PLATE VLP MINI-MOD 2.0 T 3*8H
|
Facility
|
OP
|
$6,578.30
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$855.18 |
Max. Negotiated Rate |
$6,315.17 |
Rate for Payer: Aetna Commercial |
$5,065.29
|
Rate for Payer: Anthem Medicaid |
$2,262.28
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,131.07
|
Rate for Payer: Cash Price |
$3,289.15
|
Rate for Payer: Cigna Commercial |
$5,459.99
|
Rate for Payer: First Health Commercial |
$6,249.38
|
Rate for Payer: Humana Commercial |
$5,591.56
|
Rate for Payer: Humana KY Medicaid |
$2,262.28
|
Rate for Payer: Kentucky WC Medicaid |
$2,285.30
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,394.21
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,854.79
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,973.49
|
Rate for Payer: Molina Healthcare Medicaid |
$2,307.67
|
Rate for Payer: Ohio Health Choice Commercial |
$5,788.90
|
Rate for Payer: Ohio Health Group HMO |
$4,933.72
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,315.66
|
Rate for Payer: Ohio Health Group PPO No Differential |
$855.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,039.27
|
Rate for Payer: PHCS Commercial |
$6,315.17
|
Rate for Payer: United Healthcare All Payer |
$5,788.90
|
|
PLATE VLP MINI-MOD 2.0 T 3*8H
|
Facility
|
IP
|
$6,578.30
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$855.18 |
Max. Negotiated Rate |
$6,315.17 |
Rate for Payer: Aetna Commercial |
$5,065.29
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,131.07
|
Rate for Payer: Cash Price |
$3,289.15
|
Rate for Payer: Cigna Commercial |
$5,459.99
|
Rate for Payer: First Health Commercial |
$6,249.38
|
Rate for Payer: Humana Commercial |
$5,591.56
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,394.21
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,854.79
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,973.49
|
Rate for Payer: Ohio Health Choice Commercial |
$5,788.90
|
Rate for Payer: Ohio Health Group HMO |
$4,933.72
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,315.66
|
Rate for Payer: Ohio Health Group PPO No Differential |
$855.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,039.27
|
Rate for Payer: PHCS Commercial |
$6,315.17
|
Rate for Payer: United Healthcare All Payer |
$5,788.90
|
|
PLATE VLP MINI-MOD 2.4MM 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 2.4MM 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 2.4MM Y 8H
|
Facility
|
IP
|
$6,578.30
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$855.18 |
Max. Negotiated Rate |
$6,315.17 |
Rate for Payer: Aetna Commercial |
$5,065.29
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,131.07
|
Rate for Payer: Cash Price |
$3,289.15
|
Rate for Payer: Cigna Commercial |
$5,459.99
|
Rate for Payer: First Health Commercial |
$6,249.38
|
Rate for Payer: Humana Commercial |
$5,591.56
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,394.21
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,854.79
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,973.49
|
Rate for Payer: Ohio Health Choice Commercial |
$5,788.90
|
Rate for Payer: Ohio Health Group HMO |
$4,933.72
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,315.66
|
Rate for Payer: Ohio Health Group PPO No Differential |
$855.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,039.27
|
Rate for Payer: PHCS Commercial |
$6,315.17
|
Rate for Payer: United Healthcare All Payer |
$5,788.90
|
|
PLATE VLP MINI-MOD 2.4MM Y 8H
|
Facility
|
OP
|
$6,578.30
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$855.18 |
Max. Negotiated Rate |
$6,315.17 |
Rate for Payer: Aetna Commercial |
$5,065.29
|
Rate for Payer: Anthem Medicaid |
$2,262.28
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,131.07
|
Rate for Payer: Cash Price |
$3,289.15
|
Rate for Payer: Cigna Commercial |
$5,459.99
|
Rate for Payer: First Health Commercial |
$6,249.38
|
Rate for Payer: Humana Commercial |
$5,591.56
|
Rate for Payer: Humana KY Medicaid |
$2,262.28
|
Rate for Payer: Kentucky WC Medicaid |
$2,285.30
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,394.21
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,854.79
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,973.49
|
Rate for Payer: Molina Healthcare Medicaid |
$2,307.67
|
Rate for Payer: Ohio Health Choice Commercial |
$5,788.90
|
Rate for Payer: Ohio Health Group HMO |
$4,933.72
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,315.66
|
Rate for Payer: Ohio Health Group PPO No Differential |
$855.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,039.27
|
Rate for Payer: PHCS Commercial |
$6,315.17
|
Rate for Payer: United Healthcare All Payer |
$5,788.90
|
|
PLATE VLP MINI-MOD 2.4 STR 12H
|
Facility
|
IP
|
$6,578.30
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$855.18 |
Max. Negotiated Rate |
$6,315.17 |
Rate for Payer: Aetna Commercial |
$5,065.29
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,131.07
|
Rate for Payer: Cash Price |
$3,289.15
|
Rate for Payer: Cigna Commercial |
$5,459.99
|
Rate for Payer: First Health Commercial |
$6,249.38
|
Rate for Payer: Humana Commercial |
$5,591.56
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,394.21
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,854.79
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,973.49
|
Rate for Payer: Ohio Health Choice Commercial |
$5,788.90
|
Rate for Payer: Ohio Health Group HMO |
$4,933.72
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,315.66
|
Rate for Payer: Ohio Health Group PPO No Differential |
$855.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,039.27
|
Rate for Payer: PHCS Commercial |
$6,315.17
|
Rate for Payer: United Healthcare All Payer |
$5,788.90
|
|
PLATE VLP MINI-MOD 2.4 STR 12H
|
Facility
|
OP
|
$6,578.30
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$855.18 |
Max. Negotiated Rate |
$6,315.17 |
Rate for Payer: Aetna Commercial |
$5,065.29
|
Rate for Payer: Anthem Medicaid |
$2,262.28
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,131.07
|
Rate for Payer: Cash Price |
$3,289.15
|
Rate for Payer: Cigna Commercial |
$5,459.99
|
Rate for Payer: First Health Commercial |
$6,249.38
|
Rate for Payer: Humana Commercial |
$5,591.56
|
Rate for Payer: Humana KY Medicaid |
$2,262.28
|
Rate for Payer: Kentucky WC Medicaid |
$2,285.30
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,394.21
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,854.79
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,973.49
|
Rate for Payer: Molina Healthcare Medicaid |
$2,307.67
|
Rate for Payer: Ohio Health Choice Commercial |
$5,788.90
|
Rate for Payer: Ohio Health Group HMO |
$4,933.72
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,315.66
|
Rate for Payer: Ohio Health Group PPO No Differential |
$855.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,039.27
|
Rate for Payer: PHCS Commercial |
$6,315.17
|
Rate for Payer: United Healthcare All Payer |
$5,788.90
|
|
PLATE VLP MINI-MOD 2.4 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: 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
|
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
|
|
PLATE VLP MINI-MOD 2.4 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 2.4 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 2.4 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 2.4 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 2.4 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 2.4 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 2.4 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 2.4 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 2.4 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: 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
|
Rate for Payer: Aetna Commercial |
$4,023.29
|
|
PLATE VLP MINI-MOD 2.4 T 3*8H
|
Facility
|
IP
|
$6,578.30
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$855.18 |
Max. Negotiated Rate |
$6,315.17 |
Rate for Payer: Aetna Commercial |
$5,065.29
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,131.07
|
Rate for Payer: Cash Price |
$3,289.15
|
Rate for Payer: Cigna Commercial |
$5,459.99
|
Rate for Payer: First Health Commercial |
$6,249.38
|
Rate for Payer: Humana Commercial |
$5,591.56
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,394.21
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,854.79
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,973.49
|
Rate for Payer: Ohio Health Choice Commercial |
$5,788.90
|
Rate for Payer: Ohio Health Group HMO |
$4,933.72
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,315.66
|
Rate for Payer: Ohio Health Group PPO No Differential |
$855.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,039.27
|
Rate for Payer: PHCS Commercial |
$6,315.17
|
Rate for Payer: United Healthcare All Payer |
$5,788.90
|
|
PLATE VLP MINI-MOD 2.4 T 3*8H
|
Facility
|
OP
|
$6,578.30
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$855.18 |
Max. Negotiated Rate |
$6,315.17 |
Rate for Payer: Aetna Commercial |
$5,065.29
|
Rate for Payer: Anthem Medicaid |
$2,262.28
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,131.07
|
Rate for Payer: Cash Price |
$3,289.15
|
Rate for Payer: Cigna Commercial |
$5,459.99
|
Rate for Payer: First Health Commercial |
$6,249.38
|
Rate for Payer: Humana Commercial |
$5,591.56
|
Rate for Payer: Humana KY Medicaid |
$2,262.28
|
Rate for Payer: Kentucky WC Medicaid |
$2,285.30
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,394.21
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,854.79
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,973.49
|
Rate for Payer: Molina Healthcare Medicaid |
$2,307.67
|
Rate for Payer: Ohio Health Choice Commercial |
$5,788.90
|
Rate for Payer: Ohio Health Group HMO |
$4,933.72
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,315.66
|
Rate for Payer: Ohio Health Group PPO No Differential |
$855.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,039.27
|
Rate for Payer: PHCS Commercial |
$6,315.17
|
Rate for Payer: United Healthcare All Payer |
$5,788.90
|
|
PLATE VLP MIN-MOD 1.5M STR 12H
|
Facility
|
IP
|
$4,509.82
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$586.28 |
Max. Negotiated Rate |
$4,329.43 |
Rate for Payer: Aetna Commercial |
$3,472.56
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,517.66
|
Rate for Payer: Cash Price |
$2,254.91
|
Rate for Payer: Cigna Commercial |
$3,743.15
|
Rate for Payer: First Health Commercial |
$4,284.33
|
Rate for Payer: Humana Commercial |
$3,833.35
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,698.05
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,328.25
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,352.95
|
Rate for Payer: Ohio Health Choice Commercial |
$3,968.64
|
Rate for Payer: Ohio Health Group HMO |
$3,382.36
|
Rate for Payer: Ohio Health Group PPO Differential |
$901.96
|
Rate for Payer: Ohio Health Group PPO No Differential |
$586.28
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,398.04
|
Rate for Payer: PHCS Commercial |
$4,329.43
|
Rate for Payer: United Healthcare All Payer |
$3,968.64
|
|
PLATE VLP MIN-MOD 1.5M STR 12H
|
Facility
|
OP
|
$4,509.82
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$586.28 |
Max. Negotiated Rate |
$4,329.43 |
Rate for Payer: Aetna Commercial |
$3,472.56
|
Rate for Payer: Anthem Medicaid |
$1,550.93
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,517.66
|
Rate for Payer: Cash Price |
$2,254.91
|
Rate for Payer: Cigna Commercial |
$3,743.15
|
Rate for Payer: First Health Commercial |
$4,284.33
|
Rate for Payer: Humana Commercial |
$3,833.35
|
Rate for Payer: Humana KY Medicaid |
$1,550.93
|
Rate for Payer: Kentucky WC Medicaid |
$1,566.71
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,698.05
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,328.25
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,352.95
|
Rate for Payer: Molina Healthcare Medicaid |
$1,582.04
|
Rate for Payer: Ohio Health Choice Commercial |
$3,968.64
|
Rate for Payer: Ohio Health Group HMO |
$3,382.36
|
Rate for Payer: Ohio Health Group PPO Differential |
$901.96
|
Rate for Payer: Ohio Health Group PPO No Differential |
$586.28
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,398.04
|
Rate for Payer: PHCS Commercial |
$4,329.43
|
Rate for Payer: United Healthcare All Payer |
$3,968.64
|
|
PLATE VLP MIN-MOD 1.5M STR 6H
|
Facility
|
IP
|
$3,923.57
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$510.06 |
Max. Negotiated Rate |
$3,766.63 |
Rate for Payer: Aetna Commercial |
$3,021.15
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,060.38
|
Rate for Payer: Cash Price |
$1,961.79
|
Rate for Payer: Cigna Commercial |
$3,256.56
|
Rate for Payer: First Health Commercial |
$3,727.39
|
Rate for Payer: Humana Commercial |
$3,335.03
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,217.33
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,895.59
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,177.07
|
Rate for Payer: Ohio Health Choice Commercial |
$3,452.74
|
Rate for Payer: Ohio Health Group HMO |
$2,942.68
|
Rate for Payer: Ohio Health Group PPO Differential |
$784.71
|
Rate for Payer: Ohio Health Group PPO No Differential |
$510.06
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,216.31
|
Rate for Payer: PHCS Commercial |
$3,766.63
|
Rate for Payer: United Healthcare All Payer |
$3,452.74
|
|
PLATE VLP MIN-MOD 1.5M STR 6H
|
Facility
|
OP
|
$3,923.57
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$510.06 |
Max. Negotiated Rate |
$3,766.63 |
Rate for Payer: Aetna Commercial |
$3,021.15
|
Rate for Payer: Anthem Medicaid |
$1,349.32
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,060.38
|
Rate for Payer: Cash Price |
$1,961.79
|
Rate for Payer: Cigna Commercial |
$3,256.56
|
Rate for Payer: First Health Commercial |
$3,727.39
|
Rate for Payer: Humana Commercial |
$3,335.03
|
Rate for Payer: Humana KY Medicaid |
$1,349.32
|
Rate for Payer: Kentucky WC Medicaid |
$1,363.05
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,217.33
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,895.59
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,177.07
|
Rate for Payer: Molina Healthcare Medicaid |
$1,376.39
|
Rate for Payer: Ohio Health Choice Commercial |
$3,452.74
|
Rate for Payer: Ohio Health Group HMO |
$2,942.68
|
Rate for Payer: Ohio Health Group PPO Differential |
$784.71
|
Rate for Payer: Ohio Health Group PPO No Differential |
$510.06
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,216.31
|
Rate for Payer: PHCS Commercial |
$3,766.63
|
Rate for Payer: United Healthcare All Payer |
$3,452.74
|
|
PLATE VLP MIN-MOD 1.5M STR 8H
|
Facility
|
IP
|
$4,509.82
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$586.28 |
Max. Negotiated Rate |
$4,329.43 |
Rate for Payer: Aetna Commercial |
$3,472.56
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,517.66
|
Rate for Payer: Cash Price |
$2,254.91
|
Rate for Payer: Cigna Commercial |
$3,743.15
|
Rate for Payer: First Health Commercial |
$4,284.33
|
Rate for Payer: Humana Commercial |
$3,833.35
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,698.05
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,328.25
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,352.95
|
Rate for Payer: Ohio Health Choice Commercial |
$3,968.64
|
Rate for Payer: Ohio Health Group HMO |
$3,382.36
|
Rate for Payer: Ohio Health Group PPO Differential |
$901.96
|
Rate for Payer: Ohio Health Group PPO No Differential |
$586.28
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,398.04
|
Rate for Payer: PHCS Commercial |
$4,329.43
|
Rate for Payer: United Healthcare All Payer |
$3,968.64
|
|