|
PLATE NARROW 4.5*124 6H
|
Facility
|
IP
|
$1,883.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.05 |
| Max. Negotiated Rate |
$1,808.15 |
| Rate for Payer: Aetna Commercial |
$1,450.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,469.12
|
| Rate for Payer: Cash Price |
$941.74
|
| Rate for Payer: Cigna Commercial |
$1,563.30
|
| Rate for Payer: First Health Commercial |
$1,789.32
|
| Rate for Payer: Humana Commercial |
$1,600.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,544.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,390.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,657.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,412.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,506.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,299.61
|
| Rate for Payer: PHCS Commercial |
$1,808.15
|
| Rate for Payer: United Healthcare All Payer |
$1,657.47
|
|
|
PLATE NARROW 4.5*124 6H
|
Facility
|
OP
|
$1,883.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.05 |
| Max. Negotiated Rate |
$1,808.15 |
| Rate for Payer: Aetna Commercial |
$1,450.29
|
| Rate for Payer: Anthem Medicaid |
$647.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,469.12
|
| Rate for Payer: Cash Price |
$941.74
|
| Rate for Payer: Cigna Commercial |
$1,563.30
|
| Rate for Payer: First Health Commercial |
$1,789.32
|
| Rate for Payer: Humana Commercial |
$1,600.97
|
| Rate for Payer: Humana KY Medicaid |
$647.73
|
| Rate for Payer: Kentucky WC Medicaid |
$654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,544.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,390.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$660.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,657.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,412.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,506.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,299.61
|
| Rate for Payer: PHCS Commercial |
$1,808.15
|
| Rate for Payer: United Healthcare All Payer |
$1,657.47
|
|
|
PLATE NARROW 4.5*142 7H
|
Facility
|
IP
|
$1,883.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.05 |
| Max. Negotiated Rate |
$1,808.15 |
| Rate for Payer: Aetna Commercial |
$1,450.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,469.12
|
| Rate for Payer: Cash Price |
$941.74
|
| Rate for Payer: Cigna Commercial |
$1,563.30
|
| Rate for Payer: First Health Commercial |
$1,789.32
|
| Rate for Payer: Humana Commercial |
$1,600.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,544.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,390.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,657.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,412.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,506.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,299.61
|
| Rate for Payer: PHCS Commercial |
$1,808.15
|
| Rate for Payer: United Healthcare All Payer |
$1,657.47
|
|
|
PLATE NARROW 4.5*142 7H
|
Facility
|
OP
|
$1,883.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.05 |
| Max. Negotiated Rate |
$1,808.15 |
| Rate for Payer: Aetna Commercial |
$1,450.29
|
| Rate for Payer: Anthem Medicaid |
$647.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,469.12
|
| Rate for Payer: Cash Price |
$941.74
|
| Rate for Payer: Cigna Commercial |
$1,563.30
|
| Rate for Payer: First Health Commercial |
$1,789.32
|
| Rate for Payer: Humana Commercial |
$1,600.97
|
| Rate for Payer: Humana KY Medicaid |
$647.73
|
| Rate for Payer: Kentucky WC Medicaid |
$654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,544.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,390.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$660.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,657.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,412.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,506.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,299.61
|
| Rate for Payer: PHCS Commercial |
$1,808.15
|
| Rate for Payer: United Healthcare All Payer |
$1,657.47
|
|
|
PLATE NARROW 4.5*160 8H
|
Facility
|
OP
|
$1,883.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.05 |
| Max. Negotiated Rate |
$1,808.15 |
| Rate for Payer: Aetna Commercial |
$1,450.29
|
| Rate for Payer: Anthem Medicaid |
$647.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,469.12
|
| Rate for Payer: Cash Price |
$941.74
|
| Rate for Payer: Cigna Commercial |
$1,563.30
|
| Rate for Payer: First Health Commercial |
$1,789.32
|
| Rate for Payer: Humana Commercial |
$1,600.97
|
| Rate for Payer: Humana KY Medicaid |
$647.73
|
| Rate for Payer: Kentucky WC Medicaid |
$654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,544.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,390.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$660.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,657.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,412.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,506.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,299.61
|
| Rate for Payer: PHCS Commercial |
$1,808.15
|
| Rate for Payer: United Healthcare All Payer |
$1,657.47
|
|
|
PLATE NARROW 4.5*160 8H
|
Facility
|
IP
|
$1,883.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.05 |
| Max. Negotiated Rate |
$1,808.15 |
| Rate for Payer: Aetna Commercial |
$1,450.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,469.12
|
| Rate for Payer: Cash Price |
$941.74
|
| Rate for Payer: Cigna Commercial |
$1,563.30
|
| Rate for Payer: First Health Commercial |
$1,789.32
|
| Rate for Payer: Humana Commercial |
$1,600.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,544.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,390.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,657.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,412.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,506.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,299.61
|
| Rate for Payer: PHCS Commercial |
$1,808.15
|
| Rate for Payer: United Healthcare All Payer |
$1,657.47
|
|
|
PLATE NARROW 4.5*178 9H
|
Facility
|
OP
|
$1,883.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.05 |
| Max. Negotiated Rate |
$1,808.15 |
| Rate for Payer: Aetna Commercial |
$1,450.29
|
| Rate for Payer: Anthem Medicaid |
$647.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,469.12
|
| Rate for Payer: Cash Price |
$941.74
|
| Rate for Payer: Cigna Commercial |
$1,563.30
|
| Rate for Payer: First Health Commercial |
$1,789.32
|
| Rate for Payer: Humana Commercial |
$1,600.97
|
| Rate for Payer: Humana KY Medicaid |
$647.73
|
| Rate for Payer: Kentucky WC Medicaid |
$654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,544.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,390.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$660.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,657.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,412.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,506.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,299.61
|
| Rate for Payer: PHCS Commercial |
$1,808.15
|
| Rate for Payer: United Healthcare All Payer |
$1,657.47
|
|
|
PLATE NARROW 4.5*178 9H
|
Facility
|
IP
|
$1,883.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.05 |
| Max. Negotiated Rate |
$1,808.15 |
| Rate for Payer: Aetna Commercial |
$1,450.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,469.12
|
| Rate for Payer: Cash Price |
$941.74
|
| Rate for Payer: Cigna Commercial |
$1,563.30
|
| Rate for Payer: First Health Commercial |
$1,789.32
|
| Rate for Payer: Humana Commercial |
$1,600.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,544.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,390.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,657.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,412.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,506.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,299.61
|
| Rate for Payer: PHCS Commercial |
$1,808.15
|
| Rate for Payer: United Healthcare All Payer |
$1,657.47
|
|
|
PLATE NARROW 4.5*196 10H
|
Facility
|
IP
|
$2,066.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$619.88 |
| Max. Negotiated Rate |
$1,983.62 |
| Rate for Payer: Aetna Commercial |
$1,591.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,611.69
|
| Rate for Payer: Cash Price |
$1,033.13
|
| Rate for Payer: Cigna Commercial |
$1,715.00
|
| Rate for Payer: First Health Commercial |
$1,962.96
|
| Rate for Payer: Humana Commercial |
$1,756.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,694.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,524.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$619.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,818.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,549.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,653.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,797.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,425.73
|
| Rate for Payer: PHCS Commercial |
$1,983.62
|
| Rate for Payer: United Healthcare All Payer |
$1,818.32
|
|
|
PLATE NARROW 4.5*196 10H
|
Facility
|
OP
|
$2,066.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$619.88 |
| Max. Negotiated Rate |
$1,983.62 |
| Rate for Payer: Aetna Commercial |
$1,591.03
|
| Rate for Payer: Anthem Medicaid |
$710.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,611.69
|
| Rate for Payer: Cash Price |
$1,033.13
|
| Rate for Payer: Cigna Commercial |
$1,715.00
|
| Rate for Payer: First Health Commercial |
$1,962.96
|
| Rate for Payer: Humana Commercial |
$1,756.33
|
| Rate for Payer: Humana KY Medicaid |
$710.59
|
| Rate for Payer: Kentucky WC Medicaid |
$717.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,694.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,524.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$619.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$724.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,818.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,549.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,653.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,797.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,425.73
|
| Rate for Payer: PHCS Commercial |
$1,983.62
|
| Rate for Payer: United Healthcare All Payer |
$1,818.32
|
|
|
PLATE NARROW 4.5*214 11H
|
Facility
|
OP
|
$2,066.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$619.88 |
| Max. Negotiated Rate |
$1,983.62 |
| Rate for Payer: Aetna Commercial |
$1,591.03
|
| Rate for Payer: Anthem Medicaid |
$710.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,611.69
|
| Rate for Payer: Cash Price |
$1,033.13
|
| Rate for Payer: Cigna Commercial |
$1,715.00
|
| Rate for Payer: First Health Commercial |
$1,962.96
|
| Rate for Payer: Humana Commercial |
$1,756.33
|
| Rate for Payer: Humana KY Medicaid |
$710.59
|
| Rate for Payer: Kentucky WC Medicaid |
$717.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,694.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,524.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$619.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$724.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,818.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,549.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,653.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,797.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,425.73
|
| Rate for Payer: PHCS Commercial |
$1,983.62
|
| Rate for Payer: United Healthcare All Payer |
$1,818.32
|
|
|
PLATE NARROW 4.5*214 11H
|
Facility
|
IP
|
$2,066.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$619.88 |
| Max. Negotiated Rate |
$1,983.62 |
| Rate for Payer: Aetna Commercial |
$1,591.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,611.69
|
| Rate for Payer: Cash Price |
$1,033.13
|
| Rate for Payer: Cigna Commercial |
$1,715.00
|
| Rate for Payer: First Health Commercial |
$1,962.96
|
| Rate for Payer: Humana Commercial |
$1,756.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,694.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,524.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$619.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,818.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,549.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,653.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,797.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,425.73
|
| Rate for Payer: PHCS Commercial |
$1,983.62
|
| Rate for Payer: United Healthcare All Payer |
$1,818.32
|
|
|
PLATE NARROW 4.5*232 12H
|
Facility
|
OP
|
$2,066.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$619.88 |
| Max. Negotiated Rate |
$1,983.62 |
| Rate for Payer: Aetna Commercial |
$1,591.03
|
| Rate for Payer: Anthem Medicaid |
$710.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,611.69
|
| Rate for Payer: Cash Price |
$1,033.13
|
| Rate for Payer: Cigna Commercial |
$1,715.00
|
| Rate for Payer: First Health Commercial |
$1,962.96
|
| Rate for Payer: Humana Commercial |
$1,756.33
|
| Rate for Payer: Humana KY Medicaid |
$710.59
|
| Rate for Payer: Kentucky WC Medicaid |
$717.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,694.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,524.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$619.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$724.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,818.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,549.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,653.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,797.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,425.73
|
| Rate for Payer: PHCS Commercial |
$1,983.62
|
| Rate for Payer: United Healthcare All Payer |
$1,818.32
|
|
|
PLATE NARROW 4.5*232 12H
|
Facility
|
IP
|
$2,066.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$619.88 |
| Max. Negotiated Rate |
$1,983.62 |
| Rate for Payer: Aetna Commercial |
$1,591.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,611.69
|
| Rate for Payer: Cash Price |
$1,033.13
|
| Rate for Payer: Cigna Commercial |
$1,715.00
|
| Rate for Payer: First Health Commercial |
$1,962.96
|
| Rate for Payer: Humana Commercial |
$1,756.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,694.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,524.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$619.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,818.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,549.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,653.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,797.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,425.73
|
| Rate for Payer: PHCS Commercial |
$1,983.62
|
| Rate for Payer: United Healthcare All Payer |
$1,818.32
|
|
|
PLATE NARROW 4.5*250 13H
|
Facility
|
IP
|
$2,206.87
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.06 |
| Max. Negotiated Rate |
$2,118.60 |
| Rate for Payer: Aetna Commercial |
$1,699.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,721.36
|
| Rate for Payer: Cash Price |
$1,103.43
|
| Rate for Payer: Cigna Commercial |
$1,831.70
|
| Rate for Payer: First Health Commercial |
$2,096.53
|
| Rate for Payer: Humana Commercial |
$1,875.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,809.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,628.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,942.05
|
| Rate for Payer: Ohio Health Group HMO |
$1,655.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,765.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,919.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.74
|
| Rate for Payer: PHCS Commercial |
$2,118.60
|
| Rate for Payer: United Healthcare All Payer |
$1,942.05
|
|
|
PLATE NARROW 4.5*250 13H
|
Facility
|
OP
|
$2,206.87
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.06 |
| Max. Negotiated Rate |
$2,118.60 |
| Rate for Payer: Aetna Commercial |
$1,699.29
|
| Rate for Payer: Anthem Medicaid |
$758.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,721.36
|
| Rate for Payer: Cash Price |
$1,103.43
|
| Rate for Payer: Cigna Commercial |
$1,831.70
|
| Rate for Payer: First Health Commercial |
$2,096.53
|
| Rate for Payer: Humana Commercial |
$1,875.84
|
| Rate for Payer: Humana KY Medicaid |
$758.94
|
| Rate for Payer: Kentucky WC Medicaid |
$766.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,809.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,628.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,942.05
|
| Rate for Payer: Ohio Health Group HMO |
$1,655.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,765.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,919.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.74
|
| Rate for Payer: PHCS Commercial |
$2,118.60
|
| Rate for Payer: United Healthcare All Payer |
$1,942.05
|
|
|
PLATE NARROW 4.5*268 14H
|
Facility
|
IP
|
$2,957.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.21 |
| Max. Negotiated Rate |
$2,839.08 |
| Rate for Payer: Aetna Commercial |
$2,277.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,306.76
|
| Rate for Payer: Cash Price |
$1,478.69
|
| Rate for Payer: Cigna Commercial |
$2,454.63
|
| Rate for Payer: First Health Commercial |
$2,809.51
|
| Rate for Payer: Humana Commercial |
$2,513.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,425.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,182.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$887.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,602.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,218.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,365.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,572.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.59
|
| Rate for Payer: PHCS Commercial |
$2,839.08
|
| Rate for Payer: United Healthcare All Payer |
$2,602.49
|
|
|
PLATE NARROW 4.5*268 14H
|
Facility
|
OP
|
$2,957.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.21 |
| Max. Negotiated Rate |
$2,839.08 |
| Rate for Payer: Aetna Commercial |
$2,277.18
|
| Rate for Payer: Anthem Medicaid |
$1,017.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,306.76
|
| Rate for Payer: Cash Price |
$1,478.69
|
| Rate for Payer: Cigna Commercial |
$2,454.63
|
| Rate for Payer: First Health Commercial |
$2,809.51
|
| Rate for Payer: Humana Commercial |
$2,513.77
|
| Rate for Payer: Humana KY Medicaid |
$1,017.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,027.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,425.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,182.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$887.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,037.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,602.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,218.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,365.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,572.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.59
|
| Rate for Payer: PHCS Commercial |
$2,839.08
|
| Rate for Payer: United Healthcare All Payer |
$2,602.49
|
|
|
PLATE NARROW 4.5*286 15H
|
Facility
|
IP
|
$2,957.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.21 |
| Max. Negotiated Rate |
$2,839.08 |
| Rate for Payer: Aetna Commercial |
$2,277.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,306.76
|
| Rate for Payer: Cash Price |
$1,478.69
|
| Rate for Payer: Cigna Commercial |
$2,454.63
|
| Rate for Payer: First Health Commercial |
$2,809.51
|
| Rate for Payer: Humana Commercial |
$2,513.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,425.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,182.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$887.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,602.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,218.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,365.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,572.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.59
|
| Rate for Payer: PHCS Commercial |
$2,839.08
|
| Rate for Payer: United Healthcare All Payer |
$2,602.49
|
|
|
PLATE NARROW 4.5*286 15H
|
Facility
|
OP
|
$2,957.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.21 |
| Max. Negotiated Rate |
$2,839.08 |
| Rate for Payer: Aetna Commercial |
$2,277.18
|
| Rate for Payer: Anthem Medicaid |
$1,017.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,306.76
|
| Rate for Payer: Cash Price |
$1,478.69
|
| Rate for Payer: Cigna Commercial |
$2,454.63
|
| Rate for Payer: First Health Commercial |
$2,809.51
|
| Rate for Payer: Humana Commercial |
$2,513.77
|
| Rate for Payer: Humana KY Medicaid |
$1,017.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,027.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,425.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,182.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$887.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,037.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,602.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,218.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,365.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,572.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.59
|
| Rate for Payer: PHCS Commercial |
$2,839.08
|
| Rate for Payer: United Healthcare All Payer |
$2,602.49
|
|
|
PLATE NARROW 4.5*304 16H
|
Facility
|
IP
|
$3,415.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,024.58 |
| Max. Negotiated Rate |
$3,278.64 |
| Rate for Payer: Aetna Commercial |
$2,629.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,663.89
|
| Rate for Payer: Cash Price |
$1,707.62
|
| Rate for Payer: Cigna Commercial |
$2,834.66
|
| Rate for Payer: First Health Commercial |
$3,244.49
|
| Rate for Payer: Humana Commercial |
$2,902.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,800.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,520.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,024.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,005.42
|
| Rate for Payer: Ohio Health Group HMO |
$2,561.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,732.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,971.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,356.52
|
| Rate for Payer: PHCS Commercial |
$3,278.64
|
| Rate for Payer: United Healthcare All Payer |
$3,005.42
|
|
|
PLATE NARROW 4.5*304 16H
|
Facility
|
OP
|
$3,415.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,024.58 |
| Max. Negotiated Rate |
$3,278.64 |
| Rate for Payer: Aetna Commercial |
$2,629.74
|
| Rate for Payer: Anthem Medicaid |
$1,174.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,663.89
|
| Rate for Payer: Cash Price |
$1,707.62
|
| Rate for Payer: Cigna Commercial |
$2,834.66
|
| Rate for Payer: First Health Commercial |
$3,244.49
|
| Rate for Payer: Humana Commercial |
$2,902.96
|
| Rate for Payer: Humana KY Medicaid |
$1,174.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,186.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,800.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,520.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,024.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,198.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,005.42
|
| Rate for Payer: Ohio Health Group HMO |
$2,561.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,732.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,971.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,356.52
|
| Rate for Payer: PHCS Commercial |
$3,278.64
|
| Rate for Payer: United Healthcare All Payer |
$3,005.42
|
|
|
PLATE NARROW 4.5*340 18H
|
Facility
|
OP
|
$3,574.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.44 |
| Max. Negotiated Rate |
$3,431.82 |
| Rate for Payer: Aetna Commercial |
$2,752.60
|
| Rate for Payer: Anthem Medicaid |
$1,229.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,788.35
|
| Rate for Payer: Cash Price |
$1,787.41
|
| Rate for Payer: Cigna Commercial |
$2,967.09
|
| Rate for Payer: First Health Commercial |
$3,396.07
|
| Rate for Payer: Humana Commercial |
$3,038.59
|
| Rate for Payer: Humana KY Medicaid |
$1,229.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,241.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,931.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,638.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,072.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,254.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,145.83
|
| Rate for Payer: Ohio Health Group HMO |
$2,681.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,859.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,110.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,466.62
|
| Rate for Payer: PHCS Commercial |
$3,431.82
|
| Rate for Payer: United Healthcare All Payer |
$3,145.83
|
|
|
PLATE NARROW 4.5*340 18H
|
Facility
|
IP
|
$3,574.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.44 |
| Max. Negotiated Rate |
$3,431.82 |
| Rate for Payer: Aetna Commercial |
$2,752.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,788.35
|
| Rate for Payer: Cash Price |
$1,787.41
|
| Rate for Payer: Cigna Commercial |
$2,967.09
|
| Rate for Payer: First Health Commercial |
$3,396.07
|
| Rate for Payer: Humana Commercial |
$3,038.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,931.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,638.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,072.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,145.83
|
| Rate for Payer: Ohio Health Group HMO |
$2,681.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,859.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,110.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,466.62
|
| Rate for Payer: PHCS Commercial |
$3,431.82
|
| Rate for Payer: United Healthcare All Payer |
$3,145.83
|
|
|
PLATE NARROW 4.5*376 20H
|
Facility
|
OP
|
$3,699.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,109.91 |
| Max. Negotiated Rate |
$3,551.70 |
| Rate for Payer: Aetna Commercial |
$2,848.76
|
| Rate for Payer: Anthem Medicaid |
$1,272.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,885.76
|
| Rate for Payer: Cash Price |
$1,849.84
|
| Rate for Payer: Cigna Commercial |
$3,070.74
|
| Rate for Payer: First Health Commercial |
$3,514.71
|
| Rate for Payer: Humana Commercial |
$3,144.74
|
| Rate for Payer: Humana KY Medicaid |
$1,272.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,285.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,033.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,730.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,109.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,297.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,255.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,774.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,959.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,218.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,552.79
|
| Rate for Payer: PHCS Commercial |
$3,551.70
|
| Rate for Payer: United Healthcare All Payer |
$3,255.73
|
|
