|
PLATE NARROW 4.5MM 24X390MM
|
Facility
|
IP
|
$4,481.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.61 |
| Max. Negotiated Rate |
$4,302.38 |
| Rate for Payer: Aetna Commercial |
$3,450.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,495.69
|
| Rate for Payer: Cash Price |
$2,240.82
|
| Rate for Payer: Cigna Commercial |
$3,719.77
|
| Rate for Payer: First Health Commercial |
$4,257.57
|
| Rate for Payer: Humana Commercial |
$3,809.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,674.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,307.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,344.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,943.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,361.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,389.31
|
| Rate for Payer: PHCS Commercial |
$4,302.38
|
| Rate for Payer: United Healthcare All Payer |
$3,943.85
|
|
|
PLATE NARROW 4.5MM 24X390MM
|
Facility
|
OP
|
$4,481.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.61 |
| Max. Negotiated Rate |
$4,302.38 |
| Rate for Payer: Aetna Commercial |
$3,450.87
|
| Rate for Payer: Anthem Medicaid |
$1,541.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,495.69
|
| Rate for Payer: Cash Price |
$2,240.82
|
| Rate for Payer: Cigna Commercial |
$3,719.77
|
| Rate for Payer: First Health Commercial |
$4,257.57
|
| Rate for Payer: Humana Commercial |
$3,809.40
|
| Rate for Payer: Humana KY Medicaid |
$1,541.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,556.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,674.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,307.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,344.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,572.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,943.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,361.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,389.31
|
| Rate for Payer: PHCS Commercial |
$4,302.38
|
| Rate for Payer: United Healthcare All Payer |
$3,943.85
|
|
|
PLATE NARROW 4.5MM 2X39MM
|
Facility
|
IP
|
$1,880.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.52 |
| Max. Negotiated Rate |
$1,805.71 |
| Rate for Payer: Aetna Commercial |
$1,448.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,467.14
|
| Rate for Payer: Cash Price |
$940.48
|
| Rate for Payer: Cigna Commercial |
$1,561.19
|
| Rate for Payer: First Health Commercial |
$1,786.90
|
| Rate for Payer: Humana Commercial |
$1,598.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,542.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,388.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,655.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,410.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$376.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$583.09
|
| Rate for Payer: PHCS Commercial |
$1,805.71
|
| Rate for Payer: United Healthcare All Payer |
$1,655.24
|
|
|
PLATE NARROW 4.5MM 2X39MM
|
Facility
|
OP
|
$1,880.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.52 |
| Max. Negotiated Rate |
$1,805.71 |
| Rate for Payer: Aetna Commercial |
$1,448.33
|
| Rate for Payer: Anthem Medicaid |
$646.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,467.14
|
| Rate for Payer: Cash Price |
$940.48
|
| Rate for Payer: Cigna Commercial |
$1,561.19
|
| Rate for Payer: First Health Commercial |
$1,786.90
|
| Rate for Payer: Humana Commercial |
$1,598.81
|
| Rate for Payer: Humana KY Medicaid |
$646.86
|
| Rate for Payer: Kentucky WC Medicaid |
$653.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,542.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,388.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$659.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,655.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,410.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$376.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$583.09
|
| Rate for Payer: PHCS Commercial |
$1,805.71
|
| Rate for Payer: United Healthcare All Payer |
$1,655.24
|
|
|
PLATE NARROW 4.5MM 3H 70MM
|
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 4.5MM 3H 70MM
|
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 3X55MM
|
Facility
|
IP
|
$1,902.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.32 |
| Max. Negotiated Rate |
$1,826.37 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,560.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,404.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,674.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,426.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.77
|
| Rate for Payer: PHCS Commercial |
$1,826.37
|
| Rate for Payer: United Healthcare All Payer |
$1,674.17
|
| Rate for Payer: Aetna Commercial |
$1,464.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,483.93
|
| Rate for Payer: Cash Price |
$951.24
|
| Rate for Payer: Cigna Commercial |
$1,579.05
|
| Rate for Payer: First Health Commercial |
$1,807.35
|
| Rate for Payer: Humana Commercial |
$1,617.10
|
|
|
PLATE NARROW 4.5MM 3X55MM
|
Facility
|
OP
|
$1,902.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.32 |
| Max. Negotiated Rate |
$1,826.37 |
| Rate for Payer: Aetna Commercial |
$1,464.90
|
| Rate for Payer: Anthem Medicaid |
$654.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,483.93
|
| Rate for Payer: Cash Price |
$951.24
|
| Rate for Payer: Cigna Commercial |
$1,579.05
|
| Rate for Payer: First Health Commercial |
$1,807.35
|
| Rate for Payer: Humana Commercial |
$1,617.10
|
| Rate for Payer: Humana KY Medicaid |
$654.26
|
| Rate for Payer: Kentucky WC Medicaid |
$660.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,560.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,404.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$667.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,674.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,426.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.77
|
| Rate for Payer: PHCS Commercial |
$1,826.37
|
| Rate for Payer: United Healthcare All Payer |
$1,674.17
|
|
|
PLATE NARROW 4.5MM 4H 88MM
|
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 4H 88MM
|
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 4.5MM 4X71MM
|
Facility
|
OP
|
$1,902.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.32 |
| Max. Negotiated Rate |
$1,826.37 |
| Rate for Payer: Aetna Commercial |
$1,464.90
|
| Rate for Payer: Anthem Medicaid |
$654.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,483.93
|
| Rate for Payer: Cash Price |
$951.24
|
| Rate for Payer: Cigna Commercial |
$1,579.05
|
| Rate for Payer: First Health Commercial |
$1,807.35
|
| Rate for Payer: Humana Commercial |
$1,617.10
|
| Rate for Payer: Humana KY Medicaid |
$654.26
|
| Rate for Payer: Kentucky WC Medicaid |
$660.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,560.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,404.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$667.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,674.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,426.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.77
|
| Rate for Payer: PHCS Commercial |
$1,826.37
|
| Rate for Payer: United Healthcare All Payer |
$1,674.17
|
|
|
PLATE NARROW 4.5MM 4X71MM
|
Facility
|
IP
|
$1,902.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.32 |
| Max. Negotiated Rate |
$1,826.37 |
| Rate for Payer: Aetna Commercial |
$1,464.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,483.93
|
| Rate for Payer: Cash Price |
$951.24
|
| Rate for Payer: Cigna Commercial |
$1,579.05
|
| Rate for Payer: First Health Commercial |
$1,807.35
|
| Rate for Payer: Humana Commercial |
$1,617.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,560.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,404.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,674.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,426.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.77
|
| Rate for Payer: PHCS Commercial |
$1,826.37
|
| Rate for Payer: United Healthcare All Payer |
$1,674.17
|
|
|
PLATE NARROW 4.5MM 5H 106MM
|
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 4.5MM 5H 106MM
|
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 5X87MM
|
Facility
|
IP
|
$1,902.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.32 |
| Max. Negotiated Rate |
$1,826.37 |
| Rate for Payer: Aetna Commercial |
$1,464.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,483.93
|
| Rate for Payer: Cash Price |
$951.24
|
| Rate for Payer: Cigna Commercial |
$1,579.05
|
| Rate for Payer: First Health Commercial |
$1,807.35
|
| Rate for Payer: Humana Commercial |
$1,617.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,560.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,404.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,674.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,426.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.77
|
| Rate for Payer: PHCS Commercial |
$1,826.37
|
| Rate for Payer: United Healthcare All Payer |
$1,674.17
|
|
|
PLATE NARROW 4.5MM 5X87MM
|
Facility
|
OP
|
$1,902.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.32 |
| Max. Negotiated Rate |
$1,826.37 |
| Rate for Payer: Kentucky WC Medicaid |
$660.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,560.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,404.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$667.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,674.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,426.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.77
|
| Rate for Payer: PHCS Commercial |
$1,826.37
|
| Rate for Payer: United Healthcare All Payer |
$1,674.17
|
| Rate for Payer: Aetna Commercial |
$1,464.90
|
| Rate for Payer: Anthem Medicaid |
$654.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,483.93
|
| Rate for Payer: Cash Price |
$951.24
|
| Rate for Payer: Cigna Commercial |
$1,579.05
|
| Rate for Payer: First Health Commercial |
$1,807.35
|
| Rate for Payer: Humana Commercial |
$1,617.10
|
| Rate for Payer: Humana KY Medicaid |
$654.26
|
|
|
PLATE NARROW 4.5MM 6H 124MM
|
Facility
|
IP
|
$1,887.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.36 |
| Max. Negotiated Rate |
$1,811.92 |
| Rate for Payer: Aetna Commercial |
$1,453.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.19
|
| Rate for Payer: Cash Price |
$943.71
|
| Rate for Payer: Cigna Commercial |
$1,566.56
|
| Rate for Payer: First Health Commercial |
$1,793.05
|
| Rate for Payer: Humana Commercial |
$1,604.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,547.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,392.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,660.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,415.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.10
|
| Rate for Payer: PHCS Commercial |
$1,811.92
|
| Rate for Payer: United Healthcare All Payer |
$1,660.93
|
|
|
PLATE NARROW 4.5MM 6H 124MM
|
Facility
|
OP
|
$1,887.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.36 |
| Max. Negotiated Rate |
$1,811.92 |
| Rate for Payer: Aetna Commercial |
$1,453.31
|
| Rate for Payer: Anthem Medicaid |
$649.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.19
|
| Rate for Payer: Cash Price |
$943.71
|
| Rate for Payer: Cigna Commercial |
$1,566.56
|
| Rate for Payer: First Health Commercial |
$1,793.05
|
| Rate for Payer: Humana Commercial |
$1,604.31
|
| Rate for Payer: Humana KY Medicaid |
$649.08
|
| Rate for Payer: Kentucky WC Medicaid |
$655.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,547.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,392.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,660.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,415.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.10
|
| Rate for Payer: PHCS Commercial |
$1,811.92
|
| Rate for Payer: United Healthcare All Payer |
$1,660.93
|
|
|
PLATE NARROW 4.5MM 6X103MM
|
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 6X103MM
|
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 7H 142MM
|
Facility
|
IP
|
$1,887.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.36 |
| Max. Negotiated Rate |
$1,811.92 |
| Rate for Payer: Aetna Commercial |
$1,453.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.19
|
| Rate for Payer: Cash Price |
$943.71
|
| Rate for Payer: Cigna Commercial |
$1,566.56
|
| Rate for Payer: First Health Commercial |
$1,793.05
|
| Rate for Payer: Humana Commercial |
$1,604.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,547.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,392.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,660.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,415.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.10
|
| Rate for Payer: PHCS Commercial |
$1,811.92
|
| Rate for Payer: United Healthcare All Payer |
$1,660.93
|
|
|
PLATE NARROW 4.5MM 7H 142MM
|
Facility
|
OP
|
$1,887.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.36 |
| Max. Negotiated Rate |
$1,811.92 |
| Rate for Payer: Aetna Commercial |
$1,453.31
|
| Rate for Payer: Anthem Medicaid |
$649.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.19
|
| Rate for Payer: Cash Price |
$943.71
|
| Rate for Payer: Cigna Commercial |
$1,566.56
|
| Rate for Payer: First Health Commercial |
$1,793.05
|
| Rate for Payer: Humana Commercial |
$1,604.31
|
| Rate for Payer: Humana KY Medicaid |
$649.08
|
| Rate for Payer: Kentucky WC Medicaid |
$655.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,547.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,392.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,660.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,415.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.10
|
| Rate for Payer: PHCS Commercial |
$1,811.92
|
| Rate for Payer: United Healthcare All Payer |
$1,660.93
|
|
|
PLATE NARROW 4.5MM 7X119MM
|
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 7X119MM
|
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 8H 160MM
|
Facility
|
IP
|
$1,887.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.36 |
| Max. Negotiated Rate |
$1,811.92 |
| Rate for Payer: Humana Commercial |
$1,604.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,547.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,392.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,660.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,415.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.10
|
| Rate for Payer: PHCS Commercial |
$1,811.92
|
| Rate for Payer: United Healthcare All Payer |
$1,660.93
|
| Rate for Payer: Aetna Commercial |
$1,453.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.19
|
| Rate for Payer: Cash Price |
$943.71
|
| Rate for Payer: Cigna Commercial |
$1,566.56
|
| Rate for Payer: First Health Commercial |
$1,793.05
|
|
