|
PLATE TI VA-LCP 3H 2.4*41 -90
|
Facility
|
OP
|
$4,355.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,306.52 |
| Max. Negotiated Rate |
$4,180.88 |
| Rate for Payer: Aetna Commercial |
$3,353.41
|
| Rate for Payer: Anthem Medicaid |
$1,497.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,396.96
|
| Rate for Payer: Cash Price |
$2,177.54
|
| Rate for Payer: Cigna Commercial |
$3,614.72
|
| Rate for Payer: First Health Commercial |
$4,137.33
|
| Rate for Payer: Humana Commercial |
$3,701.82
|
| Rate for Payer: Humana KY Medicaid |
$1,497.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,512.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,571.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,214.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,306.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,527.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,832.47
|
| Rate for Payer: Ohio Health Group HMO |
$3,266.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,484.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,788.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,005.01
|
| Rate for Payer: PHCS Commercial |
$4,180.88
|
| Rate for Payer: United Healthcare All Payer |
$3,832.47
|
|
|
PLATE TI VA-LCP 3H 2.4*41 -90
|
Facility
|
IP
|
$4,355.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,306.52 |
| Max. Negotiated Rate |
$4,180.88 |
| Rate for Payer: Aetna Commercial |
$3,353.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,396.96
|
| Rate for Payer: Cash Price |
$2,177.54
|
| Rate for Payer: Cigna Commercial |
$3,614.72
|
| Rate for Payer: First Health Commercial |
$4,137.33
|
| Rate for Payer: Humana Commercial |
$3,701.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,571.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,214.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,306.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,832.47
|
| Rate for Payer: Ohio Health Group HMO |
$3,266.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,484.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,788.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,005.01
|
| Rate for Payer: PHCS Commercial |
$4,180.88
|
| Rate for Payer: United Healthcare All Payer |
$3,832.47
|
|
|
PLATE TI VA-LCP 3H 2.4*54 L
|
Facility
|
IP
|
$5,639.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.87 |
| Max. Negotiated Rate |
$5,413.98 |
| Rate for Payer: Aetna Commercial |
$4,342.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,398.86
|
| Rate for Payer: Cash Price |
$2,819.78
|
| Rate for Payer: Cigna Commercial |
$4,680.83
|
| Rate for Payer: First Health Commercial |
$5,357.58
|
| Rate for Payer: Humana Commercial |
$4,793.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,624.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,162.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,962.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,229.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,511.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,906.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.30
|
| Rate for Payer: PHCS Commercial |
$5,413.98
|
| Rate for Payer: United Healthcare All Payer |
$4,962.81
|
|
|
PLATE TI VA-LCP 3H 2.4*54 L
|
Facility
|
OP
|
$5,639.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.87 |
| Max. Negotiated Rate |
$5,413.98 |
| Rate for Payer: Aetna Commercial |
$4,342.46
|
| Rate for Payer: Anthem Medicaid |
$1,939.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,398.86
|
| Rate for Payer: Cash Price |
$2,819.78
|
| Rate for Payer: Cigna Commercial |
$4,680.83
|
| Rate for Payer: First Health Commercial |
$5,357.58
|
| Rate for Payer: Humana Commercial |
$4,793.63
|
| Rate for Payer: Humana KY Medicaid |
$1,939.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,959.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,624.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,162.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,978.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,962.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,229.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,511.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,906.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.30
|
| Rate for Payer: PHCS Commercial |
$5,413.98
|
| Rate for Payer: United Healthcare All Payer |
$4,962.81
|
|
|
PLATE TI VA-LCP 4H 2.4*48 L
|
Facility
|
IP
|
$7,377.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,213.23 |
| Max. Negotiated Rate |
$7,082.34 |
| Rate for Payer: Aetna Commercial |
$5,680.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,754.40
|
| Rate for Payer: Cash Price |
$3,688.72
|
| Rate for Payer: Cigna Commercial |
$6,123.28
|
| Rate for Payer: First Health Commercial |
$7,008.57
|
| Rate for Payer: Humana Commercial |
$6,270.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,049.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,444.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,213.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,492.15
|
| Rate for Payer: Ohio Health Group HMO |
$5,533.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,901.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,418.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,090.43
|
| Rate for Payer: PHCS Commercial |
$7,082.34
|
| Rate for Payer: United Healthcare All Payer |
$6,492.15
|
|
|
PLATE TI VA-LCP 4H 2.4*48 L
|
Facility
|
OP
|
$7,377.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,213.23 |
| Max. Negotiated Rate |
$7,082.34 |
| Rate for Payer: Aetna Commercial |
$5,680.63
|
| Rate for Payer: Anthem Medicaid |
$2,537.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,754.40
|
| Rate for Payer: Cash Price |
$3,688.72
|
| Rate for Payer: Cigna Commercial |
$6,123.28
|
| Rate for Payer: First Health Commercial |
$7,008.57
|
| Rate for Payer: Humana Commercial |
$6,270.82
|
| Rate for Payer: Humana KY Medicaid |
$2,537.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,562.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,049.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,444.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,213.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,492.15
|
| Rate for Payer: Ohio Health Group HMO |
$5,533.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,901.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,418.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,090.43
|
| Rate for Payer: PHCS Commercial |
$7,082.34
|
| Rate for Payer: United Healthcare All Payer |
$6,492.15
|
|
|
PLATE TI VA-LCP 4H 2.4*48 R
|
Facility
|
OP
|
$5,639.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.87 |
| Max. Negotiated Rate |
$5,413.98 |
| Rate for Payer: Aetna Commercial |
$4,342.46
|
| Rate for Payer: Anthem Medicaid |
$1,939.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,398.86
|
| Rate for Payer: Cash Price |
$2,819.78
|
| Rate for Payer: Cigna Commercial |
$4,680.83
|
| Rate for Payer: First Health Commercial |
$5,357.58
|
| Rate for Payer: Humana Commercial |
$4,793.63
|
| Rate for Payer: Humana KY Medicaid |
$1,939.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,959.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,624.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,162.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,978.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,962.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,229.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,511.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,906.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.30
|
| Rate for Payer: PHCS Commercial |
$5,413.98
|
| Rate for Payer: United Healthcare All Payer |
$4,962.81
|
|
|
PLATE TI VA-LCP 4H 2.4*48 R
|
Facility
|
IP
|
$5,639.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.87 |
| Max. Negotiated Rate |
$5,413.98 |
| Rate for Payer: Aetna Commercial |
$4,342.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,398.86
|
| Rate for Payer: Cash Price |
$2,819.78
|
| Rate for Payer: Cigna Commercial |
$4,680.83
|
| Rate for Payer: First Health Commercial |
$5,357.58
|
| Rate for Payer: Humana Commercial |
$4,793.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,624.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,162.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,962.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,229.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,511.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,906.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.30
|
| Rate for Payer: PHCS Commercial |
$5,413.98
|
| Rate for Payer: United Healthcare All Payer |
$4,962.81
|
|
|
PLATE TI VA-LCP 4H 2.4*49 +90
|
Facility
|
OP
|
$4,434.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,330.41 |
| Max. Negotiated Rate |
$4,257.30 |
| Rate for Payer: Aetna Commercial |
$3,414.71
|
| Rate for Payer: Anthem Medicaid |
$1,525.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,459.06
|
| Rate for Payer: Cash Price |
$2,217.34
|
| Rate for Payer: Cigna Commercial |
$3,680.79
|
| Rate for Payer: First Health Commercial |
$4,212.96
|
| Rate for Payer: Humana Commercial |
$3,769.49
|
| Rate for Payer: Humana KY Medicaid |
$1,525.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,540.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,636.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,272.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,330.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,555.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,902.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,326.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,547.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,858.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,059.94
|
| Rate for Payer: PHCS Commercial |
$4,257.30
|
| Rate for Payer: United Healthcare All Payer |
$3,902.53
|
|
|
PLATE TI VA-LCP 4H 2.4*49 +90
|
Facility
|
IP
|
$4,434.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,330.41 |
| Max. Negotiated Rate |
$4,257.30 |
| Rate for Payer: Aetna Commercial |
$3,414.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,459.06
|
| Rate for Payer: Cash Price |
$2,217.34
|
| Rate for Payer: Cigna Commercial |
$3,680.79
|
| Rate for Payer: First Health Commercial |
$4,212.96
|
| Rate for Payer: Humana Commercial |
$3,769.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,636.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,272.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,330.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,902.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,326.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,547.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,858.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,059.94
|
| Rate for Payer: PHCS Commercial |
$4,257.30
|
| Rate for Payer: United Healthcare All Payer |
$3,902.53
|
|
|
PLATE TI VA-LCP 4H 2.4*49 -90
|
Facility
|
IP
|
$4,434.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,330.41 |
| Max. Negotiated Rate |
$4,257.30 |
| Rate for Payer: Aetna Commercial |
$3,414.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,459.06
|
| Rate for Payer: Cash Price |
$2,217.34
|
| Rate for Payer: Cigna Commercial |
$3,680.79
|
| Rate for Payer: First Health Commercial |
$4,212.96
|
| Rate for Payer: Humana Commercial |
$3,769.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,636.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,272.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,330.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,902.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,326.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,547.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,858.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,059.94
|
| Rate for Payer: PHCS Commercial |
$4,257.30
|
| Rate for Payer: United Healthcare All Payer |
$3,902.53
|
|
|
PLATE TI VA-LCP 4H 2.4*49 -90
|
Facility
|
OP
|
$4,434.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,330.41 |
| Max. Negotiated Rate |
$4,257.30 |
| Rate for Payer: Aetna Commercial |
$3,414.71
|
| Rate for Payer: Anthem Medicaid |
$1,525.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,459.06
|
| Rate for Payer: Cash Price |
$2,217.34
|
| Rate for Payer: Cigna Commercial |
$3,680.79
|
| Rate for Payer: First Health Commercial |
$4,212.96
|
| Rate for Payer: Humana Commercial |
$3,769.49
|
| Rate for Payer: Humana KY Medicaid |
$1,525.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,540.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,636.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,272.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,330.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,555.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,902.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,326.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,547.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,858.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,059.94
|
| Rate for Payer: PHCS Commercial |
$4,257.30
|
| Rate for Payer: United Healthcare All Payer |
$3,902.53
|
|
|
PLATE TI VA-LCP 4H 2.4*66 L
|
Facility
|
OP
|
$5,639.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.87 |
| Max. Negotiated Rate |
$5,413.98 |
| Rate for Payer: Aetna Commercial |
$4,342.46
|
| Rate for Payer: Anthem Medicaid |
$1,939.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,398.86
|
| Rate for Payer: Cash Price |
$2,819.78
|
| Rate for Payer: Cigna Commercial |
$4,680.83
|
| Rate for Payer: First Health Commercial |
$5,357.58
|
| Rate for Payer: Humana Commercial |
$4,793.63
|
| Rate for Payer: Humana KY Medicaid |
$1,939.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,959.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,624.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,162.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,978.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,962.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,229.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,511.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,906.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.30
|
| Rate for Payer: PHCS Commercial |
$5,413.98
|
| Rate for Payer: United Healthcare All Payer |
$4,962.81
|
|
|
PLATE TI VA-LCP 4H 2.4*66 L
|
Facility
|
IP
|
$5,639.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.87 |
| Max. Negotiated Rate |
$5,413.98 |
| Rate for Payer: Aetna Commercial |
$4,342.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,398.86
|
| Rate for Payer: Cash Price |
$2,819.78
|
| Rate for Payer: Cigna Commercial |
$4,680.83
|
| Rate for Payer: First Health Commercial |
$5,357.58
|
| Rate for Payer: Humana Commercial |
$4,793.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,624.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,162.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,962.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,229.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,511.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,906.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.30
|
| Rate for Payer: PHCS Commercial |
$5,413.98
|
| Rate for Payer: United Healthcare All Payer |
$4,962.81
|
|
|
PLATE TI VA-LCP 4H 2.4*66 R
|
Facility
|
OP
|
$5,639.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.87 |
| Max. Negotiated Rate |
$5,413.98 |
| Rate for Payer: Aetna Commercial |
$4,342.46
|
| Rate for Payer: Anthem Medicaid |
$1,939.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,398.86
|
| Rate for Payer: Cash Price |
$2,819.78
|
| Rate for Payer: Cigna Commercial |
$4,680.83
|
| Rate for Payer: First Health Commercial |
$5,357.58
|
| Rate for Payer: Humana Commercial |
$4,793.63
|
| Rate for Payer: Humana KY Medicaid |
$1,939.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,959.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,624.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,162.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,978.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,962.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,229.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,511.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,906.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.30
|
| Rate for Payer: PHCS Commercial |
$5,413.98
|
| Rate for Payer: United Healthcare All Payer |
$4,962.81
|
|
|
PLATE TI VA-LCP 4H 2.4*66 R
|
Facility
|
IP
|
$5,639.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.87 |
| Max. Negotiated Rate |
$5,413.98 |
| Rate for Payer: Aetna Commercial |
$4,342.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,398.86
|
| Rate for Payer: Cash Price |
$2,819.78
|
| Rate for Payer: Cigna Commercial |
$4,680.83
|
| Rate for Payer: First Health Commercial |
$5,357.58
|
| Rate for Payer: Humana Commercial |
$4,793.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,624.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,162.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,962.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,229.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,511.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,906.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.30
|
| Rate for Payer: PHCS Commercial |
$5,413.98
|
| Rate for Payer: United Healthcare All Payer |
$4,962.81
|
|
|
PLATE TI VA-LCP 4H 3.5*87 L
|
Facility
|
OP
|
$9,438.97
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,831.69 |
| Max. Negotiated Rate |
$9,061.41 |
| Rate for Payer: Aetna Commercial |
$7,268.01
|
| Rate for Payer: Anthem Medicaid |
$3,246.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,362.40
|
| Rate for Payer: Cash Price |
$4,719.48
|
| Rate for Payer: Cigna Commercial |
$7,834.35
|
| Rate for Payer: First Health Commercial |
$8,967.02
|
| Rate for Payer: Humana Commercial |
$8,023.12
|
| Rate for Payer: Humana KY Medicaid |
$3,246.06
|
| Rate for Payer: Kentucky WC Medicaid |
$3,279.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,739.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,965.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,831.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,311.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,306.29
|
| Rate for Payer: Ohio Health Group HMO |
$7,079.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,551.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,211.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,512.89
|
| Rate for Payer: PHCS Commercial |
$9,061.41
|
| Rate for Payer: United Healthcare All Payer |
$8,306.29
|
|
|
PLATE TI VA-LCP 4H 3.5*87 L
|
Facility
|
IP
|
$9,438.97
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,831.69 |
| Max. Negotiated Rate |
$9,061.41 |
| Rate for Payer: Aetna Commercial |
$7,268.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,362.40
|
| Rate for Payer: Cash Price |
$4,719.48
|
| Rate for Payer: Cigna Commercial |
$7,834.35
|
| Rate for Payer: First Health Commercial |
$8,967.02
|
| Rate for Payer: Humana Commercial |
$8,023.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,739.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,965.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,831.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,306.29
|
| Rate for Payer: Ohio Health Group HMO |
$7,079.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,551.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,211.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,512.89
|
| Rate for Payer: PHCS Commercial |
$9,061.41
|
| Rate for Payer: United Healthcare All Payer |
$8,306.29
|
|
|
PLATE TI VA-LCP 5H 2.4*48 L
|
Facility
|
OP
|
$5,639.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.87 |
| Max. Negotiated Rate |
$5,413.98 |
| Rate for Payer: Aetna Commercial |
$4,342.46
|
| Rate for Payer: Anthem Medicaid |
$1,939.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,398.86
|
| Rate for Payer: Cash Price |
$2,819.78
|
| Rate for Payer: Cigna Commercial |
$4,680.83
|
| Rate for Payer: First Health Commercial |
$5,357.58
|
| Rate for Payer: Humana Commercial |
$4,793.63
|
| Rate for Payer: Humana KY Medicaid |
$1,939.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,959.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,624.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,162.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,978.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,962.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,229.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,511.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,906.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.30
|
| Rate for Payer: PHCS Commercial |
$5,413.98
|
| Rate for Payer: United Healthcare All Payer |
$4,962.81
|
|
|
PLATE TI VA-LCP 5H 2.4*48 L
|
Facility
|
IP
|
$5,639.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.87 |
| Max. Negotiated Rate |
$5,413.98 |
| Rate for Payer: Aetna Commercial |
$4,342.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,398.86
|
| Rate for Payer: Cash Price |
$2,819.78
|
| Rate for Payer: Cigna Commercial |
$4,680.83
|
| Rate for Payer: First Health Commercial |
$5,357.58
|
| Rate for Payer: Humana Commercial |
$4,793.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,624.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,162.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,962.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,229.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,511.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,906.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.30
|
| Rate for Payer: PHCS Commercial |
$5,413.98
|
| Rate for Payer: United Healthcare All Payer |
$4,962.81
|
|
|
PLATE TI VA-LCP 5H 2.4*48 R
|
Facility
|
IP
|
$5,639.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.87 |
| Max. Negotiated Rate |
$5,413.98 |
| Rate for Payer: Aetna Commercial |
$4,342.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,398.86
|
| Rate for Payer: Cash Price |
$2,819.78
|
| Rate for Payer: Cigna Commercial |
$4,680.83
|
| Rate for Payer: First Health Commercial |
$5,357.58
|
| Rate for Payer: Humana Commercial |
$4,793.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,624.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,162.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,962.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,229.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,511.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,906.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.30
|
| Rate for Payer: PHCS Commercial |
$5,413.98
|
| Rate for Payer: United Healthcare All Payer |
$4,962.81
|
|
|
PLATE TI VA-LCP 5H 2.4*48 R
|
Facility
|
OP
|
$5,639.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.87 |
| Max. Negotiated Rate |
$5,413.98 |
| Rate for Payer: Aetna Commercial |
$4,342.46
|
| Rate for Payer: Anthem Medicaid |
$1,939.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,398.86
|
| Rate for Payer: Cash Price |
$2,819.78
|
| Rate for Payer: Cigna Commercial |
$4,680.83
|
| Rate for Payer: First Health Commercial |
$5,357.58
|
| Rate for Payer: Humana Commercial |
$4,793.63
|
| Rate for Payer: Humana KY Medicaid |
$1,939.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,959.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,624.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,162.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,978.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,962.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,229.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,511.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,906.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.30
|
| Rate for Payer: PHCS Commercial |
$5,413.98
|
| Rate for Payer: United Healthcare All Payer |
$4,962.81
|
|
|
PLATE TI VA-LCP 5H 2.4*51 +90
|
Facility
|
IP
|
$4,298.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.61 |
| Max. Negotiated Rate |
$4,126.76 |
| Rate for Payer: Aetna Commercial |
$3,310.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,352.99
|
| Rate for Payer: Cash Price |
$2,149.36
|
| Rate for Payer: Cigna Commercial |
$3,567.93
|
| Rate for Payer: First Health Commercial |
$4,083.77
|
| Rate for Payer: Humana Commercial |
$3,653.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,524.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,172.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,289.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,782.86
|
| Rate for Payer: Ohio Health Group HMO |
$3,224.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,438.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,739.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,966.11
|
| Rate for Payer: PHCS Commercial |
$4,126.76
|
| Rate for Payer: United Healthcare All Payer |
$3,782.86
|
|
|
PLATE TI VA-LCP 5H 2.4*51 +90
|
Facility
|
OP
|
$4,298.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.61 |
| Max. Negotiated Rate |
$4,126.76 |
| Rate for Payer: Aetna Commercial |
$3,310.01
|
| Rate for Payer: Anthem Medicaid |
$1,478.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,352.99
|
| Rate for Payer: Cash Price |
$2,149.36
|
| Rate for Payer: Cigna Commercial |
$3,567.93
|
| Rate for Payer: First Health Commercial |
$4,083.77
|
| Rate for Payer: Humana Commercial |
$3,653.90
|
| Rate for Payer: Humana KY Medicaid |
$1,478.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,524.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,172.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,289.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,507.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,782.86
|
| Rate for Payer: Ohio Health Group HMO |
$3,224.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,438.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,739.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,966.11
|
| Rate for Payer: PHCS Commercial |
$4,126.76
|
| Rate for Payer: United Healthcare All Payer |
$3,782.86
|
|
|
PLATE TI VA-LCP 5H 2.4*66 L
|
Facility
|
OP
|
$5,639.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.87 |
| Max. Negotiated Rate |
$5,413.98 |
| Rate for Payer: Aetna Commercial |
$4,342.46
|
| Rate for Payer: Anthem Medicaid |
$1,939.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,398.86
|
| Rate for Payer: Cash Price |
$2,819.78
|
| Rate for Payer: Cigna Commercial |
$4,680.83
|
| Rate for Payer: First Health Commercial |
$5,357.58
|
| Rate for Payer: Humana Commercial |
$4,793.63
|
| Rate for Payer: Humana KY Medicaid |
$1,939.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,959.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,624.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,162.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,978.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,962.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,229.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,511.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,906.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.30
|
| Rate for Payer: PHCS Commercial |
$5,413.98
|
| Rate for Payer: United Healthcare All Payer |
$4,962.81
|
|
