|
PLATE VLP MINI-MOD 2.4 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 2.4 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 2.4 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 2.4 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 2.4 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 2.4 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 2.4 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 2.4 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 2.4 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 MIN-MOD 1.5M STR 12H
|
Facility
|
IP
|
$4,474.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,342.44 |
| Max. Negotiated Rate |
$4,295.82 |
| Rate for Payer: Aetna Commercial |
$3,445.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.35
|
| Rate for Payer: Cash Price |
$2,237.41
|
| Rate for Payer: Cigna Commercial |
$3,714.09
|
| Rate for Payer: First Health Commercial |
$4,251.07
|
| Rate for Payer: Humana Commercial |
$3,803.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,937.83
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,579.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,893.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,087.62
|
| Rate for Payer: PHCS Commercial |
$4,295.82
|
| Rate for Payer: United Healthcare All Payer |
$3,937.83
|
|
|
PLATE VLP MIN-MOD 1.5M STR 12H
|
Facility
|
OP
|
$4,474.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,342.44 |
| Max. Negotiated Rate |
$4,295.82 |
| Rate for Payer: Aetna Commercial |
$3,445.60
|
| Rate for Payer: Anthem Medicaid |
$1,538.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.35
|
| Rate for Payer: Cash Price |
$2,237.41
|
| Rate for Payer: Cigna Commercial |
$3,714.09
|
| Rate for Payer: First Health Commercial |
$4,251.07
|
| Rate for Payer: Humana Commercial |
$3,803.59
|
| Rate for Payer: Humana KY Medicaid |
$1,538.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,554.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,569.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,937.83
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,579.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,893.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,087.62
|
| Rate for Payer: PHCS Commercial |
$4,295.82
|
| Rate for Payer: United Healthcare All Payer |
$3,937.83
|
|
|
PLATE VLP MIN-MOD 1.5M STR 6H
|
Facility
|
IP
|
$3,846.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,154.01 |
| Max. Negotiated Rate |
$3,692.82 |
| Rate for Payer: Aetna Commercial |
$2,961.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,000.42
|
| Rate for Payer: Cash Price |
$1,923.34
|
| Rate for Payer: Cigna Commercial |
$3,192.75
|
| Rate for Payer: First Health Commercial |
$3,654.36
|
| Rate for Payer: Humana Commercial |
$3,269.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,154.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,838.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,154.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,385.09
|
| Rate for Payer: Ohio Health Group HMO |
$2,885.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,077.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,346.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,654.22
|
| Rate for Payer: PHCS Commercial |
$3,692.82
|
| Rate for Payer: United Healthcare All Payer |
$3,385.09
|
|
|
PLATE VLP MIN-MOD 1.5M STR 6H
|
Facility
|
OP
|
$3,846.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,154.01 |
| Max. Negotiated Rate |
$3,692.82 |
| Rate for Payer: Aetna Commercial |
$2,961.95
|
| Rate for Payer: Anthem Medicaid |
$1,322.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,000.42
|
| Rate for Payer: Cash Price |
$1,923.34
|
| Rate for Payer: Cigna Commercial |
$3,192.75
|
| Rate for Payer: First Health Commercial |
$3,654.36
|
| Rate for Payer: Humana Commercial |
$3,269.69
|
| Rate for Payer: Humana KY Medicaid |
$1,322.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,336.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,154.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,838.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,154.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,349.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,385.09
|
| Rate for Payer: Ohio Health Group HMO |
$2,885.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,077.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,346.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,654.22
|
| Rate for Payer: PHCS Commercial |
$3,692.82
|
| Rate for Payer: United Healthcare All Payer |
$3,385.09
|
|
|
PLATE VLP MIN-MOD 1.5M STR 8H
|
Facility
|
OP
|
$4,474.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,342.44 |
| Max. Negotiated Rate |
$4,295.82 |
| Rate for Payer: Aetna Commercial |
$3,445.60
|
| Rate for Payer: Anthem Medicaid |
$1,538.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.35
|
| Rate for Payer: Cash Price |
$2,237.41
|
| Rate for Payer: Cigna Commercial |
$3,714.09
|
| Rate for Payer: First Health Commercial |
$4,251.07
|
| Rate for Payer: Humana Commercial |
$3,803.59
|
| Rate for Payer: Humana KY Medicaid |
$1,538.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,554.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,569.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,937.83
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,579.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,893.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,087.62
|
| Rate for Payer: PHCS Commercial |
$4,295.82
|
| Rate for Payer: United Healthcare All Payer |
$3,937.83
|
|
|
PLATE VLP MIN-MOD 1.5M STR 8H
|
Facility
|
IP
|
$4,474.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,342.44 |
| Max. Negotiated Rate |
$4,295.82 |
| Rate for Payer: Aetna Commercial |
$3,445.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.35
|
| Rate for Payer: Cash Price |
$2,237.41
|
| Rate for Payer: Cigna Commercial |
$3,714.09
|
| Rate for Payer: First Health Commercial |
$4,251.07
|
| Rate for Payer: Humana Commercial |
$3,803.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,937.83
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,579.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,893.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,087.62
|
| Rate for Payer: PHCS Commercial |
$4,295.82
|
| Rate for Payer: United Healthcare All Payer |
$3,937.83
|
|
|
PLATE VLP MIN-MOD 1.5M T 2H*6H
|
Facility
|
IP
|
$4,160.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.22 |
| Max. Negotiated Rate |
$3,994.32 |
| Rate for Payer: Aetna Commercial |
$3,203.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,245.39
|
| Rate for Payer: Cash Price |
$2,080.38
|
| Rate for Payer: Cigna Commercial |
$3,453.42
|
| Rate for Payer: First Health Commercial |
$3,952.71
|
| Rate for Payer: Humana Commercial |
$3,536.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,411.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,070.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,248.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,661.46
|
| Rate for Payer: Ohio Health Group HMO |
$3,120.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,328.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,619.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,870.92
|
| Rate for Payer: PHCS Commercial |
$3,994.32
|
| Rate for Payer: United Healthcare All Payer |
$3,661.46
|
|
|
PLATE VLP MIN-MOD 1.5M T 2H*6H
|
Facility
|
OP
|
$4,160.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.22 |
| Max. Negotiated Rate |
$3,994.32 |
| Rate for Payer: Aetna Commercial |
$3,203.78
|
| Rate for Payer: Anthem Medicaid |
$1,430.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,245.39
|
| Rate for Payer: Cash Price |
$2,080.38
|
| Rate for Payer: Cigna Commercial |
$3,453.42
|
| Rate for Payer: First Health Commercial |
$3,952.71
|
| Rate for Payer: Humana Commercial |
$3,536.64
|
| Rate for Payer: Humana KY Medicaid |
$1,430.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,445.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,411.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,070.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,248.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,459.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,661.46
|
| Rate for Payer: Ohio Health Group HMO |
$3,120.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,328.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,619.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,870.92
|
| Rate for Payer: PHCS Commercial |
$3,994.32
|
| Rate for Payer: United Healthcare All Payer |
$3,661.46
|
|
|
PLATE VLP MIN-MOD 1.5M T 2H*8H
|
Facility
|
OP
|
$4,776.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.89 |
| Max. Negotiated Rate |
$4,585.26 |
| Rate for Payer: Aetna Commercial |
$3,677.76
|
| Rate for Payer: Anthem Medicaid |
$1,642.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,725.52
|
| Rate for Payer: Cash Price |
$2,388.16
|
| Rate for Payer: Cigna Commercial |
$3,964.34
|
| Rate for Payer: First Health Commercial |
$4,537.49
|
| Rate for Payer: Humana Commercial |
$4,059.86
|
| Rate for Payer: Humana KY Medicaid |
$1,642.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,659.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,916.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,524.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,432.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,675.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,203.15
|
| Rate for Payer: Ohio Health Group HMO |
$3,582.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,821.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,155.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,295.65
|
| Rate for Payer: PHCS Commercial |
$4,585.26
|
| Rate for Payer: United Healthcare All Payer |
$4,203.15
|
|
|
PLATE VLP MIN-MOD 1.5M T 2H*8H
|
Facility
|
IP
|
$4,776.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.89 |
| Max. Negotiated Rate |
$4,585.26 |
| Rate for Payer: Aetna Commercial |
$3,677.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,725.52
|
| Rate for Payer: Cash Price |
$2,388.16
|
| Rate for Payer: Cigna Commercial |
$3,964.34
|
| Rate for Payer: First Health Commercial |
$4,537.49
|
| Rate for Payer: Humana Commercial |
$4,059.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,916.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,524.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,432.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,203.15
|
| Rate for Payer: Ohio Health Group HMO |
$3,582.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,821.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,155.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,295.65
|
| Rate for Payer: PHCS Commercial |
$4,585.26
|
| Rate for Payer: United Healthcare All Payer |
$4,203.15
|
|
|
PLATE VLP MIN-MOD 1.5M T 3H*6H
|
Facility
|
IP
|
$5,090.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,527.11 |
| Max. Negotiated Rate |
$4,886.76 |
| Rate for Payer: Aetna Commercial |
$3,919.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,970.50
|
| Rate for Payer: Cash Price |
$2,545.19
|
| Rate for Payer: Cigna Commercial |
$4,225.02
|
| Rate for Payer: First Health Commercial |
$4,835.86
|
| Rate for Payer: Humana Commercial |
$4,326.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,174.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,756.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,527.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,479.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,817.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,072.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,428.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.36
|
| Rate for Payer: PHCS Commercial |
$4,886.76
|
| Rate for Payer: United Healthcare All Payer |
$4,479.53
|
|
|
PLATE VLP MIN-MOD 1.5M T 3H*6H
|
Facility
|
OP
|
$5,090.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,527.11 |
| Max. Negotiated Rate |
$4,886.76 |
| Rate for Payer: Aetna Commercial |
$3,919.59
|
| Rate for Payer: Anthem Medicaid |
$1,750.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,970.50
|
| Rate for Payer: Cash Price |
$2,545.19
|
| Rate for Payer: Cigna Commercial |
$4,225.02
|
| Rate for Payer: First Health Commercial |
$4,835.86
|
| Rate for Payer: Humana Commercial |
$4,326.82
|
| Rate for Payer: Humana KY Medicaid |
$1,750.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,768.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,174.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,756.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,527.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,785.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,479.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,817.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,072.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,428.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.36
|
| Rate for Payer: PHCS Commercial |
$4,886.76
|
| Rate for Payer: United Healthcare All Payer |
$4,479.53
|
|
|
PLATE VLP MIN-MOD 1.5M T 3H*8H
|
Facility
|
OP
|
$5,693.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,708.01 |
| Max. Negotiated Rate |
$5,465.64 |
| Rate for Payer: Aetna Commercial |
$4,383.90
|
| Rate for Payer: Anthem Medicaid |
$1,957.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,440.84
|
| Rate for Payer: Cash Price |
$2,846.69
|
| Rate for Payer: Cigna Commercial |
$4,725.51
|
| Rate for Payer: First Health Commercial |
$5,408.71
|
| Rate for Payer: Humana Commercial |
$4,839.37
|
| Rate for Payer: Humana KY Medicaid |
$1,957.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,977.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,668.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,201.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,708.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,997.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,010.17
|
| Rate for Payer: Ohio Health Group HMO |
$4,270.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,554.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,953.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,928.43
|
| Rate for Payer: PHCS Commercial |
$5,465.64
|
| Rate for Payer: United Healthcare All Payer |
$5,010.17
|
|
|
PLATE VLP MIN-MOD 1.5M T 3H*8H
|
Facility
|
IP
|
$5,693.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,708.01 |
| Max. Negotiated Rate |
$5,465.64 |
| Rate for Payer: Aetna Commercial |
$4,383.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,440.84
|
| Rate for Payer: Cash Price |
$2,846.69
|
| Rate for Payer: Cigna Commercial |
$4,725.51
|
| Rate for Payer: First Health Commercial |
$5,408.71
|
| Rate for Payer: Humana Commercial |
$4,839.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,668.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,201.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,708.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,010.17
|
| Rate for Payer: Ohio Health Group HMO |
$4,270.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,554.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,953.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,928.43
|
| Rate for Payer: PHCS Commercial |
$5,465.64
|
| Rate for Payer: United Healthcare All Payer |
$5,010.17
|
|
|
PLATE VOLAR 3H STD
|
Facility
|
OP
|
$5,588.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,676.62 |
| Max. Negotiated Rate |
$5,365.20 |
| Rate for Payer: Aetna Commercial |
$4,303.34
|
| Rate for Payer: Anthem Medicaid |
$1,921.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,359.23
|
| Rate for Payer: Cash Price |
$2,794.38
|
| Rate for Payer: Cigna Commercial |
$4,638.66
|
| Rate for Payer: First Health Commercial |
$5,309.31
|
| Rate for Payer: Humana Commercial |
$4,750.44
|
| Rate for Payer: Humana KY Medicaid |
$1,921.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,941.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,582.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,124.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,676.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,960.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,918.10
|
| Rate for Payer: Ohio Health Group HMO |
$4,191.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,471.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,862.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,856.24
|
| Rate for Payer: PHCS Commercial |
$5,365.20
|
| Rate for Payer: United Healthcare All Payer |
$4,918.10
|
|
|
PLATE VOLAR 3H STD
|
Facility
|
IP
|
$5,588.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,676.62 |
| Max. Negotiated Rate |
$5,365.20 |
| Rate for Payer: Aetna Commercial |
$4,303.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,359.23
|
| Rate for Payer: Cash Price |
$2,794.38
|
| Rate for Payer: Cigna Commercial |
$4,638.66
|
| Rate for Payer: First Health Commercial |
$5,309.31
|
| Rate for Payer: Humana Commercial |
$4,750.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,582.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,124.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,676.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,918.10
|
| Rate for Payer: Ohio Health Group HMO |
$4,191.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,471.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,862.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,856.24
|
| Rate for Payer: PHCS Commercial |
$5,365.20
|
| Rate for Payer: United Healthcare All Payer |
$4,918.10
|
|
