
Max. Negotiated Rate |
$3,754.64 |
Rate for Payer: Anthem Medicaid |
$1,345.02
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,050.64
|
Rate for Payer: Cash Price |
$1,955.54
|
Rate for Payer: Cigna Commercial |
$3,246.20
|
Rate for Payer: First Health Commercial |
$3,715.53
|
Rate for Payer: Humana Commercial |
$3,324.42
|
Rate for Payer: Humana KY Medicaid |
$1,345.02
|
Rate for Payer: Kentucky WC Medicaid |
$1,358.71
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,207.09
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,886.38
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,173.32
|
Rate for Payer: Molina Healthcare Medicaid |
$1,372.01
|
Rate for Payer: Ohio Health Choice Commercial |
$3,441.75
|
Rate for Payer: Ohio Health Group HMO |
$2,933.31
|
Rate for Payer: Ohio Health Group PPO Differential |
$782.22
|
Rate for Payer: Ohio Health Group PPO No Differential |
$508.44
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,212.43
|
Rate for Payer: PHCS Commercial |
$3,754.64
|
Rate for Payer: United Healthcare All Payer |
$3,441.75
|
Rate for Payer: Aetna Commercial |
$3,011.53
|
|
PLATE VARIAX COMP NAR STR 8H
|
Facility
|
IP
|
$3,911.08
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$508.44 |
Max. Negotiated Rate |
$3,754.64 |
Rate for Payer: Aetna Commercial |
$3,011.53
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,050.64
|
Rate for Payer: Cash Price |
$1,955.54
|
Rate for Payer: Cigna Commercial |
$3,246.20
|
Rate for Payer: First Health Commercial |
$3,715.53
|
Rate for Payer: Humana Commercial |
$3,324.42
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,207.09
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,886.38
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,173.32
|
Rate for Payer: Ohio Health Choice Commercial |
$3,441.75
|
Rate for Payer: Ohio Health Group HMO |
$2,933.31
|
Rate for Payer: Ohio Health Group PPO Differential |
$782.22
|
Rate for Payer: Ohio Health Group PPO No Differential |
$508.44
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,212.43
|
Rate for Payer: PHCS Commercial |
$3,754.64
|
Rate for Payer: United Healthcare All Payer |
$3,441.75
|
|
PLATE VARIAX COMP NAR STR 9H
|
Facility
|
OP
|
$4,889.26
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$635.60 |
Max. Negotiated Rate |
$4,693.69 |
Rate for Payer: Aetna Commercial |
$3,764.73
|
Rate for Payer: Anthem Medicaid |
$1,681.42
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,813.62
|
Rate for Payer: Cash Price |
$2,444.63
|
Rate for Payer: Cigna Commercial |
$4,058.09
|
Rate for Payer: First Health Commercial |
$4,644.80
|
Rate for Payer: Humana Commercial |
$4,155.87
|
Rate for Payer: Humana KY Medicaid |
$1,681.42
|
Rate for Payer: Kentucky WC Medicaid |
$1,698.53
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,009.19
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,608.27
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,466.78
|
Rate for Payer: Molina Healthcare Medicaid |
$1,715.15
|
Rate for Payer: Ohio Health Choice Commercial |
$4,302.55
|
Rate for Payer: Ohio Health Group HMO |
$3,666.94
|
Rate for Payer: Ohio Health Group PPO Differential |
$977.85
|
Rate for Payer: Ohio Health Group PPO No Differential |
$635.60
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,515.67
|
Rate for Payer: PHCS Commercial |
$4,693.69
|
Rate for Payer: United Healthcare All Payer |
$4,302.55
|
|
PLATE VARIAX COMP NAR STR 9H
|
Facility
|
IP
|
$4,889.26
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$635.60 |
Max. Negotiated Rate |
$4,693.69 |
Rate for Payer: Aetna Commercial |
$3,764.73
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,813.62
|
Rate for Payer: Cash Price |
$2,444.63
|
Rate for Payer: Cigna Commercial |
$4,058.09
|
Rate for Payer: First Health Commercial |
$4,644.80
|
Rate for Payer: Humana Commercial |
$4,155.87
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,009.19
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,608.27
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,466.78
|
Rate for Payer: Ohio Health Choice Commercial |
$4,302.55
|
Rate for Payer: Ohio Health Group HMO |
$3,666.94
|
Rate for Payer: Ohio Health Group PPO Differential |
$977.85
|
Rate for Payer: Ohio Health Group PPO No Differential |
$635.60
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,515.67
|
Rate for Payer: PHCS Commercial |
$4,693.69
|
Rate for Payer: United Healthcare All Payer |
$4,302.55
|
|
PLATE VARIAX FIBULA 6H STR
|
Facility
|
OP
|
$4,930.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$640.90 |
Max. Negotiated Rate |
$4,732.80 |
Rate for Payer: Aetna Commercial |
$3,796.10
|
Rate for Payer: Anthem Medicaid |
$1,695.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
Rate for Payer: Cash Price |
$2,465.00
|
Rate for Payer: Cigna Commercial |
$4,091.90
|
Rate for Payer: First Health Commercial |
$4,683.50
|
Rate for Payer: Humana Commercial |
$4,190.50
|
Rate for Payer: Humana KY Medicaid |
$1,695.43
|
Rate for Payer: Kentucky WC Medicaid |
$1,712.68
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
Rate for Payer: Molina Healthcare Medicaid |
$1,729.44
|
Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
Rate for Payer: PHCS Commercial |
$4,732.80
|
Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
PLATE VARIAX FIBULA 6H STR
|
Facility
|
IP
|
$4,930.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$640.90 |
Max. Negotiated Rate |
$4,732.80 |
Rate for Payer: Aetna Commercial |
$3,796.10
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
Rate for Payer: Cash Price |
$2,465.00
|
Rate for Payer: Cigna Commercial |
$4,091.90
|
Rate for Payer: First Health Commercial |
$4,683.50
|
Rate for Payer: Humana Commercial |
$4,190.50
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
Rate for Payer: PHCS Commercial |
$4,732.80
|
Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
PLATE VLP MINI-MOD 1.5MM Y 6H
|
Facility
|
OP
|
$5,084.35
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$660.97 |
Max. Negotiated Rate |
$4,880.98 |
Rate for Payer: Aetna Commercial |
$3,914.95
|
Rate for Payer: Anthem Medicaid |
$1,748.51
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,965.79
|
Rate for Payer: Cash Price |
$2,542.18
|
Rate for Payer: Cigna Commercial |
$4,220.01
|
Rate for Payer: First Health Commercial |
$4,830.13
|
Rate for Payer: Humana Commercial |
$4,321.70
|
Rate for Payer: Humana KY Medicaid |
$1,748.51
|
Rate for Payer: Kentucky WC Medicaid |
$1,766.30
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,169.17
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,752.25
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,525.30
|
Rate for Payer: Molina Healthcare Medicaid |
$1,783.59
|
Rate for Payer: Ohio Health Choice Commercial |
$4,474.23
|
Rate for Payer: Ohio Health Group HMO |
$3,813.26
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,016.87
|
Rate for Payer: Ohio Health Group PPO No Differential |
$660.97
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,576.15
|
Rate for Payer: PHCS Commercial |
$4,880.98
|
Rate for Payer: United Healthcare All Payer |
$4,474.23
|
|
PLATE VLP MINI-MOD 1.5MM Y 6H
|
Facility
|
IP
|
$5,084.35
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$660.97 |
Max. Negotiated Rate |
$4,880.98 |
Rate for Payer: Aetna Commercial |
$3,914.95
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,965.79
|
Rate for Payer: Cash Price |
$2,542.18
|
Rate for Payer: Cigna Commercial |
$4,220.01
|
Rate for Payer: First Health Commercial |
$4,830.13
|
Rate for Payer: Humana Commercial |
$4,321.70
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,169.17
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,752.25
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,525.30
|
Rate for Payer: Ohio Health Choice Commercial |
$4,474.23
|
Rate for Payer: Ohio Health Group HMO |
$3,813.26
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,016.87
|
Rate for Payer: Ohio Health Group PPO No Differential |
$660.97
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,576.15
|
Rate for Payer: PHCS Commercial |
$4,880.98
|
Rate for Payer: United Healthcare All Payer |
$4,474.23
|
|
PLATE VLP MINI-MOD 1.5MM Y 8H
|
Facility
|
OP
|
$5,647.15
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$734.13 |
Max. Negotiated Rate |
$5,421.26 |
Rate for Payer: Aetna Commercial |
$4,348.31
|
Rate for Payer: Anthem Medicaid |
$1,942.05
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,404.78
|
Rate for Payer: Cash Price |
$2,823.57
|
Rate for Payer: Cigna Commercial |
$4,687.13
|
Rate for Payer: First Health Commercial |
$5,364.79
|
Rate for Payer: Humana Commercial |
$4,800.08
|
Rate for Payer: Humana KY Medicaid |
$1,942.05
|
Rate for Payer: Kentucky WC Medicaid |
$1,961.82
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,630.66
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,167.60
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,694.14
|
Rate for Payer: Molina Healthcare Medicaid |
$1,981.02
|
Rate for Payer: Ohio Health Choice Commercial |
$4,969.49
|
Rate for Payer: Ohio Health Group HMO |
$4,235.36
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,129.43
|
Rate for Payer: Ohio Health Group PPO No Differential |
$734.13
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,750.62
|
Rate for Payer: PHCS Commercial |
$5,421.26
|
Rate for Payer: United Healthcare All Payer |
$4,969.49
|
|
PLATE VLP MINI-MOD 1.5MM Y 8H
|
Facility
|
IP
|
$5,647.15
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$734.13 |
Max. Negotiated Rate |
$5,421.26 |
Rate for Payer: Aetna Commercial |
$4,348.31
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,404.78
|
Rate for Payer: Cash Price |
$2,823.57
|
Rate for Payer: Cigna Commercial |
$4,687.13
|
Rate for Payer: First Health Commercial |
$5,364.79
|
Rate for Payer: Humana Commercial |
$4,800.08
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,630.66
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,167.60
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,694.14
|
Rate for Payer: Ohio Health Choice Commercial |
$4,969.49
|
Rate for Payer: Ohio Health Group HMO |
$4,235.36
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,129.43
|
Rate for Payer: Ohio Health Group PPO No Differential |
$734.13
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,750.62
|
Rate for Payer: PHCS Commercial |
$5,421.26
|
Rate for Payer: United Healthcare All Payer |
$4,969.49
|
|
PLATE VLP MINI-MOD 2.0MM Y 6H
|
Facility
|
OP
|
$5,225.05
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$679.26 |
Max. Negotiated Rate |
$5,016.05 |
Rate for Payer: Aetna Commercial |
$4,023.29
|
Rate for Payer: Anthem Medicaid |
$1,796.89
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,075.54
|
Rate for Payer: Cash Price |
$2,612.52
|
Rate for Payer: Cigna Commercial |
$4,336.79
|
Rate for Payer: First Health Commercial |
$4,963.80
|
Rate for Payer: Humana Commercial |
$4,441.29
|
Rate for Payer: Humana KY Medicaid |
$1,796.89
|
Rate for Payer: Kentucky WC Medicaid |
$1,815.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,284.54
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,856.09
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,567.52
|
Rate for Payer: Molina Healthcare Medicaid |
$1,832.95
|
Rate for Payer: Ohio Health Choice Commercial |
$4,598.04
|
Rate for Payer: Ohio Health Group HMO |
$3,918.79
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,045.01
|
Rate for Payer: Ohio Health Group PPO No Differential |
$679.26
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,619.77
|
Rate for Payer: PHCS Commercial |
$5,016.05
|
Rate for Payer: United Healthcare All Payer |
$4,598.04
|
|
PLATE VLP MINI-MOD 2.0MM Y 6H
|
Facility
|
IP
|
$5,225.05
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$679.26 |
Max. Negotiated Rate |
$5,016.05 |
Rate for Payer: Aetna Commercial |
$4,023.29
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,075.54
|
Rate for Payer: Cash Price |
$2,612.52
|
Rate for Payer: Cigna Commercial |
$4,336.79
|
Rate for Payer: First Health Commercial |
$4,963.80
|
Rate for Payer: Humana Commercial |
$4,441.29
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,284.54
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,856.09
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,567.52
|
Rate for Payer: Ohio Health Choice Commercial |
$4,598.04
|
Rate for Payer: Ohio Health Group HMO |
$3,918.79
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,045.01
|
Rate for Payer: Ohio Health Group PPO No Differential |
$679.26
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,619.77
|
Rate for Payer: PHCS Commercial |
$5,016.05
|
Rate for Payer: United Healthcare All Payer |
$4,598.04
|
|
PLATE VLP MINI-MOD 2.0MM Y 8H
|
Facility
|
OP
|
$5,225.05
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$679.26 |
Max. Negotiated Rate |
$5,016.05 |
Rate for Payer: Aetna Commercial |
$4,023.29
|
Rate for Payer: Anthem Medicaid |
$1,796.89
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,075.54
|
Rate for Payer: Cash Price |
$2,612.52
|
Rate for Payer: Cigna Commercial |
$4,336.79
|
Rate for Payer: First Health Commercial |
$4,963.80
|
Rate for Payer: Humana Commercial |
$4,441.29
|
Rate for Payer: Humana KY Medicaid |
$1,796.89
|
Rate for Payer: Kentucky WC Medicaid |
$1,815.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,284.54
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,856.09
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,567.52
|
Rate for Payer: Molina Healthcare Medicaid |
$1,832.95
|
Rate for Payer: Ohio Health Choice Commercial |
$4,598.04
|
Rate for Payer: Ohio Health Group HMO |
$3,918.79
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,045.01
|
Rate for Payer: Ohio Health Group PPO No Differential |
$679.26
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,619.77
|
Rate for Payer: PHCS Commercial |
$5,016.05
|
Rate for Payer: United Healthcare All Payer |
$4,598.04
|
|
PLATE VLP MINI-MOD 2.0MM Y 8H
|
Facility
|
IP
|
$5,225.05
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$679.26 |
Max. Negotiated Rate |
$5,016.05 |
Rate for Payer: Aetna Commercial |
$4,023.29
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,075.54
|
Rate for Payer: Cash Price |
$2,612.52
|
Rate for Payer: Cigna Commercial |
$4,336.79
|
Rate for Payer: First Health Commercial |
$4,963.80
|
Rate for Payer: Humana Commercial |
$4,441.29
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,284.54
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,856.09
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,567.52
|
Rate for Payer: Ohio Health Choice Commercial |
$4,598.04
|
Rate for Payer: Ohio Health Group HMO |
$3,918.79
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,045.01
|
Rate for Payer: Ohio Health Group PPO No Differential |
$679.26
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,619.77
|
Rate for Payer: PHCS Commercial |
$5,016.05
|
Rate for Payer: United Healthcare All Payer |
$4,598.04
|
|
PLATE VLP MINI-MOD 2.0 STR 6H
|
Facility
|
IP
|
$4,017.38
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$522.26 |
Max. Negotiated Rate |
$3,856.68 |
Rate for Payer: Humana Commercial |
$3,414.77
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,294.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,964.83
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,205.21
|
Rate for Payer: Ohio Health Choice Commercial |
$3,535.29
|
Rate for Payer: Ohio Health Group HMO |
$3,013.04
|
Rate for Payer: Ohio Health Group PPO Differential |
$803.48
|
Rate for Payer: Ohio Health Group PPO No Differential |
$522.26
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,245.39
|
Rate for Payer: PHCS Commercial |
$3,856.68
|
Rate for Payer: United Healthcare All Payer |
$3,535.29
|
Rate for Payer: Aetna Commercial |
$3,093.38
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,133.56
|
Rate for Payer: Cash Price |
$2,008.69
|
Rate for Payer: Cigna Commercial |
$3,334.43
|
Rate for Payer: First Health Commercial |
$3,816.51
|
|
PLATE VLP MINI-MOD 2.0 STR 6H
|
Facility
|
OP
|
$4,017.38
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$522.26 |
Max. Negotiated Rate |
$3,856.68 |
Rate for Payer: Aetna Commercial |
$3,093.38
|
Rate for Payer: Anthem Medicaid |
$1,381.58
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,133.56
|
Rate for Payer: Cash Price |
$2,008.69
|
Rate for Payer: Cigna Commercial |
$3,334.43
|
Rate for Payer: First Health Commercial |
$3,816.51
|
Rate for Payer: Humana Commercial |
$3,414.77
|
Rate for Payer: Humana KY Medicaid |
$1,381.58
|
Rate for Payer: Kentucky WC Medicaid |
$1,395.64
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,294.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,964.83
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,205.21
|
Rate for Payer: Molina Healthcare Medicaid |
$1,409.30
|
Rate for Payer: Ohio Health Choice Commercial |
$3,535.29
|
Rate for Payer: Ohio Health Group HMO |
$3,013.04
|
Rate for Payer: Ohio Health Group PPO Differential |
$803.48
|
Rate for Payer: Ohio Health Group PPO No Differential |
$522.26
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,245.39
|
Rate for Payer: PHCS Commercial |
$3,856.68
|
Rate for Payer: United Healthcare All Payer |
$3,535.29
|
|
PLATE VLP MINI-MOD 2.0 STR 8H
|
Facility
|
OP
|
$4,615.35
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$600.00 |
Max. Negotiated Rate |
$4,430.74 |
Rate for Payer: Aetna Commercial |
$3,553.82
|
Rate for Payer: Anthem Medicaid |
$1,587.22
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.97
|
Rate for Payer: Cash Price |
$2,307.68
|
Rate for Payer: Cigna Commercial |
$3,830.74
|
Rate for Payer: First Health Commercial |
$4,384.58
|
Rate for Payer: Humana Commercial |
$3,923.05
|
Rate for Payer: Humana KY Medicaid |
$1,587.22
|
Rate for Payer: Kentucky WC Medicaid |
$1,603.37
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.59
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.13
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.60
|
Rate for Payer: Molina Healthcare Medicaid |
$1,619.06
|
Rate for Payer: Ohio Health Choice Commercial |
$4,061.51
|
Rate for Payer: Ohio Health Group HMO |
$3,461.51
|
Rate for Payer: Ohio Health Group PPO Differential |
$923.07
|
Rate for Payer: Ohio Health Group PPO No Differential |
$600.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.76
|
Rate for Payer: PHCS Commercial |
$4,430.74
|
Rate for Payer: United Healthcare All Payer |
$4,061.51
|
|
PLATE VLP MINI-MOD 2.0 STR 8H
|
Facility
|
IP
|
$4,615.35
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$600.00 |
Max. Negotiated Rate |
$4,430.74 |
Rate for Payer: Aetna Commercial |
$3,553.82
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.97
|
Rate for Payer: Cash Price |
$2,307.68
|
Rate for Payer: Cigna Commercial |
$3,830.74
|
Rate for Payer: First Health Commercial |
$4,384.58
|
Rate for Payer: Humana Commercial |
$3,923.05
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.59
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.13
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.60
|
Rate for Payer: Ohio Health Choice Commercial |
$4,061.51
|
Rate for Payer: Ohio Health Group HMO |
$3,461.51
|
Rate for Payer: Ohio Health Group PPO Differential |
$923.07
|
Rate for Payer: Ohio Health Group PPO No Differential |
$600.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.76
|
Rate for Payer: PHCS Commercial |
$4,430.74
|
Rate for Payer: United Healthcare All Payer |
$4,061.51
|
|
PLATE VLP MINI-MOD 2.0 T 2*6H
|
Facility
|
OP
|
$4,310.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$560.36 |
Max. Negotiated Rate |
$4,138.08 |
Rate for Payer: Aetna Commercial |
$3,319.08
|
Rate for Payer: Anthem Medicaid |
$1,482.38
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,362.19
|
Rate for Payer: Cash Price |
$2,155.25
|
Rate for Payer: Cigna Commercial |
$3,577.72
|
Rate for Payer: First Health Commercial |
$4,094.98
|
Rate for Payer: Humana Commercial |
$3,663.92
|
Rate for Payer: Humana KY Medicaid |
$1,482.38
|
Rate for Payer: Kentucky WC Medicaid |
$1,497.47
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,534.61
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,181.15
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.15
|
Rate for Payer: Molina Healthcare Medicaid |
$1,512.12
|
Rate for Payer: Ohio Health Choice Commercial |
$3,793.24
|
Rate for Payer: Ohio Health Group HMO |
$3,232.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$862.10
|
Rate for Payer: Ohio Health Group PPO No Differential |
$560.36
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,336.26
|
Rate for Payer: PHCS Commercial |
$4,138.08
|
Rate for Payer: United Healthcare All Payer |
$3,793.24
|
|
PLATE VLP MINI-MOD 2.0 T 2*6H
|
Facility
|
IP
|
$4,310.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$560.36 |
Max. Negotiated Rate |
$4,138.08 |
Rate for Payer: Aetna Commercial |
$3,319.08
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,362.19
|
Rate for Payer: Cash Price |
$2,155.25
|
Rate for Payer: Cigna Commercial |
$3,577.72
|
Rate for Payer: First Health Commercial |
$4,094.98
|
Rate for Payer: Humana Commercial |
$3,663.92
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,534.61
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,181.15
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.15
|
Rate for Payer: Ohio Health Choice Commercial |
$3,793.24
|
Rate for Payer: Ohio Health Group HMO |
$3,232.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$862.10
|
Rate for Payer: Ohio Health Group PPO No Differential |
$560.36
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,336.26
|
Rate for Payer: PHCS Commercial |
$4,138.08
|
Rate for Payer: United Healthcare All Payer |
$3,793.24
|
|
PLATE VLP MINI-MOD 2.0 T 2*8H
|
Facility
|
IP
|
$4,920.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$639.63 |
Max. Negotiated Rate |
$4,723.39 |
Rate for Payer: Aetna Commercial |
$3,788.55
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,837.76
|
Rate for Payer: Cash Price |
$2,460.10
|
Rate for Payer: Cigna Commercial |
$4,083.77
|
Rate for Payer: First Health Commercial |
$4,674.19
|
Rate for Payer: Humana Commercial |
$4,182.17
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,034.56
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,631.11
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,476.06
|
Rate for Payer: Ohio Health Choice Commercial |
$4,329.78
|
Rate for Payer: Ohio Health Group HMO |
$3,690.15
|
Rate for Payer: Ohio Health Group PPO Differential |
$984.04
|
Rate for Payer: Ohio Health Group PPO No Differential |
$639.63
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,525.26
|
Rate for Payer: PHCS Commercial |
$4,723.39
|
Rate for Payer: United Healthcare All Payer |
$4,329.78
|
|
PLATE VLP MINI-MOD 2.0 T 2*8H
|
Facility
|
OP
|
$4,920.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$639.63 |
Max. Negotiated Rate |
$4,723.39 |
Rate for Payer: Aetna Commercial |
$3,788.55
|
Rate for Payer: Anthem Medicaid |
$1,692.06
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,837.76
|
Rate for Payer: Cash Price |
$2,460.10
|
Rate for Payer: Cigna Commercial |
$4,083.77
|
Rate for Payer: First Health Commercial |
$4,674.19
|
Rate for Payer: Humana Commercial |
$4,182.17
|
Rate for Payer: Humana KY Medicaid |
$1,692.06
|
Rate for Payer: Kentucky WC Medicaid |
$1,709.28
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,034.56
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,631.11
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,476.06
|
Rate for Payer: Molina Healthcare Medicaid |
$1,726.01
|
Rate for Payer: Ohio Health Choice Commercial |
$4,329.78
|
Rate for Payer: Ohio Health Group HMO |
$3,690.15
|
Rate for Payer: Ohio Health Group PPO Differential |
$984.04
|
Rate for Payer: Ohio Health Group PPO No Differential |
$639.63
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,525.26
|
Rate for Payer: PHCS Commercial |
$4,723.39
|
Rate for Payer: United Healthcare All Payer |
$4,329.78
|
|
PLATE VLP MINI-MOD 2.0 T 3*6H
|
Facility
|
IP
|
$5,225.05
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$679.26 |
Max. Negotiated Rate |
$5,016.05 |
Rate for Payer: Aetna Commercial |
$4,023.29
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,075.54
|
Rate for Payer: Cash Price |
$2,612.52
|
Rate for Payer: Cigna Commercial |
$4,336.79
|
Rate for Payer: First Health Commercial |
$4,963.80
|
Rate for Payer: Humana Commercial |
$4,441.29
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,284.54
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,856.09
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,567.52
|
Rate for Payer: Ohio Health Choice Commercial |
$4,598.04
|
Rate for Payer: Ohio Health Group HMO |
$3,918.79
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,045.01
|
Rate for Payer: Ohio Health Group PPO No Differential |
$679.26
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,619.77
|
Rate for Payer: PHCS Commercial |
$5,016.05
|
Rate for Payer: United Healthcare All Payer |
$4,598.04
|
|
PLATE VLP MINI-MOD 2.0 T 3*6H
|
Facility
|
OP
|
$5,225.05
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$679.26 |
Max. Negotiated Rate |
$5,016.05 |
Rate for Payer: Humana Commercial |
$4,441.29
|
Rate for Payer: Humana KY Medicaid |
$1,796.89
|
Rate for Payer: Kentucky WC Medicaid |
$1,815.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,284.54
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,856.09
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,567.52
|
Rate for Payer: Molina Healthcare Medicaid |
$1,832.95
|
Rate for Payer: Ohio Health Choice Commercial |
$4,598.04
|
Rate for Payer: Ohio Health Group HMO |
$3,918.79
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,045.01
|
Rate for Payer: Ohio Health Group PPO No Differential |
$679.26
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,619.77
|
Rate for Payer: PHCS Commercial |
$5,016.05
|
Rate for Payer: United Healthcare All Payer |
$4,598.04
|
Rate for Payer: Aetna Commercial |
$4,023.29
|
Rate for Payer: Anthem Medicaid |
$1,796.89
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,075.54
|
Rate for Payer: Cash Price |
$2,612.52
|
Rate for Payer: Cigna Commercial |
$4,336.79
|
Rate for Payer: First Health Commercial |
$4,963.80
|
|