|
PLATE UTL HND FSN 3.5M 79M 3 R
|
Facility
|
IP
|
$7,439.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,231.90 |
| Max. Negotiated Rate |
$7,142.09 |
| Rate for Payer: Aetna Commercial |
$5,728.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,802.95
|
| Rate for Payer: Cash Price |
$3,719.84
|
| Rate for Payer: Cigna Commercial |
$6,174.93
|
| Rate for Payer: First Health Commercial |
$7,067.70
|
| Rate for Payer: Humana Commercial |
$6,323.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,100.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,490.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,231.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,546.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,579.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,951.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,472.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,133.38
|
| Rate for Payer: PHCS Commercial |
$7,142.09
|
| Rate for Payer: United Healthcare All Payer |
$6,546.92
|
|
|
PLATE VA LCP CVD 4.5*230 10H L
|
Facility
|
OP
|
$9,806.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,942.10 |
| Max. Negotiated Rate |
$9,414.71 |
| Rate for Payer: Aetna Commercial |
$7,551.38
|
| Rate for Payer: Anthem Medicaid |
$3,372.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.45
|
| Rate for Payer: Cash Price |
$4,903.50
|
| Rate for Payer: Cigna Commercial |
$8,139.80
|
| Rate for Payer: First Health Commercial |
$9,316.64
|
| Rate for Payer: Humana Commercial |
$8,335.94
|
| Rate for Payer: Humana KY Medicaid |
$3,372.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,406.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,942.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,440.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,630.15
|
| Rate for Payer: Ohio Health Group HMO |
$7,355.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,532.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.82
|
| Rate for Payer: PHCS Commercial |
$9,414.71
|
| Rate for Payer: United Healthcare All Payer |
$8,630.15
|
|
|
PLATE VA LCP CVD 4.5*230 10H L
|
Facility
|
IP
|
$9,806.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,942.10 |
| Max. Negotiated Rate |
$9,414.71 |
| Rate for Payer: Aetna Commercial |
$7,551.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.45
|
| Rate for Payer: Cash Price |
$4,903.50
|
| Rate for Payer: Cigna Commercial |
$8,139.80
|
| Rate for Payer: First Health Commercial |
$9,316.64
|
| Rate for Payer: Humana Commercial |
$8,335.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,942.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,630.15
|
| Rate for Payer: Ohio Health Group HMO |
$7,355.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,532.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.82
|
| Rate for Payer: PHCS Commercial |
$9,414.71
|
| Rate for Payer: United Healthcare All Payer |
$8,630.15
|
|
|
PLATE VA LCP CVD 4.5*301 14H L
|
Facility
|
OP
|
$10,000.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.28 |
| Max. Negotiated Rate |
$9,600.88 |
| Rate for Payer: Aetna Commercial |
$7,700.71
|
| Rate for Payer: Anthem Medicaid |
$3,439.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,800.72
|
| Rate for Payer: Cash Price |
$5,000.46
|
| Rate for Payer: Cigna Commercial |
$8,300.76
|
| Rate for Payer: First Health Commercial |
$9,500.87
|
| Rate for Payer: Humana Commercial |
$8,500.78
|
| Rate for Payer: Humana KY Medicaid |
$3,439.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,474.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,200.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,380.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,000.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,508.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,800.81
|
| Rate for Payer: Ohio Health Group HMO |
$7,500.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,000.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,700.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,900.63
|
| Rate for Payer: PHCS Commercial |
$9,600.88
|
| Rate for Payer: United Healthcare All Payer |
$8,800.81
|
|
|
PLATE VA LCP CVD 4.5*301 14H L
|
Facility
|
IP
|
$10,000.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.28 |
| Max. Negotiated Rate |
$9,600.88 |
| Rate for Payer: Aetna Commercial |
$7,700.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,800.72
|
| Rate for Payer: Cash Price |
$5,000.46
|
| Rate for Payer: Cigna Commercial |
$8,300.76
|
| Rate for Payer: First Health Commercial |
$9,500.87
|
| Rate for Payer: Humana Commercial |
$8,500.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,200.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,380.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,000.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,800.81
|
| Rate for Payer: Ohio Health Group HMO |
$7,500.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,000.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,700.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,900.63
|
| Rate for Payer: PHCS Commercial |
$9,600.88
|
| Rate for Payer: United Healthcare All Payer |
$8,800.81
|
|
|
PLATE VA-LCP PRX TIB 3.5*117
|
Facility
|
IP
|
$16,339.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,901.97 |
| Max. Negotiated Rate |
$15,686.30 |
| Rate for Payer: Aetna Commercial |
$12,581.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,745.12
|
| Rate for Payer: Cash Price |
$8,169.95
|
| Rate for Payer: Cigna Commercial |
$13,562.12
|
| Rate for Payer: First Health Commercial |
$15,522.91
|
| Rate for Payer: Humana Commercial |
$13,888.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,398.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,058.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,901.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,379.11
|
| Rate for Payer: Ohio Health Group HMO |
$12,254.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,071.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,215.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,274.53
|
| Rate for Payer: PHCS Commercial |
$15,686.30
|
| Rate for Payer: United Healthcare All Payer |
$14,379.11
|
|
|
PLATE VA-LCP PRX TIB 3.5*117
|
Facility
|
OP
|
$16,339.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,901.97 |
| Max. Negotiated Rate |
$15,686.30 |
| Rate for Payer: Aetna Commercial |
$12,581.72
|
| Rate for Payer: Anthem Medicaid |
$5,619.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,745.12
|
| Rate for Payer: Cash Price |
$8,169.95
|
| Rate for Payer: Cigna Commercial |
$13,562.12
|
| Rate for Payer: First Health Commercial |
$15,522.91
|
| Rate for Payer: Humana Commercial |
$13,888.92
|
| Rate for Payer: Humana KY Medicaid |
$5,619.29
|
| Rate for Payer: Kentucky WC Medicaid |
$5,676.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,398.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,058.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,901.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,732.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,379.11
|
| Rate for Payer: Ohio Health Group HMO |
$12,254.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,071.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,215.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,274.53
|
| Rate for Payer: PHCS Commercial |
$15,686.30
|
| Rate for Payer: United Healthcare All Payer |
$14,379.11
|
|
|
PLATE VARIAX 2 META BRD STR 2H
|
Facility
|
IP
|
$9,650.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,895.09 |
| Max. Negotiated Rate |
$9,264.29 |
| Rate for Payer: Aetna Commercial |
$7,430.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,527.23
|
| Rate for Payer: Cash Price |
$4,825.15
|
| Rate for Payer: Cigna Commercial |
$8,009.75
|
| Rate for Payer: First Health Commercial |
$9,167.78
|
| Rate for Payer: Humana Commercial |
$8,202.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,913.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,121.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,895.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,492.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,237.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,720.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,395.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,658.71
|
| Rate for Payer: PHCS Commercial |
$9,264.29
|
| Rate for Payer: United Healthcare All Payer |
$8,492.26
|
|
|
PLATE VARIAX 2 META BRD STR 2H
|
Facility
|
OP
|
$9,650.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,895.09 |
| Max. Negotiated Rate |
$9,264.29 |
| Rate for Payer: Aetna Commercial |
$7,430.73
|
| Rate for Payer: Anthem Medicaid |
$3,318.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,527.23
|
| Rate for Payer: Cash Price |
$4,825.15
|
| Rate for Payer: Cigna Commercial |
$8,009.75
|
| Rate for Payer: First Health Commercial |
$9,167.78
|
| Rate for Payer: Humana Commercial |
$8,202.75
|
| Rate for Payer: Humana KY Medicaid |
$3,318.74
|
| Rate for Payer: Kentucky WC Medicaid |
$3,352.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,913.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,121.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,895.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,385.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,492.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,237.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,720.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,395.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,658.71
|
| Rate for Payer: PHCS Commercial |
$9,264.29
|
| Rate for Payer: United Healthcare All Payer |
$8,492.26
|
|
|
PLATE VARIAX 2 META BRD STR 3H
|
Facility
|
IP
|
$7,052.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.77 |
| Max. Negotiated Rate |
$6,770.46 |
| Rate for Payer: Aetna Commercial |
$5,430.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,501.00
|
| Rate for Payer: Cash Price |
$3,526.28
|
| Rate for Payer: Cigna Commercial |
$5,853.62
|
| Rate for Payer: First Health Commercial |
$6,699.93
|
| Rate for Payer: Humana Commercial |
$5,994.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,783.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,204.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,115.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,206.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,289.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,642.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,135.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,866.27
|
| Rate for Payer: PHCS Commercial |
$6,770.46
|
| Rate for Payer: United Healthcare All Payer |
$6,206.25
|
|
|
PLATE VARIAX 2 META BRD STR 3H
|
Facility
|
OP
|
$7,052.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.77 |
| Max. Negotiated Rate |
$6,770.46 |
| Rate for Payer: Aetna Commercial |
$5,430.47
|
| Rate for Payer: Anthem Medicaid |
$2,425.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,501.00
|
| Rate for Payer: Cash Price |
$3,526.28
|
| Rate for Payer: Cigna Commercial |
$5,853.62
|
| Rate for Payer: First Health Commercial |
$6,699.93
|
| Rate for Payer: Humana Commercial |
$5,994.68
|
| Rate for Payer: Humana KY Medicaid |
$2,425.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,450.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,783.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,204.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,115.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,474.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,206.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,289.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,642.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,135.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,866.27
|
| Rate for Payer: PHCS Commercial |
$6,770.46
|
| Rate for Payer: United Healthcare All Payer |
$6,206.25
|
|
|
PLATE VARIAX 2 META BRD STR 4H
|
Facility
|
IP
|
$9,650.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,895.09 |
| Max. Negotiated Rate |
$9,264.29 |
| Rate for Payer: Aetna Commercial |
$7,430.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,527.23
|
| Rate for Payer: Cash Price |
$4,825.15
|
| Rate for Payer: Cigna Commercial |
$8,009.75
|
| Rate for Payer: First Health Commercial |
$9,167.78
|
| Rate for Payer: Humana Commercial |
$8,202.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,913.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,121.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,895.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,492.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,237.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,720.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,395.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,658.71
|
| Rate for Payer: PHCS Commercial |
$9,264.29
|
| Rate for Payer: United Healthcare All Payer |
$8,492.26
|
|
|
PLATE VARIAX 2 META BRD STR 4H
|
Facility
|
OP
|
$9,650.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,895.09 |
| Max. Negotiated Rate |
$9,264.29 |
| Rate for Payer: Aetna Commercial |
$7,430.73
|
| Rate for Payer: Anthem Medicaid |
$3,318.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,527.23
|
| Rate for Payer: Cash Price |
$4,825.15
|
| Rate for Payer: Cigna Commercial |
$8,009.75
|
| Rate for Payer: First Health Commercial |
$9,167.78
|
| Rate for Payer: Humana Commercial |
$8,202.75
|
| Rate for Payer: Humana KY Medicaid |
$3,318.74
|
| Rate for Payer: Kentucky WC Medicaid |
$3,352.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,913.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,121.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,895.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,385.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,492.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,237.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,720.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,395.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,658.71
|
| Rate for Payer: PHCS Commercial |
$9,264.29
|
| Rate for Payer: United Healthcare All Payer |
$8,492.26
|
|
|
PLATE VARIAX 2 META BRD STR 5H
|
Facility
|
OP
|
$6,686.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,005.94 |
| Max. Negotiated Rate |
$6,419.00 |
| Rate for Payer: Aetna Commercial |
$5,148.57
|
| Rate for Payer: Anthem Medicaid |
$2,299.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,215.44
|
| Rate for Payer: Cash Price |
$3,343.23
|
| Rate for Payer: Cigna Commercial |
$5,549.76
|
| Rate for Payer: First Health Commercial |
$6,352.14
|
| Rate for Payer: Humana Commercial |
$5,683.49
|
| Rate for Payer: Humana KY Medicaid |
$2,299.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,322.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,482.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,934.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,005.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,345.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,884.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,014.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,349.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,817.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,613.66
|
| Rate for Payer: PHCS Commercial |
$6,419.00
|
| Rate for Payer: United Healthcare All Payer |
$5,884.08
|
|
|
PLATE VARIAX 2 META BRD STR 5H
|
Facility
|
IP
|
$6,686.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,005.94 |
| Max. Negotiated Rate |
$6,419.00 |
| Rate for Payer: Aetna Commercial |
$5,148.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,215.44
|
| Rate for Payer: Cash Price |
$3,343.23
|
| Rate for Payer: Cigna Commercial |
$5,549.76
|
| Rate for Payer: First Health Commercial |
$6,352.14
|
| Rate for Payer: Humana Commercial |
$5,683.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,482.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,934.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,005.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,884.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,014.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,349.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,817.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,613.66
|
| Rate for Payer: PHCS Commercial |
$6,419.00
|
| Rate for Payer: United Healthcare All Payer |
$5,884.08
|
|
|
PLATE VARIAX 2 META BRD STR 6H
|
Facility
|
IP
|
$9,650.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,895.09 |
| Max. Negotiated Rate |
$9,264.29 |
| Rate for Payer: Aetna Commercial |
$7,430.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,527.23
|
| Rate for Payer: Cash Price |
$4,825.15
|
| Rate for Payer: Cigna Commercial |
$8,009.75
|
| Rate for Payer: First Health Commercial |
$9,167.78
|
| Rate for Payer: Humana Commercial |
$8,202.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,913.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,121.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,895.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,492.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,237.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,720.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,395.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,658.71
|
| Rate for Payer: PHCS Commercial |
$9,264.29
|
| Rate for Payer: United Healthcare All Payer |
$8,492.26
|
|
|
PLATE VARIAX 2 META BRD STR 6H
|
Facility
|
OP
|
$9,650.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,895.09 |
| Max. Negotiated Rate |
$9,264.29 |
| Rate for Payer: Aetna Commercial |
$7,430.73
|
| Rate for Payer: Anthem Medicaid |
$3,318.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,527.23
|
| Rate for Payer: Cash Price |
$4,825.15
|
| Rate for Payer: Cigna Commercial |
$8,009.75
|
| Rate for Payer: First Health Commercial |
$9,167.78
|
| Rate for Payer: Humana Commercial |
$8,202.75
|
| Rate for Payer: Humana KY Medicaid |
$3,318.74
|
| Rate for Payer: Kentucky WC Medicaid |
$3,352.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,913.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,121.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,895.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,385.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,492.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,237.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,720.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,395.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,658.71
|
| Rate for Payer: PHCS Commercial |
$9,264.29
|
| Rate for Payer: United Healthcare All Payer |
$8,492.26
|
|
|
PLATE VARIAX 2 META BRD STR 7H
|
Facility
|
OP
|
$9,650.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,895.09 |
| Max. Negotiated Rate |
$9,264.29 |
| Rate for Payer: Aetna Commercial |
$7,430.73
|
| Rate for Payer: Anthem Medicaid |
$3,318.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,527.23
|
| Rate for Payer: Cash Price |
$4,825.15
|
| Rate for Payer: Cigna Commercial |
$8,009.75
|
| Rate for Payer: First Health Commercial |
$9,167.78
|
| Rate for Payer: Humana Commercial |
$8,202.75
|
| Rate for Payer: Humana KY Medicaid |
$3,318.74
|
| Rate for Payer: Kentucky WC Medicaid |
$3,352.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,913.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,121.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,895.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,385.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,492.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,237.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,720.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,395.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,658.71
|
| Rate for Payer: PHCS Commercial |
$9,264.29
|
| Rate for Payer: United Healthcare All Payer |
$8,492.26
|
|
|
PLATE VARIAX 2 META BRD STR 7H
|
Facility
|
IP
|
$9,650.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,895.09 |
| Max. Negotiated Rate |
$9,264.29 |
| Rate for Payer: Aetna Commercial |
$7,430.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,527.23
|
| Rate for Payer: Cash Price |
$4,825.15
|
| Rate for Payer: Cigna Commercial |
$8,009.75
|
| Rate for Payer: First Health Commercial |
$9,167.78
|
| Rate for Payer: Humana Commercial |
$8,202.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,913.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,121.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,895.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,492.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,237.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,720.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,395.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,658.71
|
| Rate for Payer: PHCS Commercial |
$9,264.29
|
| Rate for Payer: United Healthcare All Payer |
$8,492.26
|
|
|
PLATE VARIAX 2 META SLM STR 2H
|
Facility
|
OP
|
$8,584.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,575.35 |
| Max. Negotiated Rate |
$8,241.12 |
| Rate for Payer: Aetna Commercial |
$6,610.06
|
| Rate for Payer: Anthem Medicaid |
$2,952.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.91
|
| Rate for Payer: Cash Price |
$4,292.25
|
| Rate for Payer: Cigna Commercial |
$7,125.14
|
| Rate for Payer: First Health Commercial |
$8,155.27
|
| Rate for Payer: Humana Commercial |
$7,296.82
|
| Rate for Payer: Humana KY Medicaid |
$2,952.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,982.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,011.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,867.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,468.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,923.31
|
| Rate for Payer: PHCS Commercial |
$8,241.12
|
| Rate for Payer: United Healthcare All Payer |
$7,554.36
|
|
|
PLATE VARIAX 2 META SLM STR 2H
|
Facility
|
IP
|
$8,584.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,575.35 |
| Max. Negotiated Rate |
$8,241.12 |
| Rate for Payer: Aetna Commercial |
$6,610.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.91
|
| Rate for Payer: Cash Price |
$4,292.25
|
| Rate for Payer: Cigna Commercial |
$7,125.14
|
| Rate for Payer: First Health Commercial |
$8,155.27
|
| Rate for Payer: Humana Commercial |
$7,296.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,867.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,468.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,923.31
|
| Rate for Payer: PHCS Commercial |
$8,241.12
|
| Rate for Payer: United Healthcare All Payer |
$7,554.36
|
|
|
PLATE VARIAX 2 META SLM STR 3H
|
Facility
|
OP
|
$8,584.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,575.35 |
| Max. Negotiated Rate |
$8,241.12 |
| Rate for Payer: Aetna Commercial |
$6,610.06
|
| Rate for Payer: Anthem Medicaid |
$2,952.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.91
|
| Rate for Payer: Cash Price |
$4,292.25
|
| Rate for Payer: Cigna Commercial |
$7,125.14
|
| Rate for Payer: First Health Commercial |
$8,155.27
|
| Rate for Payer: Humana Commercial |
$7,296.82
|
| Rate for Payer: Humana KY Medicaid |
$2,952.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,982.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,011.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,867.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,468.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,923.31
|
| Rate for Payer: PHCS Commercial |
$8,241.12
|
| Rate for Payer: United Healthcare All Payer |
$7,554.36
|
|
|
PLATE VARIAX 2 META SLM STR 3H
|
Facility
|
IP
|
$8,584.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,575.35 |
| Max. Negotiated Rate |
$8,241.12 |
| Rate for Payer: Aetna Commercial |
$6,610.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.91
|
| Rate for Payer: Cash Price |
$4,292.25
|
| Rate for Payer: Cigna Commercial |
$7,125.14
|
| Rate for Payer: First Health Commercial |
$8,155.27
|
| Rate for Payer: Humana Commercial |
$7,296.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,867.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,468.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,923.31
|
| Rate for Payer: PHCS Commercial |
$8,241.12
|
| Rate for Payer: United Healthcare All Payer |
$7,554.36
|
|
|
PLATE VARIAX 2 META SLM STR 4H
|
Facility
|
IP
|
$8,584.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,575.35 |
| Max. Negotiated Rate |
$8,241.12 |
| Rate for Payer: Aetna Commercial |
$6,610.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.91
|
| Rate for Payer: Cash Price |
$4,292.25
|
| Rate for Payer: Cigna Commercial |
$7,125.14
|
| Rate for Payer: First Health Commercial |
$8,155.27
|
| Rate for Payer: Humana Commercial |
$7,296.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,867.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,468.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,923.31
|
| Rate for Payer: PHCS Commercial |
$8,241.12
|
| Rate for Payer: United Healthcare All Payer |
$7,554.36
|
|
|
PLATE VARIAX 2 META SLM STR 4H
|
Facility
|
OP
|
$8,584.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,575.35 |
| Max. Negotiated Rate |
$8,241.12 |
| Rate for Payer: Aetna Commercial |
$6,610.06
|
| Rate for Payer: Anthem Medicaid |
$2,952.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.91
|
| Rate for Payer: Cash Price |
$4,292.25
|
| Rate for Payer: Cigna Commercial |
$7,125.14
|
| Rate for Payer: First Health Commercial |
$8,155.27
|
| Rate for Payer: Humana Commercial |
$7,296.82
|
| Rate for Payer: Humana KY Medicaid |
$2,952.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,982.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,011.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,867.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,468.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,923.31
|
| Rate for Payer: PHCS Commercial |
$8,241.12
|
| Rate for Payer: United Healthcare All Payer |
$7,554.36
|
|
