|
PLATE VLP MINI-MOD 2.0MM Y 6H
|
Facility
|
IP
|
$5,241.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.34 |
| Max. Negotiated Rate |
$5,031.48 |
| Rate for Payer: Aetna Commercial |
$4,035.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,088.07
|
| Rate for Payer: Cash Price |
$2,620.56
|
| Rate for Payer: Cigna Commercial |
$4,350.13
|
| Rate for Payer: First Health Commercial |
$4,979.06
|
| Rate for Payer: Humana Commercial |
$4,454.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,297.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,867.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,572.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,612.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,930.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,559.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,616.37
|
| Rate for Payer: PHCS Commercial |
$5,031.48
|
| Rate for Payer: United Healthcare All Payer |
$4,612.19
|
|
|
PLATE VLP MINI-MOD 2.0MM Y 6H
|
Facility
|
OP
|
$5,241.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.34 |
| Max. Negotiated Rate |
$5,031.48 |
| Rate for Payer: Aetna Commercial |
$4,035.66
|
| Rate for Payer: Anthem Medicaid |
$1,802.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,088.07
|
| Rate for Payer: Cash Price |
$2,620.56
|
| Rate for Payer: Cigna Commercial |
$4,350.13
|
| Rate for Payer: First Health Commercial |
$4,979.06
|
| Rate for Payer: Humana Commercial |
$4,454.95
|
| Rate for Payer: Humana KY Medicaid |
$1,802.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,820.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,297.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,867.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,572.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,838.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,612.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,930.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,559.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,616.37
|
| Rate for Payer: PHCS Commercial |
$5,031.48
|
| Rate for Payer: United Healthcare All Payer |
$4,612.19
|
|
|
PLATE VLP MINI-MOD 2.0MM Y 8H
|
Facility
|
IP
|
$5,241.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.34 |
| Max. Negotiated Rate |
$5,031.48 |
| Rate for Payer: Aetna Commercial |
$4,035.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,088.07
|
| Rate for Payer: Cash Price |
$2,620.56
|
| Rate for Payer: Cigna Commercial |
$4,350.13
|
| Rate for Payer: First Health Commercial |
$4,979.06
|
| Rate for Payer: Humana Commercial |
$4,454.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,297.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,867.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,572.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,612.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,930.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,559.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,616.37
|
| Rate for Payer: PHCS Commercial |
$5,031.48
|
| Rate for Payer: United Healthcare All Payer |
$4,612.19
|
|
|
PLATE VLP MINI-MOD 2.0MM Y 8H
|
Facility
|
OP
|
$5,241.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.34 |
| Max. Negotiated Rate |
$5,031.48 |
| Rate for Payer: Aetna Commercial |
$4,035.66
|
| Rate for Payer: Anthem Medicaid |
$1,802.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,088.07
|
| Rate for Payer: Cash Price |
$2,620.56
|
| Rate for Payer: Cigna Commercial |
$4,350.13
|
| Rate for Payer: First Health Commercial |
$4,979.06
|
| Rate for Payer: Humana Commercial |
$4,454.95
|
| Rate for Payer: Humana KY Medicaid |
$1,802.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,820.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,297.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,867.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,572.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,838.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,612.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,930.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,559.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,616.37
|
| Rate for Payer: PHCS Commercial |
$5,031.48
|
| Rate for Payer: United Healthcare All Payer |
$4,612.19
|
|
|
PLATE VLP MINI-MOD 2.0 STR 6H
|
Facility
|
OP
|
$3,947.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,184.16 |
| Max. Negotiated Rate |
$3,789.30 |
| Rate for Payer: Aetna Commercial |
$3,039.34
|
| Rate for Payer: Anthem Medicaid |
$1,357.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,078.81
|
| Rate for Payer: Cash Price |
$1,973.59
|
| Rate for Payer: Cigna Commercial |
$3,276.17
|
| Rate for Payer: First Health Commercial |
$3,749.83
|
| Rate for Payer: Humana Commercial |
$3,355.11
|
| Rate for Payer: Humana KY Medicaid |
$1,357.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,371.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,236.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,913.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,184.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,384.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,473.53
|
| Rate for Payer: Ohio Health Group HMO |
$2,960.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,157.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,434.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.56
|
| Rate for Payer: PHCS Commercial |
$3,789.30
|
| Rate for Payer: United Healthcare All Payer |
$3,473.53
|
|
|
PLATE VLP MINI-MOD 2.0 STR 6H
|
Facility
|
IP
|
$3,947.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,184.16 |
| Max. Negotiated Rate |
$3,789.30 |
| Rate for Payer: Aetna Commercial |
$3,039.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,078.81
|
| Rate for Payer: Cash Price |
$1,973.59
|
| Rate for Payer: Cigna Commercial |
$3,276.17
|
| Rate for Payer: First Health Commercial |
$3,749.83
|
| Rate for Payer: Humana Commercial |
$3,355.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,236.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,913.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,184.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,473.53
|
| Rate for Payer: Ohio Health Group HMO |
$2,960.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,157.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,434.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.56
|
| Rate for Payer: PHCS Commercial |
$3,789.30
|
| Rate for Payer: United Healthcare All Payer |
$3,473.53
|
|
|
PLATE VLP MINI-MOD 2.0 STR 8H
|
Facility
|
IP
|
$4,587.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.36 |
| Max. Negotiated Rate |
$4,404.36 |
| Rate for Payer: Aetna Commercial |
$3,532.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.55
|
| Rate for Payer: Cash Price |
$2,293.94
|
| Rate for Payer: Cigna Commercial |
$3,807.94
|
| Rate for Payer: First Health Commercial |
$4,358.49
|
| Rate for Payer: Humana Commercial |
$3,899.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,762.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.33
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.64
|
| Rate for Payer: PHCS Commercial |
$4,404.36
|
| Rate for Payer: United Healthcare All Payer |
$4,037.33
|
|
|
PLATE VLP MINI-MOD 2.0 STR 8H
|
Facility
|
OP
|
$4,587.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.36 |
| Max. Negotiated Rate |
$4,404.36 |
| Rate for Payer: Aetna Commercial |
$3,532.67
|
| Rate for Payer: Anthem Medicaid |
$1,577.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.55
|
| Rate for Payer: Cash Price |
$2,293.94
|
| Rate for Payer: Cigna Commercial |
$3,807.94
|
| Rate for Payer: First Health Commercial |
$4,358.49
|
| Rate for Payer: Humana Commercial |
$3,899.70
|
| Rate for Payer: Humana KY Medicaid |
$1,577.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,762.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,609.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.33
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.64
|
| Rate for Payer: PHCS Commercial |
$4,404.36
|
| Rate for Payer: United Healthcare All Payer |
$4,037.33
|
|
|
PLATE VLP MINI-MOD 2.0 T 2*6H
|
Facility
|
IP
|
$4,261.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.38 |
| Max. Negotiated Rate |
$4,090.80 |
| Rate for Payer: Aetna Commercial |
$3,281.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,323.78
|
| Rate for Payer: Cash Price |
$2,130.62
|
| Rate for Payer: Cigna Commercial |
$3,536.84
|
| Rate for Payer: First Health Commercial |
$4,048.19
|
| Rate for Payer: Humana Commercial |
$3,622.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,494.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,144.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,749.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,409.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,707.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,940.26
|
| Rate for Payer: PHCS Commercial |
$4,090.80
|
| Rate for Payer: United Healthcare All Payer |
$3,749.90
|
|
|
PLATE VLP MINI-MOD 2.0 T 2*6H
|
Facility
|
OP
|
$4,261.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.38 |
| Max. Negotiated Rate |
$4,090.80 |
| Rate for Payer: Aetna Commercial |
$3,281.16
|
| Rate for Payer: Anthem Medicaid |
$1,465.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,323.78
|
| Rate for Payer: Cash Price |
$2,130.62
|
| Rate for Payer: Cigna Commercial |
$3,536.84
|
| Rate for Payer: First Health Commercial |
$4,048.19
|
| Rate for Payer: Humana Commercial |
$3,622.06
|
| Rate for Payer: Humana KY Medicaid |
$1,465.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,480.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,494.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,144.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,494.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,749.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,409.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,707.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,940.26
|
| Rate for Payer: PHCS Commercial |
$4,090.80
|
| Rate for Payer: United Healthcare All Payer |
$3,749.90
|
|
|
PLATE VLP MINI-MOD 2.0 T 2*8H
|
Facility
|
OP
|
$4,914.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,474.35 |
| Max. Negotiated Rate |
$4,717.92 |
| Rate for Payer: Aetna Commercial |
$3,784.16
|
| Rate for Payer: Anthem Medicaid |
$1,690.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,833.31
|
| Rate for Payer: Cash Price |
$2,457.25
|
| Rate for Payer: Cigna Commercial |
$4,079.03
|
| Rate for Payer: First Health Commercial |
$4,668.77
|
| Rate for Payer: Humana Commercial |
$4,177.32
|
| Rate for Payer: Humana KY Medicaid |
$1,690.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,707.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,029.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,626.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,474.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,724.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,324.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,685.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,931.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,275.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,391.01
|
| Rate for Payer: PHCS Commercial |
$4,717.92
|
| Rate for Payer: United Healthcare All Payer |
$4,324.76
|
|
|
PLATE VLP MINI-MOD 2.0 T 2*8H
|
Facility
|
IP
|
$4,914.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,474.35 |
| Max. Negotiated Rate |
$4,717.92 |
| Rate for Payer: Aetna Commercial |
$3,784.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,833.31
|
| Rate for Payer: Cash Price |
$2,457.25
|
| Rate for Payer: Cigna Commercial |
$4,079.03
|
| Rate for Payer: First Health Commercial |
$4,668.77
|
| Rate for Payer: Humana Commercial |
$4,177.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,029.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,626.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,474.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,324.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,685.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,931.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,275.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,391.01
|
| Rate for Payer: PHCS Commercial |
$4,717.92
|
| Rate for Payer: United Healthcare All Payer |
$4,324.76
|
|
|
PLATE VLP MINI-MOD 2.0 T 3*6H
|
Facility
|
IP
|
$5,241.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.34 |
| Max. Negotiated Rate |
$5,031.48 |
| Rate for Payer: Aetna Commercial |
$4,035.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,088.07
|
| Rate for Payer: Cash Price |
$2,620.56
|
| Rate for Payer: Cigna Commercial |
$4,350.13
|
| Rate for Payer: First Health Commercial |
$4,979.06
|
| Rate for Payer: Humana Commercial |
$4,454.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,297.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,867.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,572.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,612.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,930.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,559.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,616.37
|
| Rate for Payer: PHCS Commercial |
$5,031.48
|
| Rate for Payer: United Healthcare All Payer |
$4,612.19
|
|
|
PLATE VLP MINI-MOD 2.0 T 3*6H
|
Facility
|
OP
|
$5,241.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.34 |
| Max. Negotiated Rate |
$5,031.48 |
| Rate for Payer: Aetna Commercial |
$4,035.66
|
| Rate for Payer: Anthem Medicaid |
$1,802.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,088.07
|
| Rate for Payer: Cash Price |
$2,620.56
|
| Rate for Payer: Cigna Commercial |
$4,350.13
|
| Rate for Payer: First Health Commercial |
$4,979.06
|
| Rate for Payer: Humana Commercial |
$4,454.95
|
| Rate for Payer: Humana KY Medicaid |
$1,802.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,820.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,297.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,867.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,572.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,838.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,612.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,930.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,559.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,616.37
|
| Rate for Payer: PHCS Commercial |
$5,031.48
|
| Rate for Payer: United Healthcare All Payer |
$4,612.19
|
|
|
PLATE VLP MINI-MOD 2.0 T 3*8H
|
Facility
|
OP
|
$6,778.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,033.49 |
| Max. Negotiated Rate |
$6,507.17 |
| Rate for Payer: Aetna Commercial |
$5,219.29
|
| Rate for Payer: Anthem Medicaid |
$2,331.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,287.07
|
| Rate for Payer: Cash Price |
$3,389.15
|
| Rate for Payer: Cigna Commercial |
$5,625.99
|
| Rate for Payer: First Health Commercial |
$6,439.39
|
| Rate for Payer: Humana Commercial |
$5,761.56
|
| Rate for Payer: Humana KY Medicaid |
$2,331.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,354.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,558.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,002.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,033.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,377.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,964.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,083.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,422.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,897.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,677.03
|
| Rate for Payer: PHCS Commercial |
$6,507.17
|
| Rate for Payer: United Healthcare All Payer |
$5,964.90
|
|
|
PLATE VLP MINI-MOD 2.0 T 3*8H
|
Facility
|
IP
|
$6,778.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,033.49 |
| Max. Negotiated Rate |
$6,507.17 |
| Rate for Payer: Aetna Commercial |
$5,219.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,287.07
|
| Rate for Payer: Cash Price |
$3,389.15
|
| Rate for Payer: Cigna Commercial |
$5,625.99
|
| Rate for Payer: First Health Commercial |
$6,439.39
|
| Rate for Payer: Humana Commercial |
$5,761.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,558.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,002.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,033.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,964.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,083.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,422.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,897.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,677.03
|
| Rate for Payer: PHCS Commercial |
$6,507.17
|
| Rate for Payer: United Healthcare All Payer |
$5,964.90
|
|
|
PLATE VLP MINI-MOD 2.4MM Y 6H
|
Facility
|
OP
|
$5,241.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.34 |
| Max. Negotiated Rate |
$5,031.48 |
| Rate for Payer: Aetna Commercial |
$4,035.66
|
| Rate for Payer: Anthem Medicaid |
$1,802.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,088.07
|
| Rate for Payer: Cash Price |
$2,620.56
|
| Rate for Payer: Cigna Commercial |
$4,350.13
|
| Rate for Payer: First Health Commercial |
$4,979.06
|
| Rate for Payer: Humana Commercial |
$4,454.95
|
| Rate for Payer: Humana KY Medicaid |
$1,802.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,820.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,297.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,867.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,572.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,838.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,612.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,930.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,559.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,616.37
|
| Rate for Payer: PHCS Commercial |
$5,031.48
|
| Rate for Payer: United Healthcare All Payer |
$4,612.19
|
|
|
PLATE VLP MINI-MOD 2.4MM Y 6H
|
Facility
|
IP
|
$5,241.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.34 |
| Max. Negotiated Rate |
$5,031.48 |
| Rate for Payer: Aetna Commercial |
$4,035.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,088.07
|
| Rate for Payer: Cash Price |
$2,620.56
|
| Rate for Payer: Cigna Commercial |
$4,350.13
|
| Rate for Payer: First Health Commercial |
$4,979.06
|
| Rate for Payer: Humana Commercial |
$4,454.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,297.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,867.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,572.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,612.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,930.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,559.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,616.37
|
| Rate for Payer: PHCS Commercial |
$5,031.48
|
| Rate for Payer: United Healthcare All Payer |
$4,612.19
|
|
|
PLATE VLP MINI-MOD 2.4MM Y 8H
|
Facility
|
IP
|
$6,778.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,033.49 |
| Max. Negotiated Rate |
$6,507.17 |
| Rate for Payer: Aetna Commercial |
$5,219.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,287.07
|
| Rate for Payer: Cash Price |
$3,389.15
|
| Rate for Payer: Cigna Commercial |
$5,625.99
|
| Rate for Payer: First Health Commercial |
$6,439.39
|
| Rate for Payer: Humana Commercial |
$5,761.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,558.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,002.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,033.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,964.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,083.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,422.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,897.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,677.03
|
| Rate for Payer: PHCS Commercial |
$6,507.17
|
| Rate for Payer: United Healthcare All Payer |
$5,964.90
|
|
|
PLATE VLP MINI-MOD 2.4MM Y 8H
|
Facility
|
OP
|
$6,778.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,033.49 |
| Max. Negotiated Rate |
$6,507.17 |
| Rate for Payer: Aetna Commercial |
$5,219.29
|
| Rate for Payer: Anthem Medicaid |
$2,331.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,287.07
|
| Rate for Payer: Cash Price |
$3,389.15
|
| Rate for Payer: Cigna Commercial |
$5,625.99
|
| Rate for Payer: First Health Commercial |
$6,439.39
|
| Rate for Payer: Humana Commercial |
$5,761.56
|
| Rate for Payer: Humana KY Medicaid |
$2,331.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,354.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,558.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,002.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,033.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,377.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,964.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,083.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,422.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,897.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,677.03
|
| Rate for Payer: PHCS Commercial |
$6,507.17
|
| Rate for Payer: United Healthcare All Payer |
$5,964.90
|
|
|
PLATE VLP MINI-MOD 2.4 STR 12H
|
Facility
|
IP
|
$6,778.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,033.49 |
| Max. Negotiated Rate |
$6,507.17 |
| Rate for Payer: Aetna Commercial |
$5,219.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,287.07
|
| Rate for Payer: Cash Price |
$3,389.15
|
| Rate for Payer: Cigna Commercial |
$5,625.99
|
| Rate for Payer: First Health Commercial |
$6,439.39
|
| Rate for Payer: Humana Commercial |
$5,761.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,558.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,002.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,033.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,964.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,083.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,422.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,897.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,677.03
|
| Rate for Payer: PHCS Commercial |
$6,507.17
|
| Rate for Payer: United Healthcare All Payer |
$5,964.90
|
|
|
PLATE VLP MINI-MOD 2.4 STR 12H
|
Facility
|
OP
|
$6,778.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,033.49 |
| Max. Negotiated Rate |
$6,507.17 |
| Rate for Payer: Aetna Commercial |
$5,219.29
|
| Rate for Payer: Anthem Medicaid |
$2,331.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,287.07
|
| Rate for Payer: Cash Price |
$3,389.15
|
| Rate for Payer: Cigna Commercial |
$5,625.99
|
| Rate for Payer: First Health Commercial |
$6,439.39
|
| Rate for Payer: Humana Commercial |
$5,761.56
|
| Rate for Payer: Humana KY Medicaid |
$2,331.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,354.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,558.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,002.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,033.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,377.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,964.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,083.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,422.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,897.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,677.03
|
| Rate for Payer: PHCS Commercial |
$6,507.17
|
| Rate for Payer: United Healthcare All Payer |
$5,964.90
|
|
|
PLATE VLP MINI-MOD 2.4 STR 6H
|
Facility
|
OP
|
$3,947.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,184.16 |
| Max. Negotiated Rate |
$3,789.30 |
| Rate for Payer: Aetna Commercial |
$3,039.34
|
| Rate for Payer: Anthem Medicaid |
$1,357.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,078.81
|
| Rate for Payer: Cash Price |
$1,973.59
|
| Rate for Payer: Cigna Commercial |
$3,276.17
|
| Rate for Payer: First Health Commercial |
$3,749.83
|
| Rate for Payer: Humana Commercial |
$3,355.11
|
| Rate for Payer: Humana KY Medicaid |
$1,357.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,371.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,236.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,913.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,184.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,384.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,473.53
|
| Rate for Payer: Ohio Health Group HMO |
$2,960.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,157.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,434.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.56
|
| Rate for Payer: PHCS Commercial |
$3,789.30
|
| Rate for Payer: United Healthcare All Payer |
$3,473.53
|
|
|
PLATE VLP MINI-MOD 2.4 STR 6H
|
Facility
|
IP
|
$3,947.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,184.16 |
| Max. Negotiated Rate |
$3,789.30 |
| Rate for Payer: Aetna Commercial |
$3,039.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,078.81
|
| Rate for Payer: Cash Price |
$1,973.59
|
| Rate for Payer: Cigna Commercial |
$3,276.17
|
| Rate for Payer: First Health Commercial |
$3,749.83
|
| Rate for Payer: Humana Commercial |
$3,355.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,236.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,913.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,184.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,473.53
|
| Rate for Payer: Ohio Health Group HMO |
$2,960.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,157.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,434.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.56
|
| Rate for Payer: PHCS Commercial |
$3,789.30
|
| Rate for Payer: United Healthcare All Payer |
$3,473.53
|
|
|
PLATE VLP MINI-MOD 2.4 STR 8H
|
Facility
|
OP
|
$4,587.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.36 |
| Max. Negotiated Rate |
$4,404.36 |
| Rate for Payer: Aetna Commercial |
$3,532.67
|
| Rate for Payer: Anthem Medicaid |
$1,577.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.55
|
| Rate for Payer: Cash Price |
$2,293.94
|
| Rate for Payer: Cigna Commercial |
$3,807.94
|
| Rate for Payer: First Health Commercial |
$4,358.49
|
| Rate for Payer: Humana Commercial |
$3,899.70
|
| Rate for Payer: Humana KY Medicaid |
$1,577.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,762.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,609.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.33
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.64
|
| Rate for Payer: PHCS Commercial |
$4,404.36
|
| Rate for Payer: United Healthcare All Payer |
$4,037.33
|
|
