|
PLATE NARROW CP 4.5MM 4X72MM
|
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: 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
|
| Rate for Payer: Aetna Commercial |
$1,487.00
|
|
|
PLATE NARROW CP 4.5MM 4X72MM
|
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 5X90MM
|
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 5X90MM
|
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
|
|
|
PLATE NARROW CP 4.5MM 6X108MM
|
Facility
|
OP
|
$2,017.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.25 |
| Max. Negotiated Rate |
$1,936.59 |
| Rate for Payer: Aetna Commercial |
$1,553.31
|
| Rate for Payer: Anthem Medicaid |
$693.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,573.48
|
| Rate for Payer: Cash Price |
$1,008.64
|
| Rate for Payer: Cigna Commercial |
$1,674.34
|
| Rate for Payer: First Health Commercial |
$1,916.42
|
| Rate for Payer: Humana Commercial |
$1,714.69
|
| Rate for Payer: Humana KY Medicaid |
$693.74
|
| Rate for Payer: Kentucky WC Medicaid |
$700.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,654.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,488.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$707.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,775.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,512.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.36
|
| Rate for Payer: PHCS Commercial |
$1,936.59
|
| Rate for Payer: United Healthcare All Payer |
$1,775.21
|
|
|
PLATE NARROW CP 4.5MM 6X108MM
|
Facility
|
IP
|
$2,017.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.25 |
| Max. Negotiated Rate |
$1,936.59 |
| Rate for Payer: Aetna Commercial |
$1,553.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,573.48
|
| Rate for Payer: Cash Price |
$1,008.64
|
| Rate for Payer: Cigna Commercial |
$1,674.34
|
| Rate for Payer: First Health Commercial |
$1,916.42
|
| Rate for Payer: Humana Commercial |
$1,714.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,654.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,488.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,775.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,512.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.36
|
| Rate for Payer: PHCS Commercial |
$1,936.59
|
| Rate for Payer: United Healthcare All Payer |
$1,775.21
|
|
|
PLATE NARROW CP 4.5MM 7X126MM
|
Facility
|
IP
|
$2,017.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.25 |
| Max. Negotiated Rate |
$1,936.59 |
| Rate for Payer: Aetna Commercial |
$1,553.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,573.48
|
| Rate for Payer: Cash Price |
$1,008.64
|
| Rate for Payer: Cigna Commercial |
$1,674.34
|
| Rate for Payer: First Health Commercial |
$1,916.42
|
| Rate for Payer: Humana Commercial |
$1,714.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,654.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,488.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,775.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,512.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.36
|
| Rate for Payer: PHCS Commercial |
$1,936.59
|
| Rate for Payer: United Healthcare All Payer |
$1,775.21
|
|
|
PLATE NARROW CP 4.5MM 7X126MM
|
Facility
|
OP
|
$2,017.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.25 |
| Max. Negotiated Rate |
$1,936.59 |
| Rate for Payer: Aetna Commercial |
$1,553.31
|
| Rate for Payer: Anthem Medicaid |
$693.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,573.48
|
| Rate for Payer: Cash Price |
$1,008.64
|
| Rate for Payer: Cigna Commercial |
$1,674.34
|
| Rate for Payer: First Health Commercial |
$1,916.42
|
| Rate for Payer: Humana Commercial |
$1,714.69
|
| Rate for Payer: Humana KY Medicaid |
$693.74
|
| Rate for Payer: Kentucky WC Medicaid |
$700.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,654.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,488.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$707.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,775.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,512.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.36
|
| Rate for Payer: PHCS Commercial |
$1,936.59
|
| Rate for Payer: United Healthcare All Payer |
$1,775.21
|
|
|
PLATE NARROW CP 4.5MM 8X144MM
|
Facility
|
OP
|
$2,017.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.25 |
| Max. Negotiated Rate |
$1,936.59 |
| Rate for Payer: Aetna Commercial |
$1,553.31
|
| Rate for Payer: Anthem Medicaid |
$693.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,573.48
|
| Rate for Payer: Cash Price |
$1,008.64
|
| Rate for Payer: Cigna Commercial |
$1,674.34
|
| Rate for Payer: First Health Commercial |
$1,916.42
|
| Rate for Payer: Humana Commercial |
$1,714.69
|
| Rate for Payer: Humana KY Medicaid |
$693.74
|
| Rate for Payer: Kentucky WC Medicaid |
$700.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,654.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,488.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$707.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,775.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,512.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.36
|
| Rate for Payer: PHCS Commercial |
$1,936.59
|
| Rate for Payer: United Healthcare All Payer |
$1,775.21
|
|
|
PLATE NARROW CP 4.5MM 8X144MM
|
Facility
|
IP
|
$2,017.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.25 |
| Max. Negotiated Rate |
$1,936.59 |
| Rate for Payer: Aetna Commercial |
$1,553.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,573.48
|
| Rate for Payer: Cash Price |
$1,008.64
|
| Rate for Payer: Cigna Commercial |
$1,674.34
|
| Rate for Payer: First Health Commercial |
$1,916.42
|
| Rate for Payer: Humana Commercial |
$1,714.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,654.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,488.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,775.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,512.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.36
|
| Rate for Payer: PHCS Commercial |
$1,936.59
|
| Rate for Payer: United Healthcare All Payer |
$1,775.21
|
|
|
PLATE NARROW CP 4.5MM 9X162MM
|
Facility
|
IP
|
$2,017.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.25 |
| Max. Negotiated Rate |
$1,936.59 |
| Rate for Payer: Aetna Commercial |
$1,553.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,573.48
|
| Rate for Payer: Cash Price |
$1,008.64
|
| Rate for Payer: Cigna Commercial |
$1,674.34
|
| Rate for Payer: First Health Commercial |
$1,916.42
|
| Rate for Payer: Humana Commercial |
$1,714.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,654.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,488.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,775.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,512.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.36
|
| Rate for Payer: PHCS Commercial |
$1,936.59
|
| Rate for Payer: United Healthcare All Payer |
$1,775.21
|
|
|
PLATE NARROW CP 4.5MM 9X162MM
|
Facility
|
OP
|
$2,017.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.25 |
| Max. Negotiated Rate |
$1,936.59 |
| Rate for Payer: Aetna Commercial |
$1,553.31
|
| Rate for Payer: Anthem Medicaid |
$693.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,573.48
|
| Rate for Payer: Cash Price |
$1,008.64
|
| Rate for Payer: Cigna Commercial |
$1,674.34
|
| Rate for Payer: First Health Commercial |
$1,916.42
|
| Rate for Payer: Humana Commercial |
$1,714.69
|
| Rate for Payer: Humana KY Medicaid |
$693.74
|
| Rate for Payer: Kentucky WC Medicaid |
$700.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,654.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,488.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$707.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,775.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,512.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.36
|
| Rate for Payer: PHCS Commercial |
$1,936.59
|
| Rate for Payer: United Healthcare All Payer |
$1,775.21
|
|
|
PLATE NARROW LCK CMP 4.5 10H
|
Facility
|
IP
|
$3,516.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.08 |
| Max. Negotiated Rate |
$3,375.36 |
| Rate for Payer: Aetna Commercial |
$2,707.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,742.48
|
| Rate for Payer: Cash Price |
$1,758.00
|
| Rate for Payer: Cigna Commercial |
$2,918.28
|
| Rate for Payer: First Health Commercial |
$3,340.20
|
| Rate for Payer: Humana Commercial |
$2,988.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,883.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,594.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,054.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,094.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,637.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$703.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,089.96
|
| Rate for Payer: PHCS Commercial |
$3,375.36
|
| Rate for Payer: United Healthcare All Payer |
$3,094.08
|
|
|
PLATE NARROW LCK CMP 4.5 10H
|
Facility
|
OP
|
$3,516.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.08 |
| Max. Negotiated Rate |
$3,375.36 |
| Rate for Payer: Aetna Commercial |
$2,707.32
|
| Rate for Payer: Anthem Medicaid |
$1,209.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,742.48
|
| Rate for Payer: Cash Price |
$1,758.00
|
| Rate for Payer: Cigna Commercial |
$2,918.28
|
| Rate for Payer: First Health Commercial |
$3,340.20
|
| Rate for Payer: Humana Commercial |
$2,988.60
|
| Rate for Payer: Humana KY Medicaid |
$1,209.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,221.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,883.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,594.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,054.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,233.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,094.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,637.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$703.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,089.96
|
| Rate for Payer: PHCS Commercial |
$3,375.36
|
| Rate for Payer: United Healthcare All Payer |
$3,094.08
|
|
|
PLATE NARROW LCK CMP 4.5 12H
|
Facility
|
OP
|
$3,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.20 |
| Max. Negotiated Rate |
$3,590.40 |
| Rate for Payer: Aetna Commercial |
$2,879.80
|
| Rate for Payer: Anthem Medicaid |
$1,286.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,917.20
|
| Rate for Payer: Cash Price |
$1,870.00
|
| Rate for Payer: Cigna Commercial |
$3,104.20
|
| Rate for Payer: First Health Commercial |
$3,553.00
|
| Rate for Payer: Humana Commercial |
$3,179.00
|
| Rate for Payer: Humana KY Medicaid |
$1,286.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,299.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,066.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,760.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,122.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,311.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,805.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,159.40
|
| Rate for Payer: PHCS Commercial |
$3,590.40
|
| Rate for Payer: United Healthcare All Payer |
$3,291.20
|
|
|
PLATE NARROW LCK CMP 4.5 12H
|
Facility
|
IP
|
$3,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.20 |
| Max. Negotiated Rate |
$3,590.40 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,066.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,760.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,122.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,805.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,159.40
|
| Rate for Payer: PHCS Commercial |
$3,590.40
|
| Rate for Payer: United Healthcare All Payer |
$3,291.20
|
| Rate for Payer: Aetna Commercial |
$2,879.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,917.20
|
| Rate for Payer: Cash Price |
$1,870.00
|
| Rate for Payer: Cigna Commercial |
$3,104.20
|
| Rate for Payer: First Health Commercial |
$3,553.00
|
| Rate for Payer: Humana Commercial |
$3,179.00
|
|
|
PLATE NARROW LCK CMP 4.5 14H
|
Facility
|
IP
|
$3,824.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.12 |
| Max. Negotiated Rate |
$3,671.04 |
| Rate for Payer: Aetna Commercial |
$2,944.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,982.72
|
| Rate for Payer: Cash Price |
$1,912.00
|
| Rate for Payer: Cigna Commercial |
$3,173.92
|
| Rate for Payer: First Health Commercial |
$3,632.80
|
| Rate for Payer: Humana Commercial |
$3,250.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,135.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,822.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,147.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,365.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,868.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$764.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$497.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,185.44
|
| Rate for Payer: PHCS Commercial |
$3,671.04
|
| Rate for Payer: United Healthcare All Payer |
$3,365.12
|
|
|
PLATE NARROW LCK CMP 4.5 14H
|
Facility
|
OP
|
$3,824.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.12 |
| Max. Negotiated Rate |
$3,671.04 |
| Rate for Payer: Aetna Commercial |
$2,944.48
|
| Rate for Payer: Anthem Medicaid |
$1,315.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,982.72
|
| Rate for Payer: Cash Price |
$1,912.00
|
| Rate for Payer: Cigna Commercial |
$3,173.92
|
| Rate for Payer: First Health Commercial |
$3,632.80
|
| Rate for Payer: Humana Commercial |
$3,250.40
|
| Rate for Payer: Humana KY Medicaid |
$1,315.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,328.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,135.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,822.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,147.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,341.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,365.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,868.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$764.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$497.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,185.44
|
| Rate for Payer: PHCS Commercial |
$3,671.04
|
| Rate for Payer: United Healthcare All Payer |
$3,365.12
|
|
|
PLATE NARROW LCK COMP 4.5 6H
|
Facility
|
OP
|
$3,488.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$453.44 |
| Max. Negotiated Rate |
$3,348.48 |
| Rate for Payer: Aetna Commercial |
$2,685.76
|
| Rate for Payer: Anthem Medicaid |
$1,199.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,720.64
|
| Rate for Payer: Cash Price |
$1,744.00
|
| Rate for Payer: Cigna Commercial |
$2,895.04
|
| Rate for Payer: First Health Commercial |
$3,313.60
|
| Rate for Payer: Humana Commercial |
$2,964.80
|
| Rate for Payer: Humana KY Medicaid |
$1,199.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,211.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,860.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,574.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,046.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,223.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,069.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,616.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$697.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$453.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,081.28
|
| Rate for Payer: PHCS Commercial |
$3,348.48
|
| Rate for Payer: United Healthcare All Payer |
$3,069.44
|
|
|
PLATE NARROW LCK COMP 4.5 6H
|
Facility
|
IP
|
$3,488.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$453.44 |
| Max. Negotiated Rate |
$3,348.48 |
| Rate for Payer: Aetna Commercial |
$2,685.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,720.64
|
| Rate for Payer: Cash Price |
$1,744.00
|
| Rate for Payer: Cigna Commercial |
$2,895.04
|
| Rate for Payer: First Health Commercial |
$3,313.60
|
| Rate for Payer: Humana Commercial |
$2,964.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,860.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,574.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,046.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,069.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,616.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$697.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$453.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,081.28
|
| Rate for Payer: PHCS Commercial |
$3,348.48
|
| Rate for Payer: United Healthcare All Payer |
$3,069.44
|
|
|
PLATE NARROW LCK COMP 4.5 7H
|
Facility
|
OP
|
$3,516.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.08 |
| Max. Negotiated Rate |
$3,375.36 |
| Rate for Payer: Aetna Commercial |
$2,707.32
|
| Rate for Payer: Anthem Medicaid |
$1,209.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,742.48
|
| Rate for Payer: Cash Price |
$1,758.00
|
| Rate for Payer: Cigna Commercial |
$2,918.28
|
| Rate for Payer: First Health Commercial |
$3,340.20
|
| Rate for Payer: Humana Commercial |
$2,988.60
|
| Rate for Payer: Humana KY Medicaid |
$1,209.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,221.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,883.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,594.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,054.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,233.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,094.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,637.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$703.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,089.96
|
| Rate for Payer: PHCS Commercial |
$3,375.36
|
| Rate for Payer: United Healthcare All Payer |
$3,094.08
|
|
|
PLATE NARROW LCK COMP 4.5 7H
|
Facility
|
IP
|
$3,516.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.08 |
| Max. Negotiated Rate |
$3,375.36 |
| Rate for Payer: Aetna Commercial |
$2,707.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,742.48
|
| Rate for Payer: Cash Price |
$1,758.00
|
| Rate for Payer: Cigna Commercial |
$2,918.28
|
| Rate for Payer: First Health Commercial |
$3,340.20
|
| Rate for Payer: Humana Commercial |
$2,988.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,883.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,594.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,054.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,094.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,637.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$703.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,089.96
|
| Rate for Payer: PHCS Commercial |
$3,375.36
|
| Rate for Payer: United Healthcare All Payer |
$3,094.08
|
|
|
PLATE NARROW LCK COMP 4.5 8H
|
Facility
|
IP
|
$3,516.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.08 |
| Max. Negotiated Rate |
$3,375.36 |
| Rate for Payer: Aetna Commercial |
$2,707.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,742.48
|
| Rate for Payer: Cash Price |
$1,758.00
|
| Rate for Payer: Cigna Commercial |
$2,918.28
|
| Rate for Payer: First Health Commercial |
$3,340.20
|
| Rate for Payer: Humana Commercial |
$2,988.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,883.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,594.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,054.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,094.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,637.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$703.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,089.96
|
| Rate for Payer: PHCS Commercial |
$3,375.36
|
| Rate for Payer: United Healthcare All Payer |
$3,094.08
|
|
|
PLATE NARROW LCK COMP 4.5 8H
|
Facility
|
OP
|
$3,516.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.08 |
| Max. Negotiated Rate |
$3,375.36 |
| Rate for Payer: Kentucky WC Medicaid |
$1,221.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,883.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,594.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,054.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,233.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,094.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,637.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$703.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,089.96
|
| Rate for Payer: PHCS Commercial |
$3,375.36
|
| Rate for Payer: United Healthcare All Payer |
$3,094.08
|
| Rate for Payer: Aetna Commercial |
$2,707.32
|
| Rate for Payer: Anthem Medicaid |
$1,209.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,742.48
|
| Rate for Payer: Cash Price |
$1,758.00
|
| Rate for Payer: Cigna Commercial |
$2,918.28
|
| Rate for Payer: First Health Commercial |
$3,340.20
|
| Rate for Payer: Humana Commercial |
$2,988.60
|
| Rate for Payer: Humana KY Medicaid |
$1,209.15
|
|
|
PLATE NARROW LCK COMP 4.5 9H
|
Facility
|
OP
|
$3,516.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.08 |
| Max. Negotiated Rate |
$3,375.36 |
| Rate for Payer: Aetna Commercial |
$2,707.32
|
| Rate for Payer: Anthem Medicaid |
$1,209.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,742.48
|
| Rate for Payer: Cash Price |
$1,758.00
|
| Rate for Payer: Cigna Commercial |
$2,918.28
|
| Rate for Payer: First Health Commercial |
$3,340.20
|
| Rate for Payer: Humana Commercial |
$2,988.60
|
| Rate for Payer: Humana KY Medicaid |
$1,209.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,221.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,883.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,594.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,054.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,233.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,094.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,637.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$703.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,089.96
|
| Rate for Payer: PHCS Commercial |
$3,375.36
|
| Rate for Payer: United Healthcare All Payer |
$3,094.08
|
|
