|
PLATE NARROW 4.5*214 11H
|
Facility
|
OP
|
$2,055.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.25 |
| Max. Negotiated Rate |
$1,973.55 |
| Rate for Payer: Aetna Commercial |
$1,582.95
|
| Rate for Payer: Anthem Medicaid |
$706.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,603.51
|
| Rate for Payer: Cash Price |
$1,027.89
|
| Rate for Payer: Cigna Commercial |
$1,706.30
|
| Rate for Payer: First Health Commercial |
$1,952.99
|
| Rate for Payer: Humana Commercial |
$1,747.41
|
| Rate for Payer: Humana KY Medicaid |
$706.98
|
| Rate for Payer: Kentucky WC Medicaid |
$714.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,685.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,517.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$721.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,809.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.29
|
| Rate for Payer: PHCS Commercial |
$1,973.55
|
| Rate for Payer: United Healthcare All Payer |
$1,809.09
|
|
|
PLATE NARROW 4.5*214 11H
|
Facility
|
IP
|
$2,055.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.25 |
| Max. Negotiated Rate |
$1,973.55 |
| Rate for Payer: Aetna Commercial |
$1,582.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,603.51
|
| Rate for Payer: Cash Price |
$1,027.89
|
| Rate for Payer: Cigna Commercial |
$1,706.30
|
| Rate for Payer: First Health Commercial |
$1,952.99
|
| Rate for Payer: Humana Commercial |
$1,747.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,685.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,517.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,809.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.29
|
| Rate for Payer: PHCS Commercial |
$1,973.55
|
| Rate for Payer: United Healthcare All Payer |
$1,809.09
|
|
|
PLATE NARROW 4.5*232 12H
|
Facility
|
IP
|
$2,055.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.25 |
| Max. Negotiated Rate |
$1,973.55 |
| Rate for Payer: Aetna Commercial |
$1,582.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,603.51
|
| Rate for Payer: Cash Price |
$1,027.89
|
| Rate for Payer: Cigna Commercial |
$1,706.30
|
| Rate for Payer: First Health Commercial |
$1,952.99
|
| Rate for Payer: Humana Commercial |
$1,747.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,685.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,517.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,809.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.29
|
| Rate for Payer: PHCS Commercial |
$1,973.55
|
| Rate for Payer: United Healthcare All Payer |
$1,809.09
|
|
|
PLATE NARROW 4.5*232 12H
|
Facility
|
OP
|
$2,055.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.25 |
| Max. Negotiated Rate |
$1,973.55 |
| Rate for Payer: Aetna Commercial |
$1,582.95
|
| Rate for Payer: Anthem Medicaid |
$706.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,603.51
|
| Rate for Payer: Cash Price |
$1,027.89
|
| Rate for Payer: Cigna Commercial |
$1,706.30
|
| Rate for Payer: First Health Commercial |
$1,952.99
|
| Rate for Payer: Humana Commercial |
$1,747.41
|
| Rate for Payer: Humana KY Medicaid |
$706.98
|
| Rate for Payer: Kentucky WC Medicaid |
$714.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,685.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,517.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$721.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,809.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.29
|
| Rate for Payer: PHCS Commercial |
$1,973.55
|
| Rate for Payer: United Healthcare All Payer |
$1,809.09
|
|
|
PLATE NARROW 4.5*250 13H
|
Facility
|
IP
|
$2,185.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.09 |
| Max. Negotiated Rate |
$2,097.87 |
| Rate for Payer: Aetna Commercial |
$1,682.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,704.52
|
| Rate for Payer: Cash Price |
$1,092.64
|
| Rate for Payer: Cigna Commercial |
$1,813.78
|
| Rate for Payer: First Health Commercial |
$2,076.02
|
| Rate for Payer: Humana Commercial |
$1,857.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,791.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,612.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$655.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,923.05
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$677.44
|
| Rate for Payer: PHCS Commercial |
$2,097.87
|
| Rate for Payer: United Healthcare All Payer |
$1,923.05
|
|
|
PLATE NARROW 4.5*250 13H
|
Facility
|
OP
|
$2,185.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.09 |
| Max. Negotiated Rate |
$2,097.87 |
| Rate for Payer: Aetna Commercial |
$1,682.67
|
| Rate for Payer: Anthem Medicaid |
$751.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,704.52
|
| Rate for Payer: Cash Price |
$1,092.64
|
| Rate for Payer: Cigna Commercial |
$1,813.78
|
| Rate for Payer: First Health Commercial |
$2,076.02
|
| Rate for Payer: Humana Commercial |
$1,857.49
|
| Rate for Payer: Humana KY Medicaid |
$751.52
|
| Rate for Payer: Kentucky WC Medicaid |
$759.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,791.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,612.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$655.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$766.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,923.05
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$677.44
|
| Rate for Payer: PHCS Commercial |
$2,097.87
|
| Rate for Payer: United Healthcare All Payer |
$1,923.05
|
|
|
PLATE NARROW 4.5*268 14H
|
Facility
|
IP
|
$3,093.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$402.16 |
| Max. Negotiated Rate |
$2,969.81 |
| Rate for Payer: Aetna Commercial |
$2,382.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,412.97
|
| Rate for Payer: Cash Price |
$1,546.78
|
| Rate for Payer: Cigna Commercial |
$2,567.65
|
| Rate for Payer: First Health Commercial |
$2,938.87
|
| Rate for Payer: Humana Commercial |
$2,629.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,536.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,283.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$928.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,722.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,320.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$618.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$402.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$959.00
|
| Rate for Payer: PHCS Commercial |
$2,969.81
|
| Rate for Payer: United Healthcare All Payer |
$2,722.32
|
|
|
PLATE NARROW 4.5*268 14H
|
Facility
|
OP
|
$3,093.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$402.16 |
| Max. Negotiated Rate |
$2,969.81 |
| Rate for Payer: Kentucky WC Medicaid |
$1,074.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,536.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,283.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$928.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,085.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,722.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,320.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$618.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$402.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$959.00
|
| Rate for Payer: PHCS Commercial |
$2,969.81
|
| Rate for Payer: United Healthcare All Payer |
$2,722.32
|
| Rate for Payer: Aetna Commercial |
$2,382.03
|
| Rate for Payer: Anthem Medicaid |
$1,063.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,412.97
|
| Rate for Payer: Cash Price |
$1,546.78
|
| Rate for Payer: Cigna Commercial |
$2,567.65
|
| Rate for Payer: First Health Commercial |
$2,938.87
|
| Rate for Payer: Humana Commercial |
$2,629.52
|
| Rate for Payer: Humana KY Medicaid |
$1,063.87
|
|
|
PLATE NARROW 4.5*286 15H
|
Facility
|
IP
|
$3,093.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$402.16 |
| Max. Negotiated Rate |
$2,969.81 |
| Rate for Payer: Aetna Commercial |
$2,382.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,412.97
|
| Rate for Payer: Cash Price |
$1,546.78
|
| Rate for Payer: Cigna Commercial |
$2,567.65
|
| Rate for Payer: First Health Commercial |
$2,938.87
|
| Rate for Payer: Humana Commercial |
$2,629.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,536.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,283.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$928.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,722.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,320.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$618.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$402.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$959.00
|
| Rate for Payer: PHCS Commercial |
$2,969.81
|
| Rate for Payer: United Healthcare All Payer |
$2,722.32
|
|
|
PLATE NARROW 4.5*286 15H
|
Facility
|
OP
|
$3,093.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$402.16 |
| Max. Negotiated Rate |
$2,969.81 |
| Rate for Payer: Aetna Commercial |
$2,382.03
|
| Rate for Payer: Anthem Medicaid |
$1,063.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,412.97
|
| Rate for Payer: Cash Price |
$1,546.78
|
| Rate for Payer: Cigna Commercial |
$2,567.65
|
| Rate for Payer: First Health Commercial |
$2,938.87
|
| Rate for Payer: Humana Commercial |
$2,629.52
|
| Rate for Payer: Humana KY Medicaid |
$1,063.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,074.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,536.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,283.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$928.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,085.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,722.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,320.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$618.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$402.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$959.00
|
| Rate for Payer: PHCS Commercial |
$2,969.81
|
| Rate for Payer: United Healthcare All Payer |
$2,722.32
|
|
|
PLATE NARROW 4.5*304 16H
|
Facility
|
IP
|
$3,520.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.72 |
| Max. Negotiated Rate |
$3,380.06 |
| Rate for Payer: Aetna Commercial |
$2,711.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,746.30
|
| Rate for Payer: Cash Price |
$1,760.45
|
| Rate for Payer: Cigna Commercial |
$2,922.35
|
| Rate for Payer: First Health Commercial |
$3,344.86
|
| Rate for Payer: Humana Commercial |
$2,992.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,887.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,598.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,056.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,098.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,640.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$704.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,091.48
|
| Rate for Payer: PHCS Commercial |
$3,380.06
|
| Rate for Payer: United Healthcare All Payer |
$3,098.39
|
|
|
PLATE NARROW 4.5*304 16H
|
Facility
|
OP
|
$3,520.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.72 |
| Max. Negotiated Rate |
$3,380.06 |
| Rate for Payer: Aetna Commercial |
$2,711.09
|
| Rate for Payer: Anthem Medicaid |
$1,210.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,746.30
|
| Rate for Payer: Cash Price |
$1,760.45
|
| Rate for Payer: Cigna Commercial |
$2,922.35
|
| Rate for Payer: First Health Commercial |
$3,344.86
|
| Rate for Payer: Humana Commercial |
$2,992.76
|
| Rate for Payer: Humana KY Medicaid |
$1,210.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,223.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,887.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,598.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,056.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,235.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,098.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,640.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$704.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,091.48
|
| Rate for Payer: PHCS Commercial |
$3,380.06
|
| Rate for Payer: United Healthcare All Payer |
$3,098.39
|
|
|
PLATE NARROW 4.5*340 18H
|
Facility
|
OP
|
$3,669.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.08 |
| Max. Negotiated Rate |
$3,523.03 |
| Rate for Payer: Aetna Commercial |
$2,825.76
|
| Rate for Payer: Anthem Medicaid |
$1,262.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,862.46
|
| Rate for Payer: Cash Price |
$1,834.91
|
| Rate for Payer: Cigna Commercial |
$3,045.95
|
| Rate for Payer: First Health Commercial |
$3,486.33
|
| Rate for Payer: Humana Commercial |
$3,119.35
|
| Rate for Payer: Humana KY Medicaid |
$1,262.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,274.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,009.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,708.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,100.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,287.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,229.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,752.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$733.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$477.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,137.64
|
| Rate for Payer: PHCS Commercial |
$3,523.03
|
| Rate for Payer: United Healthcare All Payer |
$3,229.44
|
|
|
PLATE NARROW 4.5*340 18H
|
Facility
|
IP
|
$3,669.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.08 |
| Max. Negotiated Rate |
$3,523.03 |
| Rate for Payer: Aetna Commercial |
$2,825.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,862.46
|
| Rate for Payer: Cash Price |
$1,834.91
|
| Rate for Payer: Cigna Commercial |
$3,045.95
|
| Rate for Payer: First Health Commercial |
$3,486.33
|
| Rate for Payer: Humana Commercial |
$3,119.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,009.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,708.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,100.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,229.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,752.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$733.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$477.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,137.64
|
| Rate for Payer: PHCS Commercial |
$3,523.03
|
| Rate for Payer: United Healthcare All Payer |
$3,229.44
|
|
|
PLATE NARROW 4.5*376 20H
|
Facility
|
OP
|
$3,786.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$492.23 |
| Max. Negotiated Rate |
$3,634.92 |
| Rate for Payer: Aetna Commercial |
$2,915.51
|
| Rate for Payer: Anthem Medicaid |
$1,302.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,953.38
|
| Rate for Payer: Cash Price |
$1,893.19
|
| Rate for Payer: Cigna Commercial |
$3,142.70
|
| Rate for Payer: First Health Commercial |
$3,597.06
|
| Rate for Payer: Humana Commercial |
$3,218.42
|
| Rate for Payer: Humana KY Medicaid |
$1,302.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,315.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,104.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,135.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,328.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,332.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,839.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$757.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$492.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.78
|
| Rate for Payer: PHCS Commercial |
$3,634.92
|
| Rate for Payer: United Healthcare All Payer |
$3,332.01
|
|
|
PLATE NARROW 4.5*376 20H
|
Facility
|
IP
|
$3,786.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$492.23 |
| Max. Negotiated Rate |
$3,634.92 |
| Rate for Payer: Aetna Commercial |
$2,915.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,953.38
|
| Rate for Payer: Cash Price |
$1,893.19
|
| Rate for Payer: Cigna Commercial |
$3,142.70
|
| Rate for Payer: First Health Commercial |
$3,597.06
|
| Rate for Payer: Humana Commercial |
$3,218.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,104.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,135.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,332.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,839.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$757.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$492.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.78
|
| Rate for Payer: PHCS Commercial |
$3,634.92
|
| Rate for Payer: United Healthcare All Payer |
$3,332.01
|
|
|
PLATE NARROW 4.5*412 22H
|
Facility
|
IP
|
$3,857.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.49 |
| Max. Negotiated Rate |
$3,703.30 |
| Rate for Payer: Humana Commercial |
$3,278.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,163.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,846.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,157.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,394.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,893.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$771.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.86
|
| Rate for Payer: PHCS Commercial |
$3,703.30
|
| Rate for Payer: United Healthcare All Payer |
$3,394.69
|
| Rate for Payer: Aetna Commercial |
$2,970.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,008.93
|
| Rate for Payer: Cash Price |
$1,928.80
|
| Rate for Payer: Cigna Commercial |
$3,201.81
|
| Rate for Payer: First Health Commercial |
$3,664.72
|
|
|
PLATE NARROW 4.5*412 22H
|
Facility
|
OP
|
$3,857.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.49 |
| Max. Negotiated Rate |
$3,703.30 |
| Rate for Payer: Aetna Commercial |
$2,970.35
|
| Rate for Payer: Anthem Medicaid |
$1,326.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,008.93
|
| Rate for Payer: Cash Price |
$1,928.80
|
| Rate for Payer: Cigna Commercial |
$3,201.81
|
| Rate for Payer: First Health Commercial |
$3,664.72
|
| Rate for Payer: Humana Commercial |
$3,278.96
|
| Rate for Payer: Humana KY Medicaid |
$1,326.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1,340.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,163.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,846.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,157.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,353.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,394.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,893.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$771.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.86
|
| Rate for Payer: PHCS Commercial |
$3,703.30
|
| Rate for Payer: United Healthcare All Payer |
$3,394.69
|
|
|
PLATE NARROW 4.5*52 2H
|
Facility
|
IP
|
$1,829.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.79 |
| Max. Negotiated Rate |
$1,755.98 |
| Rate for Payer: Aetna Commercial |
$1,408.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,426.74
|
| Rate for Payer: Cash Price |
$914.58
|
| Rate for Payer: Cigna Commercial |
$1,518.19
|
| Rate for Payer: First Health Commercial |
$1,737.69
|
| Rate for Payer: Humana Commercial |
$1,554.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,499.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,609.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,371.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.04
|
| Rate for Payer: PHCS Commercial |
$1,755.98
|
| Rate for Payer: United Healthcare All Payer |
$1,609.65
|
|
|
PLATE NARROW 4.5*52 2H
|
Facility
|
OP
|
$1,829.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.79 |
| Max. Negotiated Rate |
$1,755.98 |
| Rate for Payer: Aetna Commercial |
$1,408.45
|
| Rate for Payer: Anthem Medicaid |
$629.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,426.74
|
| Rate for Payer: Cash Price |
$914.58
|
| Rate for Payer: Cigna Commercial |
$1,518.19
|
| Rate for Payer: First Health Commercial |
$1,737.69
|
| Rate for Payer: Humana Commercial |
$1,554.78
|
| Rate for Payer: Humana KY Medicaid |
$629.04
|
| Rate for Payer: Kentucky WC Medicaid |
$635.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,499.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$641.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,609.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,371.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.04
|
| Rate for Payer: PHCS Commercial |
$1,755.98
|
| Rate for Payer: United Healthcare All Payer |
$1,609.65
|
|
|
PLATE NARROW 4.5*70 3H
|
Facility
|
IP
|
$1,829.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.79 |
| Max. Negotiated Rate |
$1,755.98 |
| Rate for Payer: Aetna Commercial |
$1,408.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,426.74
|
| Rate for Payer: Cash Price |
$914.58
|
| Rate for Payer: Cigna Commercial |
$1,518.19
|
| Rate for Payer: First Health Commercial |
$1,737.69
|
| Rate for Payer: Humana Commercial |
$1,554.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,499.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,609.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,371.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.04
|
| Rate for Payer: PHCS Commercial |
$1,755.98
|
| Rate for Payer: United Healthcare All Payer |
$1,609.65
|
|
|
PLATE NARROW 4.5*70 3H
|
Facility
|
OP
|
$1,829.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.79 |
| Max. Negotiated Rate |
$1,755.98 |
| Rate for Payer: Aetna Commercial |
$1,408.45
|
| Rate for Payer: Anthem Medicaid |
$629.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,426.74
|
| Rate for Payer: Cash Price |
$914.58
|
| Rate for Payer: Cigna Commercial |
$1,518.19
|
| Rate for Payer: First Health Commercial |
$1,737.69
|
| Rate for Payer: Humana Commercial |
$1,554.78
|
| Rate for Payer: Humana KY Medicaid |
$629.04
|
| Rate for Payer: Kentucky WC Medicaid |
$635.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,499.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$641.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,609.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,371.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.04
|
| Rate for Payer: PHCS Commercial |
$1,755.98
|
| Rate for Payer: United Healthcare All Payer |
$1,609.65
|
|
|
PLATE NARROW 4.5*88 4H
|
Facility
|
OP
|
$1,829.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.79 |
| Max. Negotiated Rate |
$1,755.98 |
| Rate for Payer: Aetna Commercial |
$1,408.45
|
| Rate for Payer: Anthem Medicaid |
$629.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,426.74
|
| Rate for Payer: Cash Price |
$914.58
|
| Rate for Payer: Cigna Commercial |
$1,518.19
|
| Rate for Payer: First Health Commercial |
$1,737.69
|
| Rate for Payer: Humana Commercial |
$1,554.78
|
| Rate for Payer: Humana KY Medicaid |
$629.04
|
| Rate for Payer: Kentucky WC Medicaid |
$635.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,499.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$641.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,609.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,371.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.04
|
| Rate for Payer: PHCS Commercial |
$1,755.98
|
| Rate for Payer: United Healthcare All Payer |
$1,609.65
|
|
|
PLATE NARROW 4.5*88 4H
|
Facility
|
IP
|
$1,829.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.79 |
| Max. Negotiated Rate |
$1,755.98 |
| Rate for Payer: Aetna Commercial |
$1,408.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,426.74
|
| Rate for Payer: Cash Price |
$914.58
|
| Rate for Payer: Cigna Commercial |
$1,518.19
|
| Rate for Payer: First Health Commercial |
$1,737.69
|
| Rate for Payer: Humana Commercial |
$1,554.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,499.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,609.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,371.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.04
|
| Rate for Payer: PHCS Commercial |
$1,755.98
|
| Rate for Payer: United Healthcare All Payer |
$1,609.65
|
|
|
PLATE NARROW 4.5MM 10H 196MM
|
Facility
|
IP
|
$2,055.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.25 |
| Max. Negotiated Rate |
$1,973.55 |
| Rate for Payer: Aetna Commercial |
$1,582.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,603.51
|
| Rate for Payer: Cash Price |
$1,027.89
|
| Rate for Payer: Cigna Commercial |
$1,706.30
|
| Rate for Payer: First Health Commercial |
$1,952.99
|
| Rate for Payer: Humana Commercial |
$1,747.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,685.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,517.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,809.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.29
|
| Rate for Payer: PHCS Commercial |
$1,973.55
|
| Rate for Payer: United Healthcare All Payer |
$1,809.09
|
|
