|
PLATE NARROW 4.5MM 10H 196MM
|
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: 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
|
| 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
|
|
|
PLATE NARROW 4.5MM 10X167MM
|
Facility
|
IP
|
$1,967.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.72 |
| Max. Negotiated Rate |
$1,888.37 |
| Rate for Payer: Aetna Commercial |
$1,514.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,534.30
|
| Rate for Payer: Cash Price |
$983.52
|
| Rate for Payer: Cigna Commercial |
$1,632.65
|
| Rate for Payer: First Health Commercial |
$1,868.70
|
| Rate for Payer: Humana Commercial |
$1,671.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,612.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,451.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,731.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,475.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.79
|
| Rate for Payer: PHCS Commercial |
$1,888.37
|
| Rate for Payer: United Healthcare All Payer |
$1,731.00
|
|
|
PLATE NARROW 4.5MM 10X167MM
|
Facility
|
OP
|
$1,967.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.72 |
| Max. Negotiated Rate |
$1,888.37 |
| Rate for Payer: Aetna Commercial |
$1,514.63
|
| Rate for Payer: Anthem Medicaid |
$676.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,534.30
|
| Rate for Payer: Cash Price |
$983.52
|
| Rate for Payer: Cigna Commercial |
$1,632.65
|
| Rate for Payer: First Health Commercial |
$1,868.70
|
| Rate for Payer: Humana Commercial |
$1,671.99
|
| Rate for Payer: Humana KY Medicaid |
$676.47
|
| Rate for Payer: Kentucky WC Medicaid |
$683.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,612.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,451.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$690.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,731.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,475.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.79
|
| Rate for Payer: PHCS Commercial |
$1,888.37
|
| Rate for Payer: United Healthcare All Payer |
$1,731.00
|
|
|
PLATE NARROW 4.5MM 11H 214MM
|
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 4.5MM 11H 214MM
|
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 4.5MM 11X183MM
|
Facility
|
IP
|
$2,160.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.90 |
| Max. Negotiated Rate |
$2,074.35 |
| Rate for Payer: Aetna Commercial |
$1,663.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,685.41
|
| Rate for Payer: Cash Price |
$1,080.39
|
| Rate for Payer: Cigna Commercial |
$1,793.45
|
| Rate for Payer: First Health Commercial |
$2,052.74
|
| Rate for Payer: Humana Commercial |
$1,836.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,771.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,594.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$648.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,901.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,620.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.84
|
| Rate for Payer: PHCS Commercial |
$2,074.35
|
| Rate for Payer: United Healthcare All Payer |
$1,901.49
|
|
|
PLATE NARROW 4.5MM 11X183MM
|
Facility
|
OP
|
$2,160.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.90 |
| Max. Negotiated Rate |
$2,074.35 |
| Rate for Payer: Aetna Commercial |
$1,663.80
|
| Rate for Payer: Anthem Medicaid |
$743.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,685.41
|
| Rate for Payer: Cash Price |
$1,080.39
|
| Rate for Payer: Cigna Commercial |
$1,793.45
|
| Rate for Payer: First Health Commercial |
$2,052.74
|
| Rate for Payer: Humana Commercial |
$1,836.66
|
| Rate for Payer: Humana KY Medicaid |
$743.09
|
| Rate for Payer: Kentucky WC Medicaid |
$750.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,771.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,594.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$648.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$758.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,901.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,620.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.84
|
| Rate for Payer: PHCS Commercial |
$2,074.35
|
| Rate for Payer: United Healthcare All Payer |
$1,901.49
|
|
|
PLATE NARROW 4.5MM 12H 232MM
|
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 4.5MM 12H 232MM
|
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 4.5MM 12X199MM
|
Facility
|
OP
|
$2,160.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.90 |
| Max. Negotiated Rate |
$2,074.35 |
| Rate for Payer: Aetna Commercial |
$1,663.80
|
| Rate for Payer: Anthem Medicaid |
$743.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,685.41
|
| Rate for Payer: Cash Price |
$1,080.39
|
| Rate for Payer: Cigna Commercial |
$1,793.45
|
| Rate for Payer: First Health Commercial |
$2,052.74
|
| Rate for Payer: Humana Commercial |
$1,836.66
|
| Rate for Payer: Humana KY Medicaid |
$743.09
|
| Rate for Payer: Kentucky WC Medicaid |
$750.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,771.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,594.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$648.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$758.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,901.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,620.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.84
|
| Rate for Payer: PHCS Commercial |
$2,074.35
|
| Rate for Payer: United Healthcare All Payer |
$1,901.49
|
|
|
PLATE NARROW 4.5MM 12X199MM
|
Facility
|
IP
|
$2,160.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.90 |
| Max. Negotiated Rate |
$2,074.35 |
| Rate for Payer: Aetna Commercial |
$1,663.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,685.41
|
| Rate for Payer: Cash Price |
$1,080.39
|
| Rate for Payer: Cigna Commercial |
$1,793.45
|
| Rate for Payer: First Health Commercial |
$2,052.74
|
| Rate for Payer: Humana Commercial |
$1,836.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,771.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,594.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$648.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,901.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,620.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.84
|
| Rate for Payer: PHCS Commercial |
$2,074.35
|
| Rate for Payer: United Healthcare All Payer |
$1,901.49
|
|
|
PLATE NARROW 4.5MM 13X215MM
|
Facility
|
IP
|
$2,160.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.90 |
| Max. Negotiated Rate |
$2,074.35 |
| Rate for Payer: Aetna Commercial |
$1,663.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,685.41
|
| Rate for Payer: Cash Price |
$1,080.39
|
| Rate for Payer: Cigna Commercial |
$1,793.45
|
| Rate for Payer: First Health Commercial |
$2,052.74
|
| Rate for Payer: Humana Commercial |
$1,836.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,771.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,594.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$648.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,901.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,620.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.84
|
| Rate for Payer: PHCS Commercial |
$2,074.35
|
| Rate for Payer: United Healthcare All Payer |
$1,901.49
|
|
|
PLATE NARROW 4.5MM 13X215MM
|
Facility
|
OP
|
$2,160.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.90 |
| Max. Negotiated Rate |
$2,074.35 |
| Rate for Payer: Aetna Commercial |
$1,663.80
|
| Rate for Payer: Anthem Medicaid |
$743.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,685.41
|
| Rate for Payer: Cash Price |
$1,080.39
|
| Rate for Payer: Cigna Commercial |
$1,793.45
|
| Rate for Payer: First Health Commercial |
$2,052.74
|
| Rate for Payer: Humana Commercial |
$1,836.66
|
| Rate for Payer: Humana KY Medicaid |
$743.09
|
| Rate for Payer: Kentucky WC Medicaid |
$750.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,771.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,594.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$648.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$758.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,901.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,620.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.84
|
| Rate for Payer: PHCS Commercial |
$2,074.35
|
| Rate for Payer: United Healthcare All Payer |
$1,901.49
|
|
|
PLATE NARROW 4.5MM 14X231MM
|
Facility
|
IP
|
$3,348.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$435.24 |
| Max. Negotiated Rate |
$3,214.08 |
| Rate for Payer: Aetna Commercial |
$2,577.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,611.44
|
| Rate for Payer: Cash Price |
$1,674.00
|
| Rate for Payer: Cigna Commercial |
$2,778.84
|
| Rate for Payer: First Health Commercial |
$3,180.60
|
| Rate for Payer: Humana Commercial |
$2,845.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,745.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,470.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,004.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,946.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,511.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,037.88
|
| Rate for Payer: PHCS Commercial |
$3,214.08
|
| Rate for Payer: United Healthcare All Payer |
$2,946.24
|
|
|
PLATE NARROW 4.5MM 14X231MM
|
Facility
|
OP
|
$3,348.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$435.24 |
| Max. Negotiated Rate |
$3,214.08 |
| Rate for Payer: Aetna Commercial |
$2,577.96
|
| Rate for Payer: Anthem Medicaid |
$1,151.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,611.44
|
| Rate for Payer: Cash Price |
$1,674.00
|
| Rate for Payer: Cigna Commercial |
$2,778.84
|
| Rate for Payer: First Health Commercial |
$3,180.60
|
| Rate for Payer: Humana Commercial |
$2,845.80
|
| Rate for Payer: Humana KY Medicaid |
$1,151.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,163.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,745.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,470.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,004.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,174.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,946.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,511.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,037.88
|
| Rate for Payer: PHCS Commercial |
$3,214.08
|
| Rate for Payer: United Healthcare All Payer |
$2,946.24
|
|
|
PLATE NARROW 4.5MM 15X247MM
|
Facility
|
OP
|
$3,412.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$443.63 |
| Max. Negotiated Rate |
$3,276.07 |
| Rate for Payer: Aetna Commercial |
$2,627.68
|
| Rate for Payer: Anthem Medicaid |
$1,173.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,661.80
|
| Rate for Payer: Cash Price |
$1,706.29
|
| Rate for Payer: Cigna Commercial |
$2,832.43
|
| Rate for Payer: First Health Commercial |
$3,241.94
|
| Rate for Payer: Humana Commercial |
$2,900.68
|
| Rate for Payer: Humana KY Medicaid |
$1,173.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,185.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,798.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,518.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,197.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,003.06
|
| Rate for Payer: Ohio Health Group HMO |
$2,559.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$682.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$443.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,057.90
|
| Rate for Payer: PHCS Commercial |
$3,276.07
|
| Rate for Payer: United Healthcare All Payer |
$3,003.06
|
|
|
PLATE NARROW 4.5MM 15X247MM
|
Facility
|
IP
|
$3,412.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$443.63 |
| Max. Negotiated Rate |
$3,276.07 |
| Rate for Payer: Aetna Commercial |
$2,627.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,661.80
|
| Rate for Payer: Cash Price |
$1,706.29
|
| Rate for Payer: Cigna Commercial |
$2,832.43
|
| Rate for Payer: First Health Commercial |
$3,241.94
|
| Rate for Payer: Humana Commercial |
$2,900.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,798.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,518.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,003.06
|
| Rate for Payer: Ohio Health Group HMO |
$2,559.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$682.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$443.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,057.90
|
| Rate for Payer: PHCS Commercial |
$3,276.07
|
| Rate for Payer: United Healthcare All Payer |
$3,003.06
|
|
|
PLATE NARROW 4.5MM 16X263MM
|
Facility
|
OP
|
$3,412.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$443.63 |
| Max. Negotiated Rate |
$3,276.07 |
| Rate for Payer: Anthem Medicaid |
$1,173.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,661.80
|
| Rate for Payer: Cash Price |
$1,706.29
|
| Rate for Payer: Cigna Commercial |
$2,832.43
|
| Rate for Payer: First Health Commercial |
$3,241.94
|
| Rate for Payer: Humana Commercial |
$2,900.68
|
| Rate for Payer: Humana KY Medicaid |
$1,173.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,185.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,798.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,518.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,197.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,003.06
|
| Rate for Payer: Ohio Health Group HMO |
$2,559.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$682.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$443.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,057.90
|
| Rate for Payer: PHCS Commercial |
$3,276.07
|
| Rate for Payer: United Healthcare All Payer |
$3,003.06
|
| Rate for Payer: Aetna Commercial |
$2,627.68
|
|
|
PLATE NARROW 4.5MM 16X263MM
|
Facility
|
IP
|
$3,412.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$443.63 |
| Max. Negotiated Rate |
$3,276.07 |
| Rate for Payer: Aetna Commercial |
$2,627.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,661.80
|
| Rate for Payer: Cash Price |
$1,706.29
|
| Rate for Payer: Cigna Commercial |
$2,832.43
|
| Rate for Payer: First Health Commercial |
$3,241.94
|
| Rate for Payer: Humana Commercial |
$2,900.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,798.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,518.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,003.06
|
| Rate for Payer: Ohio Health Group HMO |
$2,559.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$682.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$443.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,057.90
|
| Rate for Payer: PHCS Commercial |
$3,276.07
|
| Rate for Payer: United Healthcare All Payer |
$3,003.06
|
|
|
PLATE NARROW 4.5MM 18X295MM
|
Facility
|
OP
|
$3,936.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.73 |
| Max. Negotiated Rate |
$3,778.90 |
| Rate for Payer: Aetna Commercial |
$3,030.99
|
| Rate for Payer: Anthem Medicaid |
$1,353.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,070.35
|
| Rate for Payer: Cash Price |
$1,968.17
|
| Rate for Payer: Cigna Commercial |
$3,267.17
|
| Rate for Payer: First Health Commercial |
$3,739.53
|
| Rate for Payer: Humana Commercial |
$3,345.90
|
| Rate for Payer: Humana KY Medicaid |
$1,353.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,367.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,227.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,180.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,380.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,463.99
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$787.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,220.27
|
| Rate for Payer: PHCS Commercial |
$3,778.90
|
| Rate for Payer: United Healthcare All Payer |
$3,463.99
|
|
|
PLATE NARROW 4.5MM 18X295MM
|
Facility
|
IP
|
$3,936.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.73 |
| Max. Negotiated Rate |
$3,778.90 |
| Rate for Payer: Aetna Commercial |
$3,030.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,070.35
|
| Rate for Payer: Cash Price |
$1,968.17
|
| Rate for Payer: Cigna Commercial |
$3,267.17
|
| Rate for Payer: First Health Commercial |
$3,739.53
|
| Rate for Payer: Humana Commercial |
$3,345.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,227.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,180.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,463.99
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$787.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,220.27
|
| Rate for Payer: PHCS Commercial |
$3,778.90
|
| Rate for Payer: United Healthcare All Payer |
$3,463.99
|
|
|
PLATE NARROW 4.5MM 20X326MM
|
Facility
|
OP
|
$3,764.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.34 |
| Max. Negotiated Rate |
$3,613.58 |
| Rate for Payer: Aetna Commercial |
$2,898.40
|
| Rate for Payer: Anthem Medicaid |
$1,294.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,936.04
|
| Rate for Payer: Cash Price |
$1,882.08
|
| Rate for Payer: Cigna Commercial |
$3,124.24
|
| Rate for Payer: First Health Commercial |
$3,575.94
|
| Rate for Payer: Humana Commercial |
$3,199.53
|
| Rate for Payer: Humana KY Medicaid |
$1,294.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,307.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,086.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,777.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,129.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,320.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,312.45
|
| Rate for Payer: Ohio Health Group HMO |
$2,823.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$489.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,166.89
|
| Rate for Payer: PHCS Commercial |
$3,613.58
|
| Rate for Payer: United Healthcare All Payer |
$3,312.45
|
|
|
PLATE NARROW 4.5MM 20X326MM
|
Facility
|
IP
|
$3,764.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.34 |
| Max. Negotiated Rate |
$3,613.58 |
| Rate for Payer: Aetna Commercial |
$2,898.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,936.04
|
| Rate for Payer: Cash Price |
$1,882.08
|
| Rate for Payer: Cigna Commercial |
$3,124.24
|
| Rate for Payer: First Health Commercial |
$3,575.94
|
| Rate for Payer: Humana Commercial |
$3,199.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,086.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,777.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,129.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,312.45
|
| Rate for Payer: Ohio Health Group HMO |
$2,823.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$489.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,166.89
|
| Rate for Payer: PHCS Commercial |
$3,613.58
|
| Rate for Payer: United Healthcare All Payer |
$3,312.45
|
|
|
PLATE NARROW 4.5MM 22X358MM
|
Facility
|
OP
|
$4,309.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.23 |
| Max. Negotiated Rate |
$4,137.07 |
| Rate for Payer: Aetna Commercial |
$3,318.28
|
| Rate for Payer: Anthem Medicaid |
$1,482.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,361.37
|
| Rate for Payer: Cash Price |
$2,154.72
|
| Rate for Payer: Cigna Commercial |
$3,576.84
|
| Rate for Payer: First Health Commercial |
$4,093.98
|
| Rate for Payer: Humana Commercial |
$3,663.03
|
| Rate for Payer: Humana KY Medicaid |
$1,482.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,497.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,180.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,292.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,511.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,792.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,232.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$861.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,335.93
|
| Rate for Payer: PHCS Commercial |
$4,137.07
|
| Rate for Payer: United Healthcare All Payer |
$3,792.32
|
|
|
PLATE NARROW 4.5MM 22X358MM
|
Facility
|
IP
|
$4,309.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.23 |
| Max. Negotiated Rate |
$4,137.07 |
| Rate for Payer: Aetna Commercial |
$3,318.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,361.37
|
| Rate for Payer: Cash Price |
$2,154.72
|
| Rate for Payer: Cigna Commercial |
$3,576.84
|
| Rate for Payer: First Health Commercial |
$4,093.98
|
| Rate for Payer: Humana Commercial |
$3,663.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,180.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,292.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,792.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,232.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$861.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,335.93
|
| Rate for Payer: PHCS Commercial |
$4,137.07
|
| Rate for Payer: United Healthcare All Payer |
$3,792.32
|
|
