|
PLATE TI VA-LCP 6H 2.4*72 L
|
Facility
|
IP
|
$6,812.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.74 |
| Max. Negotiated Rate |
$6,539.96 |
| Rate for Payer: Aetna Commercial |
$5,245.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,313.72
|
| Rate for Payer: Cash Price |
$3,406.23
|
| Rate for Payer: Cigna Commercial |
$5,654.34
|
| Rate for Payer: First Health Commercial |
$6,471.84
|
| Rate for Payer: Humana Commercial |
$5,790.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,586.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,027.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,043.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,994.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,109.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,449.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,926.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,700.60
|
| Rate for Payer: PHCS Commercial |
$6,539.96
|
| Rate for Payer: United Healthcare All Payer |
$5,994.96
|
|
|
PLATE TI VA-LCP 6H 2.4*72 L
|
Facility
|
OP
|
$6,812.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.74 |
| Max. Negotiated Rate |
$6,539.96 |
| Rate for Payer: Aetna Commercial |
$5,245.59
|
| Rate for Payer: Anthem Medicaid |
$2,342.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,313.72
|
| Rate for Payer: Cash Price |
$3,406.23
|
| Rate for Payer: Cigna Commercial |
$5,654.34
|
| Rate for Payer: First Health Commercial |
$6,471.84
|
| Rate for Payer: Humana Commercial |
$5,790.59
|
| Rate for Payer: Humana KY Medicaid |
$2,342.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,366.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,586.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,027.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,043.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,389.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,994.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,109.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,449.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,926.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,700.60
|
| Rate for Payer: PHCS Commercial |
$6,539.96
|
| Rate for Payer: United Healthcare All Payer |
$5,994.96
|
|
|
PLATE TI VA-LCP 6H 2.4*72 R
|
Facility
|
OP
|
$6,812.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.74 |
| Max. Negotiated Rate |
$6,539.96 |
| Rate for Payer: Aetna Commercial |
$5,245.59
|
| Rate for Payer: Anthem Medicaid |
$2,342.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,313.72
|
| Rate for Payer: Cash Price |
$3,406.23
|
| Rate for Payer: Cigna Commercial |
$5,654.34
|
| Rate for Payer: First Health Commercial |
$6,471.84
|
| Rate for Payer: Humana Commercial |
$5,790.59
|
| Rate for Payer: Humana KY Medicaid |
$2,342.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,366.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,586.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,027.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,043.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,389.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,994.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,109.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,449.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,926.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,700.60
|
| Rate for Payer: PHCS Commercial |
$6,539.96
|
| Rate for Payer: United Healthcare All Payer |
$5,994.96
|
|
|
PLATE TI VA-LCP 6H 2.4*72 R
|
Facility
|
IP
|
$6,812.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.74 |
| Max. Negotiated Rate |
$6,539.96 |
| Rate for Payer: Aetna Commercial |
$5,245.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,313.72
|
| Rate for Payer: Cash Price |
$3,406.23
|
| Rate for Payer: Cigna Commercial |
$5,654.34
|
| Rate for Payer: First Health Commercial |
$6,471.84
|
| Rate for Payer: Humana Commercial |
$5,790.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,586.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,027.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,043.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,994.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,109.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,449.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,926.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,700.60
|
| Rate for Payer: PHCS Commercial |
$6,539.96
|
| Rate for Payer: United Healthcare All Payer |
$5,994.96
|
|
|
PLATE TI VA-LCP 6H 2.4*75 L
|
Facility
|
OP
|
$6,812.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.74 |
| Max. Negotiated Rate |
$6,539.96 |
| Rate for Payer: Aetna Commercial |
$5,245.59
|
| Rate for Payer: Anthem Medicaid |
$2,342.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,313.72
|
| Rate for Payer: Cash Price |
$3,406.23
|
| Rate for Payer: Cigna Commercial |
$5,654.34
|
| Rate for Payer: First Health Commercial |
$6,471.84
|
| Rate for Payer: Humana Commercial |
$5,790.59
|
| Rate for Payer: Humana KY Medicaid |
$2,342.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,366.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,586.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,027.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,043.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,389.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,994.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,109.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,449.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,926.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,700.60
|
| Rate for Payer: PHCS Commercial |
$6,539.96
|
| Rate for Payer: United Healthcare All Payer |
$5,994.96
|
|
|
PLATE TI VA-LCP 6H 2.4*75 L
|
Facility
|
IP
|
$6,812.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.74 |
| Max. Negotiated Rate |
$6,539.96 |
| Rate for Payer: Aetna Commercial |
$5,245.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,313.72
|
| Rate for Payer: Cash Price |
$3,406.23
|
| Rate for Payer: Cigna Commercial |
$5,654.34
|
| Rate for Payer: First Health Commercial |
$6,471.84
|
| Rate for Payer: Humana Commercial |
$5,790.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,586.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,027.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,043.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,994.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,109.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,449.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,926.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,700.60
|
| Rate for Payer: PHCS Commercial |
$6,539.96
|
| Rate for Payer: United Healthcare All Payer |
$5,994.96
|
|
|
PLATE TI VA-LCP 6H 2.4*75 R
|
Facility
|
OP
|
$6,812.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.74 |
| Max. Negotiated Rate |
$6,539.96 |
| Rate for Payer: Aetna Commercial |
$5,245.59
|
| Rate for Payer: Anthem Medicaid |
$2,342.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,313.72
|
| Rate for Payer: Cash Price |
$3,406.23
|
| Rate for Payer: Cigna Commercial |
$5,654.34
|
| Rate for Payer: First Health Commercial |
$6,471.84
|
| Rate for Payer: Humana Commercial |
$5,790.59
|
| Rate for Payer: Humana KY Medicaid |
$2,342.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,366.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,586.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,027.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,043.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,389.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,994.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,109.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,449.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,926.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,700.60
|
| Rate for Payer: PHCS Commercial |
$6,539.96
|
| Rate for Payer: United Healthcare All Payer |
$5,994.96
|
|
|
PLATE TI VA-LCP 6H 2.4*75 R
|
Facility
|
IP
|
$6,812.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.74 |
| Max. Negotiated Rate |
$6,539.96 |
| Rate for Payer: Aetna Commercial |
$5,245.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,313.72
|
| Rate for Payer: Cash Price |
$3,406.23
|
| Rate for Payer: Cigna Commercial |
$5,654.34
|
| Rate for Payer: First Health Commercial |
$6,471.84
|
| Rate for Payer: Humana Commercial |
$5,790.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,586.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,027.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,043.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,994.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,109.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,449.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,926.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,700.60
|
| Rate for Payer: PHCS Commercial |
$6,539.96
|
| Rate for Payer: United Healthcare All Payer |
$5,994.96
|
|
|
PLATE TI VA-LCP 7H 2.4*47 L
|
Facility
|
OP
|
$5,500.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.28 |
| Max. Negotiated Rate |
$5,280.88 |
| Rate for Payer: Aetna Commercial |
$4,235.71
|
| Rate for Payer: Anthem Medicaid |
$1,891.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,290.72
|
| Rate for Payer: Cash Price |
$2,750.46
|
| Rate for Payer: Cigna Commercial |
$4,565.76
|
| Rate for Payer: First Health Commercial |
$5,225.87
|
| Rate for Payer: Humana Commercial |
$4,675.78
|
| Rate for Payer: Humana KY Medicaid |
$1,891.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,911.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,510.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,059.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,929.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,840.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,125.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,400.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,785.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.63
|
| Rate for Payer: PHCS Commercial |
$5,280.88
|
| Rate for Payer: United Healthcare All Payer |
$4,840.81
|
|
|
PLATE TI VA-LCP 7H 2.4*47 L
|
Facility
|
IP
|
$5,500.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.28 |
| Max. Negotiated Rate |
$5,280.88 |
| Rate for Payer: Aetna Commercial |
$4,235.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,290.72
|
| Rate for Payer: Cash Price |
$2,750.46
|
| Rate for Payer: Cigna Commercial |
$4,565.76
|
| Rate for Payer: First Health Commercial |
$5,225.87
|
| Rate for Payer: Humana Commercial |
$4,675.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,510.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,059.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,840.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,125.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,400.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,785.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.63
|
| Rate for Payer: PHCS Commercial |
$5,280.88
|
| Rate for Payer: United Healthcare All Payer |
$4,840.81
|
|
|
PLATE TI VA-LCP 7H 2.4*47 R
|
Facility
|
IP
|
$5,500.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.28 |
| Max. Negotiated Rate |
$5,280.88 |
| Rate for Payer: Aetna Commercial |
$4,235.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,290.72
|
| Rate for Payer: Cash Price |
$2,750.46
|
| Rate for Payer: Cigna Commercial |
$4,565.76
|
| Rate for Payer: First Health Commercial |
$5,225.87
|
| Rate for Payer: Humana Commercial |
$4,675.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,510.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,059.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,840.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,125.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,400.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,785.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.63
|
| Rate for Payer: PHCS Commercial |
$5,280.88
|
| Rate for Payer: United Healthcare All Payer |
$4,840.81
|
|
|
PLATE TI VA-LCP 7H 2.4*47 R
|
Facility
|
OP
|
$5,500.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.28 |
| Max. Negotiated Rate |
$5,280.88 |
| Rate for Payer: Aetna Commercial |
$4,235.71
|
| Rate for Payer: Anthem Medicaid |
$1,891.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,290.72
|
| Rate for Payer: Cash Price |
$2,750.46
|
| Rate for Payer: Cigna Commercial |
$4,565.76
|
| Rate for Payer: First Health Commercial |
$5,225.87
|
| Rate for Payer: Humana Commercial |
$4,675.78
|
| Rate for Payer: Humana KY Medicaid |
$1,891.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,911.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,510.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,059.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,929.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,840.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,125.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,400.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,785.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.63
|
| Rate for Payer: PHCS Commercial |
$5,280.88
|
| Rate for Payer: United Healthcare All Payer |
$4,840.81
|
|
|
PLATE TI VA-LCP 7H 2.4*55 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 7H 2.4*55 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 7H 2.4*55 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 7H 2.4*55 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 7H 2.4*68 L
|
Facility
|
IP
|
$6,677.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,003.26 |
| Max. Negotiated Rate |
$6,410.42 |
| Rate for Payer: Aetna Commercial |
$5,141.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,208.47
|
| Rate for Payer: Cash Price |
$3,338.76
|
| Rate for Payer: Cigna Commercial |
$5,542.34
|
| Rate for Payer: First Health Commercial |
$6,343.64
|
| Rate for Payer: Humana Commercial |
$5,675.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,475.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,928.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,876.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,008.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,342.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,809.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,607.49
|
| Rate for Payer: PHCS Commercial |
$6,410.42
|
| Rate for Payer: United Healthcare All Payer |
$5,876.22
|
|
|
PLATE TI VA-LCP 7H 2.4*68 L
|
Facility
|
OP
|
$6,677.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,003.26 |
| Max. Negotiated Rate |
$6,410.42 |
| Rate for Payer: Aetna Commercial |
$5,141.69
|
| Rate for Payer: Anthem Medicaid |
$2,296.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,208.47
|
| Rate for Payer: Cash Price |
$3,338.76
|
| Rate for Payer: Cigna Commercial |
$5,542.34
|
| Rate for Payer: First Health Commercial |
$6,343.64
|
| Rate for Payer: Humana Commercial |
$5,675.89
|
| Rate for Payer: Humana KY Medicaid |
$2,296.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,319.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,475.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,928.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,342.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,876.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,008.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,342.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,809.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,607.49
|
| Rate for Payer: PHCS Commercial |
$6,410.42
|
| Rate for Payer: United Healthcare All Payer |
$5,876.22
|
|
|
PLATE TI VA-LCP 7H 2.4*68 R
|
Facility
|
OP
|
$6,677.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,003.26 |
| Max. Negotiated Rate |
$6,410.42 |
| Rate for Payer: Aetna Commercial |
$5,141.69
|
| Rate for Payer: Anthem Medicaid |
$2,296.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,208.47
|
| Rate for Payer: Cash Price |
$3,338.76
|
| Rate for Payer: Cigna Commercial |
$5,542.34
|
| Rate for Payer: First Health Commercial |
$6,343.64
|
| Rate for Payer: Humana Commercial |
$5,675.89
|
| Rate for Payer: Humana KY Medicaid |
$2,296.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,319.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,475.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,928.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,342.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,876.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,008.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,342.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,809.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,607.49
|
| Rate for Payer: PHCS Commercial |
$6,410.42
|
| Rate for Payer: United Healthcare All Payer |
$5,876.22
|
|
|
PLATE TI VA-LCP 7H 2.4*68 R
|
Facility
|
IP
|
$6,677.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,003.26 |
| Max. Negotiated Rate |
$6,410.42 |
| Rate for Payer: Aetna Commercial |
$5,141.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,208.47
|
| Rate for Payer: Cash Price |
$3,338.76
|
| Rate for Payer: Cigna Commercial |
$5,542.34
|
| Rate for Payer: First Health Commercial |
$6,343.64
|
| Rate for Payer: Humana Commercial |
$5,675.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,475.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,928.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,876.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,008.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,342.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,809.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,607.49
|
| Rate for Payer: PHCS Commercial |
$6,410.42
|
| Rate for Payer: United Healthcare All Payer |
$5,876.22
|
|
|
PLATE TI VA-LCP 7H 2.4*77 L
|
Facility
|
OP
|
$6,812.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.74 |
| Max. Negotiated Rate |
$6,539.96 |
| Rate for Payer: Aetna Commercial |
$5,245.59
|
| Rate for Payer: Anthem Medicaid |
$2,342.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,313.72
|
| Rate for Payer: Cash Price |
$3,406.23
|
| Rate for Payer: Cigna Commercial |
$5,654.34
|
| Rate for Payer: First Health Commercial |
$6,471.84
|
| Rate for Payer: Humana Commercial |
$5,790.59
|
| Rate for Payer: Humana KY Medicaid |
$2,342.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,366.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,586.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,027.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,043.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,389.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,994.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,109.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,449.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,926.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,700.60
|
| Rate for Payer: PHCS Commercial |
$6,539.96
|
| Rate for Payer: United Healthcare All Payer |
$5,994.96
|
|
|
PLATE TI VA-LCP 7H 2.4*77 L
|
Facility
|
IP
|
$6,812.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.74 |
| Max. Negotiated Rate |
$6,539.96 |
| Rate for Payer: Aetna Commercial |
$5,245.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,313.72
|
| Rate for Payer: Cash Price |
$3,406.23
|
| Rate for Payer: Cigna Commercial |
$5,654.34
|
| Rate for Payer: First Health Commercial |
$6,471.84
|
| Rate for Payer: Humana Commercial |
$5,790.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,586.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,027.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,043.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,994.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,109.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,449.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,926.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,700.60
|
| Rate for Payer: PHCS Commercial |
$6,539.96
|
| Rate for Payer: United Healthcare All Payer |
$5,994.96
|
|
|
PLATE TI VA-LCP 7H 2.4*77 R
|
Facility
|
IP
|
$6,666.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,999.94 |
| Max. Negotiated Rate |
$6,399.80 |
| Rate for Payer: Aetna Commercial |
$5,133.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,199.84
|
| Rate for Payer: Cash Price |
$3,333.23
|
| Rate for Payer: Cigna Commercial |
$5,533.16
|
| Rate for Payer: First Health Commercial |
$6,333.14
|
| Rate for Payer: Humana Commercial |
$5,666.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,466.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,919.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,999.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,866.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,999.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,333.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,799.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,599.86
|
| Rate for Payer: PHCS Commercial |
$6,399.80
|
| Rate for Payer: United Healthcare All Payer |
$5,866.48
|
|
|
PLATE TI VA-LCP 7H 2.4*77 R
|
Facility
|
OP
|
$6,666.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,999.94 |
| Max. Negotiated Rate |
$6,399.80 |
| Rate for Payer: Aetna Commercial |
$5,133.17
|
| Rate for Payer: Anthem Medicaid |
$2,292.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,199.84
|
| Rate for Payer: Cash Price |
$3,333.23
|
| Rate for Payer: Cigna Commercial |
$5,533.16
|
| Rate for Payer: First Health Commercial |
$6,333.14
|
| Rate for Payer: Humana Commercial |
$5,666.49
|
| Rate for Payer: Humana KY Medicaid |
$2,292.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,315.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,466.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,919.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,999.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,338.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,866.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,999.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,333.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,799.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,599.86
|
| Rate for Payer: PHCS Commercial |
$6,399.80
|
| Rate for Payer: United Healthcare All Payer |
$5,866.48
|
|
|
PLATE TI VA-LCP DOR 5H 2.4*46
|
Facility
|
IP
|
$4,262.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.67 |
| Max. Negotiated Rate |
$4,091.74 |
| Rate for Payer: Aetna Commercial |
$3,281.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,324.54
|
| Rate for Payer: Cash Price |
$2,131.11
|
| Rate for Payer: Cigna Commercial |
$3,537.65
|
| Rate for Payer: First Health Commercial |
$4,049.12
|
| Rate for Payer: Humana Commercial |
$3,622.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,495.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,145.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,750.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,196.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,409.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,708.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,940.94
|
| Rate for Payer: PHCS Commercial |
$4,091.74
|
| Rate for Payer: United Healthcare All Payer |
$3,750.76
|
|
