|
PLATE NARROW 4.5MM 8H 160MM
|
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 8X135MM
|
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 8X135MM
|
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 9H 178MM
|
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 9H 178MM
|
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 9X151MM
|
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 9X151MM
|
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 CP 4.5MM 10X180MM
|
Facility
|
OP
|
$2,203.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.50 |
| Max. Negotiated Rate |
$2,115.67 |
| Rate for Payer: Humana Commercial |
$1,873.25
|
| Rate for Payer: Humana KY Medicaid |
$757.89
|
| Rate for Payer: Kentucky WC Medicaid |
$765.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,807.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,626.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$661.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$773.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,939.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,652.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$683.18
|
| Rate for Payer: PHCS Commercial |
$2,115.67
|
| Rate for Payer: United Healthcare All Payer |
$1,939.36
|
| Rate for Payer: Aetna Commercial |
$1,696.94
|
| Rate for Payer: Anthem Medicaid |
$757.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,718.98
|
| Rate for Payer: Cash Price |
$1,101.91
|
| Rate for Payer: Cigna Commercial |
$1,829.17
|
| Rate for Payer: First Health Commercial |
$2,093.63
|
|
|
PLATE NARROW CP 4.5MM 10X180MM
|
Facility
|
IP
|
$2,203.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.50 |
| Max. Negotiated Rate |
$2,115.67 |
| Rate for Payer: Aetna Commercial |
$1,696.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,718.98
|
| Rate for Payer: Cash Price |
$1,101.91
|
| Rate for Payer: Cigna Commercial |
$1,829.17
|
| Rate for Payer: First Health Commercial |
$2,093.63
|
| Rate for Payer: Humana Commercial |
$1,873.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,807.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,626.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$661.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,939.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,652.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$683.18
|
| Rate for Payer: PHCS Commercial |
$2,115.67
|
| Rate for Payer: United Healthcare All Payer |
$1,939.36
|
|
|
PLATE NARROW CP 4.5MM 11X198MM
|
Facility
|
IP
|
$2,203.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.50 |
| Max. Negotiated Rate |
$2,115.67 |
| Rate for Payer: Aetna Commercial |
$1,696.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,718.98
|
| Rate for Payer: Cash Price |
$1,101.91
|
| Rate for Payer: Cigna Commercial |
$1,829.17
|
| Rate for Payer: First Health Commercial |
$2,093.63
|
| Rate for Payer: Humana Commercial |
$1,873.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,807.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,626.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$661.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,939.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,652.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$683.18
|
| Rate for Payer: PHCS Commercial |
$2,115.67
|
| Rate for Payer: United Healthcare All Payer |
$1,939.36
|
|
|
PLATE NARROW CP 4.5MM 11X198MM
|
Facility
|
OP
|
$2,203.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.50 |
| Max. Negotiated Rate |
$2,115.67 |
| Rate for Payer: Aetna Commercial |
$1,696.94
|
| Rate for Payer: Anthem Medicaid |
$757.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,718.98
|
| Rate for Payer: Cash Price |
$1,101.91
|
| Rate for Payer: Cigna Commercial |
$1,829.17
|
| Rate for Payer: First Health Commercial |
$2,093.63
|
| Rate for Payer: Humana Commercial |
$1,873.25
|
| Rate for Payer: Humana KY Medicaid |
$757.89
|
| Rate for Payer: Kentucky WC Medicaid |
$765.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,807.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,626.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$661.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$773.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,939.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,652.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$683.18
|
| Rate for Payer: PHCS Commercial |
$2,115.67
|
| Rate for Payer: United Healthcare All Payer |
$1,939.36
|
|
|
PLATE NARROW CP 4.5MM 12X216MM
|
Facility
|
IP
|
$2,203.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.50 |
| Max. Negotiated Rate |
$2,115.67 |
| Rate for Payer: Aetna Commercial |
$1,696.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,718.98
|
| Rate for Payer: Cash Price |
$1,101.91
|
| Rate for Payer: Cigna Commercial |
$1,829.17
|
| Rate for Payer: First Health Commercial |
$2,093.63
|
| Rate for Payer: Humana Commercial |
$1,873.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,807.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,626.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$661.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,939.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,652.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$683.18
|
| Rate for Payer: PHCS Commercial |
$2,115.67
|
| Rate for Payer: United Healthcare All Payer |
$1,939.36
|
|
|
PLATE NARROW CP 4.5MM 12X216MM
|
Facility
|
OP
|
$2,203.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.50 |
| Max. Negotiated Rate |
$2,115.67 |
| Rate for Payer: Aetna Commercial |
$1,696.94
|
| Rate for Payer: Anthem Medicaid |
$757.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,718.98
|
| Rate for Payer: Cash Price |
$1,101.91
|
| Rate for Payer: Cigna Commercial |
$1,829.17
|
| Rate for Payer: First Health Commercial |
$2,093.63
|
| Rate for Payer: Humana Commercial |
$1,873.25
|
| Rate for Payer: Humana KY Medicaid |
$757.89
|
| Rate for Payer: Kentucky WC Medicaid |
$765.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,807.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,626.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$661.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$773.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,939.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,652.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$683.18
|
| Rate for Payer: PHCS Commercial |
$2,115.67
|
| Rate for Payer: United Healthcare All Payer |
$1,939.36
|
|
|
PLATE NARROW CP 4.5MM 13X234MM
|
Facility
|
IP
|
$3,434.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.43 |
| Max. Negotiated Rate |
$3,296.74 |
| Rate for Payer: Aetna Commercial |
$2,644.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,678.60
|
| Rate for Payer: Cash Price |
$1,717.05
|
| Rate for Payer: Cigna Commercial |
$2,850.30
|
| Rate for Payer: First Health Commercial |
$3,262.40
|
| Rate for Payer: Humana Commercial |
$2,918.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,815.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,534.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,030.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,022.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,575.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,064.57
|
| Rate for Payer: PHCS Commercial |
$3,296.74
|
| Rate for Payer: United Healthcare All Payer |
$3,022.01
|
|
|
PLATE NARROW CP 4.5MM 13X234MM
|
Facility
|
OP
|
$3,434.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.43 |
| Max. Negotiated Rate |
$3,296.74 |
| Rate for Payer: Aetna Commercial |
$2,644.26
|
| Rate for Payer: Anthem Medicaid |
$1,180.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,678.60
|
| Rate for Payer: Cash Price |
$1,717.05
|
| Rate for Payer: Cigna Commercial |
$2,850.30
|
| Rate for Payer: First Health Commercial |
$3,262.40
|
| Rate for Payer: Humana Commercial |
$2,918.98
|
| Rate for Payer: Humana KY Medicaid |
$1,180.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,193.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,815.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,534.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,030.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,204.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,022.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,575.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,064.57
|
| Rate for Payer: PHCS Commercial |
$3,296.74
|
| Rate for Payer: United Healthcare All Payer |
$3,022.01
|
|
|
PLATE NARROW CP 4.5MM 14X252MM
|
Facility
|
IP
|
$3,434.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.43 |
| Max. Negotiated Rate |
$3,296.74 |
| Rate for Payer: Aetna Commercial |
$2,644.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,678.60
|
| Rate for Payer: Cash Price |
$1,717.05
|
| Rate for Payer: Cigna Commercial |
$2,850.30
|
| Rate for Payer: First Health Commercial |
$3,262.40
|
| Rate for Payer: Humana Commercial |
$2,918.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,815.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,534.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,030.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,022.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,575.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,064.57
|
| Rate for Payer: PHCS Commercial |
$3,296.74
|
| Rate for Payer: United Healthcare All Payer |
$3,022.01
|
|
|
PLATE NARROW CP 4.5MM 14X252MM
|
Facility
|
OP
|
$3,434.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.43 |
| Max. Negotiated Rate |
$3,296.74 |
| Rate for Payer: Aetna Commercial |
$2,644.26
|
| Rate for Payer: Anthem Medicaid |
$1,180.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,678.60
|
| Rate for Payer: Cash Price |
$1,717.05
|
| Rate for Payer: Cigna Commercial |
$2,850.30
|
| Rate for Payer: First Health Commercial |
$3,262.40
|
| Rate for Payer: Humana Commercial |
$2,918.98
|
| Rate for Payer: Humana KY Medicaid |
$1,180.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,193.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,815.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,534.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,030.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,204.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,022.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,575.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,064.57
|
| Rate for Payer: PHCS Commercial |
$3,296.74
|
| Rate for Payer: United Healthcare All Payer |
$3,022.01
|
|
|
PLATE NARROW CP 4.5MM 16X288MM
|
Facility
|
OP
|
$3,505.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$455.76 |
| Max. Negotiated Rate |
$3,365.62 |
| Rate for Payer: Aetna Commercial |
$2,699.50
|
| Rate for Payer: Anthem Medicaid |
$1,205.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,734.56
|
| Rate for Payer: Cash Price |
$1,752.92
|
| Rate for Payer: Cigna Commercial |
$2,909.86
|
| Rate for Payer: First Health Commercial |
$3,330.56
|
| Rate for Payer: Humana Commercial |
$2,979.97
|
| Rate for Payer: Humana KY Medicaid |
$1,205.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,217.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,874.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,587.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,229.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,085.15
|
| Rate for Payer: Ohio Health Group HMO |
$2,629.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$701.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,086.81
|
| Rate for Payer: PHCS Commercial |
$3,365.62
|
| Rate for Payer: United Healthcare All Payer |
$3,085.15
|
|
|
PLATE NARROW CP 4.5MM 16X288MM
|
Facility
|
IP
|
$3,505.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$455.76 |
| Max. Negotiated Rate |
$3,365.62 |
| Rate for Payer: Aetna Commercial |
$2,699.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,734.56
|
| Rate for Payer: Cash Price |
$1,752.92
|
| Rate for Payer: Cigna Commercial |
$2,909.86
|
| Rate for Payer: First Health Commercial |
$3,330.56
|
| Rate for Payer: Humana Commercial |
$2,979.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,874.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,587.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,085.15
|
| Rate for Payer: Ohio Health Group HMO |
$2,629.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$701.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,086.81
|
| Rate for Payer: PHCS Commercial |
$3,365.62
|
| Rate for Payer: United Healthcare All Payer |
$3,085.15
|
|
|
PLATE NARROW CP 4.5MM 18X329MM
|
Facility
|
IP
|
$4,115.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.04 |
| Max. Negotiated Rate |
$3,951.10 |
| Rate for Payer: Aetna Commercial |
$3,169.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,210.27
|
| Rate for Payer: Cash Price |
$2,057.86
|
| Rate for Payer: Cigna Commercial |
$3,416.06
|
| Rate for Payer: First Health Commercial |
$3,909.94
|
| Rate for Payer: Humana Commercial |
$3,498.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,374.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,037.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,234.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,621.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,086.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$823.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,275.88
|
| Rate for Payer: PHCS Commercial |
$3,951.10
|
| Rate for Payer: United Healthcare All Payer |
$3,621.84
|
|
|
PLATE NARROW CP 4.5MM 18X329MM
|
Facility
|
OP
|
$4,115.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.04 |
| Max. Negotiated Rate |
$3,951.10 |
| Rate for Payer: Aetna Commercial |
$3,169.11
|
| Rate for Payer: Anthem Medicaid |
$1,415.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,210.27
|
| Rate for Payer: Cash Price |
$2,057.86
|
| Rate for Payer: Cigna Commercial |
$3,416.06
|
| Rate for Payer: First Health Commercial |
$3,909.94
|
| Rate for Payer: Humana Commercial |
$3,498.37
|
| Rate for Payer: Humana KY Medicaid |
$1,415.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,429.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,374.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,037.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,234.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,443.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,621.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,086.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$823.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,275.88
|
| Rate for Payer: PHCS Commercial |
$3,951.10
|
| Rate for Payer: United Healthcare All Payer |
$3,621.84
|
|
|
PLATE NARROW CP 4.5MM 2X36MM
|
Facility
|
IP
|
$2,067.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.78 |
| Max. Negotiated Rate |
$1,984.80 |
| Rate for Payer: Aetna Commercial |
$1,591.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,612.65
|
| Rate for Payer: Cash Price |
$1,033.75
|
| Rate for Payer: Cigna Commercial |
$1,716.02
|
| Rate for Payer: First Health Commercial |
$1,964.12
|
| Rate for Payer: Humana Commercial |
$1,757.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,695.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,525.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$620.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,819.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,550.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$413.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$640.92
|
| Rate for Payer: PHCS Commercial |
$1,984.80
|
| Rate for Payer: United Healthcare All Payer |
$1,819.40
|
|
|
PLATE NARROW CP 4.5MM 2X36MM
|
Facility
|
OP
|
$2,067.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.78 |
| Max. Negotiated Rate |
$1,984.80 |
| Rate for Payer: Aetna Commercial |
$1,591.98
|
| Rate for Payer: Anthem Medicaid |
$711.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,612.65
|
| Rate for Payer: Cash Price |
$1,033.75
|
| Rate for Payer: Cigna Commercial |
$1,716.02
|
| Rate for Payer: First Health Commercial |
$1,964.12
|
| Rate for Payer: Humana Commercial |
$1,757.38
|
| Rate for Payer: Humana KY Medicaid |
$711.01
|
| Rate for Payer: Kentucky WC Medicaid |
$718.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,695.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,525.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$620.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$725.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,819.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,550.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$413.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$640.92
|
| Rate for Payer: PHCS Commercial |
$1,984.80
|
| Rate for Payer: United Healthcare All Payer |
$1,819.40
|
|
|
PLATE NARROW CP 4.5MM 3X54MM
|
Facility
|
IP
|
$1,931.17
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.05 |
| Max. Negotiated Rate |
$1,853.92 |
| Rate for Payer: Aetna Commercial |
$1,487.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.31
|
| Rate for Payer: Cash Price |
$965.59
|
| Rate for Payer: Cigna Commercial |
$1,602.87
|
| Rate for Payer: First Health Commercial |
$1,834.61
|
| Rate for Payer: Humana Commercial |
$1,641.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.43
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.66
|
| Rate for Payer: PHCS Commercial |
$1,853.92
|
| Rate for Payer: United Healthcare All Payer |
$1,699.43
|
|
|
PLATE NARROW CP 4.5MM 3X54MM
|
Facility
|
OP
|
$1,931.17
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.05 |
| Max. Negotiated Rate |
$1,853.92 |
| Rate for Payer: Aetna Commercial |
$1,487.00
|
| Rate for Payer: Anthem Medicaid |
$664.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.31
|
| Rate for Payer: Cash Price |
$965.59
|
| Rate for Payer: Cigna Commercial |
$1,602.87
|
| Rate for Payer: First Health Commercial |
$1,834.61
|
| Rate for Payer: Humana Commercial |
$1,641.49
|
| Rate for Payer: Humana KY Medicaid |
$664.13
|
| Rate for Payer: Kentucky WC Medicaid |
$670.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.43
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.66
|
| Rate for Payer: PHCS Commercial |
$1,853.92
|
| Rate for Payer: United Healthcare All Payer |
$1,699.43
|
|
