|
PLATE TI VA-LCP DOR 5H 2.4*46
|
Facility
|
OP
|
$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 Medicaid |
$1,465.78
|
| 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: Humana KY Medicaid |
$1,465.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,480.70
|
| 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: Molina Healthcare Medicaid |
$1,495.19
|
| 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
|
|
|
PLATE TI VA-LCP DOR 6H 2.4*57
|
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 DOR 6H 2.4*57
|
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 T 3H 2.4*37 3H
|
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
|
|
|
PLATE TI VA-LCP T 3H 2.4*37 3H
|
Facility
|
OP
|
$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 Medicaid |
$1,465.78
|
| 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: Humana KY Medicaid |
$1,465.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,480.70
|
| 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: Molina Healthcare Medicaid |
$1,495.19
|
| 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
|
|
|
PLATE TI VA-LCP T 3H 2.4*51 5H
|
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 T 3H 2.4*51 5H
|
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-LP 3H 2.4*37+90 2H
|
Facility
|
OP
|
$4,195.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,258.77 |
| Max. Negotiated Rate |
$4,028.05 |
| Rate for Payer: Aetna Commercial |
$3,230.84
|
| Rate for Payer: Anthem Medicaid |
$1,442.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,272.79
|
| Rate for Payer: Cash Price |
$2,097.94
|
| Rate for Payer: Cigna Commercial |
$3,482.59
|
| Rate for Payer: First Health Commercial |
$3,986.10
|
| Rate for Payer: Humana Commercial |
$3,566.51
|
| Rate for Payer: Humana KY Medicaid |
$1,442.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,457.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,440.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,096.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,471.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,692.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,146.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,650.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,895.16
|
| Rate for Payer: PHCS Commercial |
$4,028.05
|
| Rate for Payer: United Healthcare All Payer |
$3,692.38
|
|
|
PLATE TI VA-LP 3H 2.4*37+90 2H
|
Facility
|
IP
|
$4,195.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,258.77 |
| Max. Negotiated Rate |
$4,028.05 |
| Rate for Payer: Aetna Commercial |
$3,230.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,272.79
|
| Rate for Payer: Cash Price |
$2,097.94
|
| Rate for Payer: Cigna Commercial |
$3,482.59
|
| Rate for Payer: First Health Commercial |
$3,986.10
|
| Rate for Payer: Humana Commercial |
$3,566.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,440.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,096.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,692.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,146.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,650.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,895.16
|
| Rate for Payer: PHCS Commercial |
$4,028.05
|
| Rate for Payer: United Healthcare All Payer |
$3,692.38
|
|
|
PLATE TI VA-LP 3H 2.4*37+90 3H
|
Facility
|
OP
|
$4,195.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,258.77 |
| Max. Negotiated Rate |
$4,028.05 |
| Rate for Payer: Aetna Commercial |
$3,230.84
|
| Rate for Payer: Anthem Medicaid |
$1,442.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,272.79
|
| Rate for Payer: Cash Price |
$2,097.94
|
| Rate for Payer: Cigna Commercial |
$3,482.59
|
| Rate for Payer: First Health Commercial |
$3,986.10
|
| Rate for Payer: Humana Commercial |
$3,566.51
|
| Rate for Payer: Humana KY Medicaid |
$1,442.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,457.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,440.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,096.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,471.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,692.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,146.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,650.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,895.16
|
| Rate for Payer: PHCS Commercial |
$4,028.05
|
| Rate for Payer: United Healthcare All Payer |
$3,692.38
|
|
|
PLATE TI VA-LP 3H 2.4*37+90 3H
|
Facility
|
IP
|
$4,195.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,258.77 |
| Max. Negotiated Rate |
$4,028.05 |
| Rate for Payer: Aetna Commercial |
$3,230.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,272.79
|
| Rate for Payer: Cash Price |
$2,097.94
|
| Rate for Payer: Cigna Commercial |
$3,482.59
|
| Rate for Payer: First Health Commercial |
$3,986.10
|
| Rate for Payer: Humana Commercial |
$3,566.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,440.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,096.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,692.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,146.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,650.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,895.16
|
| Rate for Payer: PHCS Commercial |
$4,028.05
|
| Rate for Payer: United Healthcare All Payer |
$3,692.38
|
|
|
PLATE TI VA-LP 3H2.4*37 -90 3H
|
Facility
|
IP
|
$4,195.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,258.77 |
| Max. Negotiated Rate |
$4,028.05 |
| Rate for Payer: Aetna Commercial |
$3,230.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,272.79
|
| Rate for Payer: Cash Price |
$2,097.94
|
| Rate for Payer: Cigna Commercial |
$3,482.59
|
| Rate for Payer: First Health Commercial |
$3,986.10
|
| Rate for Payer: Humana Commercial |
$3,566.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,440.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,096.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,692.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,146.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,650.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,895.16
|
| Rate for Payer: PHCS Commercial |
$4,028.05
|
| Rate for Payer: United Healthcare All Payer |
$3,692.38
|
|
|
PLATE TI VA-LP 3H2.4*37 -90 3H
|
Facility
|
OP
|
$4,195.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,258.77 |
| Max. Negotiated Rate |
$4,028.05 |
| Rate for Payer: Aetna Commercial |
$3,230.84
|
| Rate for Payer: Anthem Medicaid |
$1,442.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,272.79
|
| Rate for Payer: Cash Price |
$2,097.94
|
| Rate for Payer: Cigna Commercial |
$3,482.59
|
| Rate for Payer: First Health Commercial |
$3,986.10
|
| Rate for Payer: Humana Commercial |
$3,566.51
|
| Rate for Payer: Humana KY Medicaid |
$1,442.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,457.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,440.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,096.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,471.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,692.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,146.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,650.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,895.16
|
| Rate for Payer: PHCS Commercial |
$4,028.05
|
| Rate for Payer: United Healthcare All Payer |
$3,692.38
|
|
|
PLATE TI VA-LP 3H 2.4*41+20 3H
|
Facility
|
IP
|
$4,195.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,258.77 |
| Max. Negotiated Rate |
$4,028.05 |
| Rate for Payer: Aetna Commercial |
$3,230.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,272.79
|
| Rate for Payer: Cash Price |
$2,097.94
|
| Rate for Payer: Cigna Commercial |
$3,482.59
|
| Rate for Payer: First Health Commercial |
$3,986.10
|
| Rate for Payer: Humana Commercial |
$3,566.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,440.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,096.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,692.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,146.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,650.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,895.16
|
| Rate for Payer: PHCS Commercial |
$4,028.05
|
| Rate for Payer: United Healthcare All Payer |
$3,692.38
|
|
|
PLATE TI VA-LP 3H 2.4*41+20 3H
|
Facility
|
OP
|
$4,195.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,258.77 |
| Max. Negotiated Rate |
$4,028.05 |
| Rate for Payer: Aetna Commercial |
$3,230.84
|
| Rate for Payer: Anthem Medicaid |
$1,442.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,272.79
|
| Rate for Payer: Cash Price |
$2,097.94
|
| Rate for Payer: Cigna Commercial |
$3,482.59
|
| Rate for Payer: First Health Commercial |
$3,986.10
|
| Rate for Payer: Humana Commercial |
$3,566.51
|
| Rate for Payer: Humana KY Medicaid |
$1,442.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,457.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,440.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,096.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,471.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,692.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,146.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,650.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,895.16
|
| Rate for Payer: PHCS Commercial |
$4,028.05
|
| Rate for Payer: United Healthcare All Payer |
$3,692.38
|
|
|
PLATE TI VA-LP 3H 2.4*41-20 3H
|
Facility
|
IP
|
$4,195.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,258.77 |
| Max. Negotiated Rate |
$4,028.05 |
| Rate for Payer: Aetna Commercial |
$3,230.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,272.79
|
| Rate for Payer: Cash Price |
$2,097.94
|
| Rate for Payer: Cigna Commercial |
$3,482.59
|
| Rate for Payer: First Health Commercial |
$3,986.10
|
| Rate for Payer: Humana Commercial |
$3,566.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,440.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,096.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,692.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,146.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,650.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,895.16
|
| Rate for Payer: PHCS Commercial |
$4,028.05
|
| Rate for Payer: United Healthcare All Payer |
$3,692.38
|
|
|
PLATE TI VA-LP 3H 2.4*41-20 3H
|
Facility
|
OP
|
$4,195.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,258.77 |
| Max. Negotiated Rate |
$4,028.05 |
| Rate for Payer: Aetna Commercial |
$3,230.84
|
| Rate for Payer: Anthem Medicaid |
$1,442.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,272.79
|
| Rate for Payer: Cash Price |
$2,097.94
|
| Rate for Payer: Cigna Commercial |
$3,482.59
|
| Rate for Payer: First Health Commercial |
$3,986.10
|
| Rate for Payer: Humana Commercial |
$3,566.51
|
| Rate for Payer: Humana KY Medicaid |
$1,442.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,457.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,440.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,096.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,471.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,692.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,146.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,650.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,895.16
|
| Rate for Payer: PHCS Commercial |
$4,028.05
|
| Rate for Payer: United Healthcare All Payer |
$3,692.38
|
|
|
PLATE TI VA-LP 5H2.4*51 -90 2H
|
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-LP 5H2.4*51 -90 2H
|
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-LP 5H 2.4*51+90 3H
|
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-LP 5H 2.4*51+90 3H
|
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-LP 5H 2.4*51-90 3H
|
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-LP 5H 2.4*51-90 3H
|
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-LP 5H 2.4*55+20 3H
|
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-LP 5H 2.4*55+20 3H
|
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
|
|
