|
PLATE NARROW 4.5*376 20H
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE NARROW 4.5*412 22H
|
Facility
|
OP
|
$3,776.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.80 |
| Max. Negotiated Rate |
$3,624.96 |
| Rate for Payer: Aetna Commercial |
$2,907.52
|
| Rate for Payer: Anthem Medicaid |
$1,298.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,945.28
|
| Rate for Payer: Cash Price |
$1,888.00
|
| Rate for Payer: Cigna Commercial |
$3,134.08
|
| Rate for Payer: First Health Commercial |
$3,587.20
|
| Rate for Payer: Humana Commercial |
$3,209.60
|
| Rate for Payer: Humana KY Medicaid |
$1,298.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,096.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,786.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,832.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,285.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,605.44
|
| Rate for Payer: PHCS Commercial |
$3,624.96
|
| Rate for Payer: United Healthcare All Payer |
$3,322.88
|
|
|
PLATE NARROW 4.5*412 22H
|
Facility
|
IP
|
$3,776.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.80 |
| Max. Negotiated Rate |
$3,624.96 |
| Rate for Payer: Aetna Commercial |
$2,907.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,945.28
|
| Rate for Payer: Cash Price |
$1,888.00
|
| Rate for Payer: Cigna Commercial |
$3,134.08
|
| Rate for Payer: First Health Commercial |
$3,587.20
|
| Rate for Payer: Humana Commercial |
$3,209.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,096.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,786.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,832.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,285.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,605.44
|
| Rate for Payer: PHCS Commercial |
$3,624.96
|
| Rate for Payer: United Healthcare All Payer |
$3,322.88
|
|
|
PLATE NARROW 4.5*52 2H
|
Facility
|
OP
|
$1,820.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.07 |
| Max. Negotiated Rate |
$1,747.41 |
| Rate for Payer: Aetna Commercial |
$1,401.57
|
| Rate for Payer: Anthem Medicaid |
$625.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,419.77
|
| Rate for Payer: Cash Price |
$910.11
|
| Rate for Payer: Cigna Commercial |
$1,510.78
|
| Rate for Payer: First Health Commercial |
$1,729.21
|
| Rate for Payer: Humana Commercial |
$1,547.19
|
| Rate for Payer: Humana KY Medicaid |
$625.97
|
| Rate for Payer: Kentucky WC Medicaid |
$632.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$638.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,601.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,583.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,255.95
|
| Rate for Payer: PHCS Commercial |
$1,747.41
|
| Rate for Payer: United Healthcare All Payer |
$1,601.79
|
|
|
PLATE NARROW 4.5*52 2H
|
Facility
|
IP
|
$1,820.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.07 |
| Max. Negotiated Rate |
$1,747.41 |
| Rate for Payer: Aetna Commercial |
$1,401.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,419.77
|
| Rate for Payer: Cash Price |
$910.11
|
| Rate for Payer: Cigna Commercial |
$1,510.78
|
| Rate for Payer: First Health Commercial |
$1,729.21
|
| Rate for Payer: Humana Commercial |
$1,547.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,601.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,583.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,255.95
|
| Rate for Payer: PHCS Commercial |
$1,747.41
|
| Rate for Payer: United Healthcare All Payer |
$1,601.79
|
|
|
PLATE NARROW 4.5*70 3H
|
Facility
|
IP
|
$1,820.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.07 |
| Max. Negotiated Rate |
$1,747.41 |
| Rate for Payer: Aetna Commercial |
$1,401.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,419.77
|
| Rate for Payer: Cash Price |
$910.11
|
| Rate for Payer: Cigna Commercial |
$1,510.78
|
| Rate for Payer: First Health Commercial |
$1,729.21
|
| Rate for Payer: Humana Commercial |
$1,547.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,601.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,583.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,255.95
|
| Rate for Payer: PHCS Commercial |
$1,747.41
|
| Rate for Payer: United Healthcare All Payer |
$1,601.79
|
|
|
PLATE NARROW 4.5*70 3H
|
Facility
|
OP
|
$1,820.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.07 |
| Max. Negotiated Rate |
$1,747.41 |
| Rate for Payer: Aetna Commercial |
$1,401.57
|
| Rate for Payer: Anthem Medicaid |
$625.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,419.77
|
| Rate for Payer: Cash Price |
$910.11
|
| Rate for Payer: Cigna Commercial |
$1,510.78
|
| Rate for Payer: First Health Commercial |
$1,729.21
|
| Rate for Payer: Humana Commercial |
$1,547.19
|
| Rate for Payer: Humana KY Medicaid |
$625.97
|
| Rate for Payer: Kentucky WC Medicaid |
$632.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$638.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,601.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,583.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,255.95
|
| Rate for Payer: PHCS Commercial |
$1,747.41
|
| Rate for Payer: United Healthcare All Payer |
$1,601.79
|
|
|
PLATE NARROW 4.5*88 4H
|
Facility
|
IP
|
$1,820.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.07 |
| Max. Negotiated Rate |
$1,747.41 |
| Rate for Payer: Aetna Commercial |
$1,401.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,419.77
|
| Rate for Payer: Cash Price |
$910.11
|
| Rate for Payer: Cigna Commercial |
$1,510.78
|
| Rate for Payer: First Health Commercial |
$1,729.21
|
| Rate for Payer: Humana Commercial |
$1,547.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,601.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,583.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,255.95
|
| Rate for Payer: PHCS Commercial |
$1,747.41
|
| Rate for Payer: United Healthcare All Payer |
$1,601.79
|
|
|
PLATE NARROW 4.5*88 4H
|
Facility
|
OP
|
$1,820.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.07 |
| Max. Negotiated Rate |
$1,747.41 |
| Rate for Payer: Aetna Commercial |
$1,401.57
|
| Rate for Payer: Anthem Medicaid |
$625.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,419.77
|
| Rate for Payer: Cash Price |
$910.11
|
| Rate for Payer: Cigna Commercial |
$1,510.78
|
| Rate for Payer: First Health Commercial |
$1,729.21
|
| Rate for Payer: Humana Commercial |
$1,547.19
|
| Rate for Payer: Humana KY Medicaid |
$625.97
|
| Rate for Payer: Kentucky WC Medicaid |
$632.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$638.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,601.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,583.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,255.95
|
| Rate for Payer: PHCS Commercial |
$1,747.41
|
| Rate for Payer: United Healthcare All Payer |
$1,601.79
|
|
|
PLATE NARROW 4.5MM 10H 196MM
|
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 4.5MM 10H 196MM
|
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 4.5MM 10X167MM
|
Facility
|
OP
|
$1,969.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.98 |
| Max. Negotiated Rate |
$1,891.14 |
| Rate for Payer: Aetna Commercial |
$1,516.85
|
| Rate for Payer: Anthem Medicaid |
$677.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,536.55
|
| Rate for Payer: Cash Price |
$984.97
|
| Rate for Payer: Cigna Commercial |
$1,635.05
|
| Rate for Payer: First Health Commercial |
$1,871.44
|
| Rate for Payer: Humana Commercial |
$1,674.45
|
| Rate for Payer: Humana KY Medicaid |
$677.46
|
| Rate for Payer: Kentucky WC Medicaid |
$684.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,615.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,453.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$691.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,733.55
|
| Rate for Payer: Ohio Health Group HMO |
$1,477.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,575.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,713.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,359.26
|
| Rate for Payer: PHCS Commercial |
$1,891.14
|
| Rate for Payer: United Healthcare All Payer |
$1,733.55
|
|
|
PLATE NARROW 4.5MM 10X167MM
|
Facility
|
IP
|
$1,969.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.98 |
| Max. Negotiated Rate |
$1,891.14 |
| Rate for Payer: Aetna Commercial |
$1,516.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,536.55
|
| Rate for Payer: Cash Price |
$984.97
|
| Rate for Payer: Cigna Commercial |
$1,635.05
|
| Rate for Payer: First Health Commercial |
$1,871.44
|
| Rate for Payer: Humana Commercial |
$1,674.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,615.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,453.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,733.55
|
| Rate for Payer: Ohio Health Group HMO |
$1,477.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,575.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,713.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,359.26
|
| Rate for Payer: PHCS Commercial |
$1,891.14
|
| Rate for Payer: United Healthcare All Payer |
$1,733.55
|
|
|
PLATE NARROW 4.5MM 11H 214MM
|
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 4.5MM 11H 214MM
|
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 4.5MM 11X183MM
|
Facility
|
OP
|
$2,180.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.08 |
| Max. Negotiated Rate |
$2,093.06 |
| Rate for Payer: Aetna Commercial |
$1,678.81
|
| Rate for Payer: Anthem Medicaid |
$749.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,700.61
|
| Rate for Payer: Cash Price |
$1,090.13
|
| Rate for Payer: Cigna Commercial |
$1,809.62
|
| Rate for Payer: First Health Commercial |
$2,071.26
|
| Rate for Payer: Humana Commercial |
$1,853.23
|
| Rate for Payer: Humana KY Medicaid |
$749.79
|
| Rate for Payer: Kentucky WC Medicaid |
$757.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,787.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,609.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$764.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,918.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,635.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,744.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,896.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.39
|
| Rate for Payer: PHCS Commercial |
$2,093.06
|
| Rate for Payer: United Healthcare All Payer |
$1,918.64
|
|
|
PLATE NARROW 4.5MM 11X183MM
|
Facility
|
IP
|
$2,180.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.08 |
| Max. Negotiated Rate |
$2,093.06 |
| Rate for Payer: Aetna Commercial |
$1,678.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,700.61
|
| Rate for Payer: Cash Price |
$1,090.13
|
| Rate for Payer: Cigna Commercial |
$1,809.62
|
| Rate for Payer: First Health Commercial |
$2,071.26
|
| Rate for Payer: Humana Commercial |
$1,853.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,787.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,609.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,918.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,635.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,744.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,896.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.39
|
| Rate for Payer: PHCS Commercial |
$2,093.06
|
| Rate for Payer: United Healthcare All Payer |
$1,918.64
|
|
|
PLATE NARROW 4.5MM 12H 232MM
|
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 4.5MM 12H 232MM
|
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 4.5MM 12X199MM
|
Facility
|
OP
|
$2,180.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.08 |
| Max. Negotiated Rate |
$2,093.06 |
| Rate for Payer: Aetna Commercial |
$1,678.81
|
| Rate for Payer: Anthem Medicaid |
$749.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,700.61
|
| Rate for Payer: Cash Price |
$1,090.13
|
| Rate for Payer: Cigna Commercial |
$1,809.62
|
| Rate for Payer: First Health Commercial |
$2,071.26
|
| Rate for Payer: Humana Commercial |
$1,853.23
|
| Rate for Payer: Humana KY Medicaid |
$749.79
|
| Rate for Payer: Kentucky WC Medicaid |
$757.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,787.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,609.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$764.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,918.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,635.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,744.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,896.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.39
|
| Rate for Payer: PHCS Commercial |
$2,093.06
|
| Rate for Payer: United Healthcare All Payer |
$1,918.64
|
|
|
PLATE NARROW 4.5MM 12X199MM
|
Facility
|
IP
|
$2,180.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.08 |
| Max. Negotiated Rate |
$2,093.06 |
| Rate for Payer: Aetna Commercial |
$1,678.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,700.61
|
| Rate for Payer: Cash Price |
$1,090.13
|
| Rate for Payer: Cigna Commercial |
$1,809.62
|
| Rate for Payer: First Health Commercial |
$2,071.26
|
| Rate for Payer: Humana Commercial |
$1,853.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,787.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,609.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,918.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,635.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,744.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,896.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.39
|
| Rate for Payer: PHCS Commercial |
$2,093.06
|
| Rate for Payer: United Healthcare All Payer |
$1,918.64
|
|
|
PLATE NARROW 4.5MM 13X215MM
|
Facility
|
IP
|
$2,180.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.08 |
| Max. Negotiated Rate |
$2,093.06 |
| Rate for Payer: Aetna Commercial |
$1,678.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,700.61
|
| Rate for Payer: Cash Price |
$1,090.13
|
| Rate for Payer: Cigna Commercial |
$1,809.62
|
| Rate for Payer: First Health Commercial |
$2,071.26
|
| Rate for Payer: Humana Commercial |
$1,853.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,787.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,609.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,918.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,635.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,744.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,896.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.39
|
| Rate for Payer: PHCS Commercial |
$2,093.06
|
| Rate for Payer: United Healthcare All Payer |
$1,918.64
|
|
|
PLATE NARROW 4.5MM 13X215MM
|
Facility
|
OP
|
$2,180.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.08 |
| Max. Negotiated Rate |
$2,093.06 |
| Rate for Payer: Aetna Commercial |
$1,678.81
|
| Rate for Payer: Anthem Medicaid |
$749.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,700.61
|
| Rate for Payer: Cash Price |
$1,090.13
|
| Rate for Payer: Cigna Commercial |
$1,809.62
|
| Rate for Payer: First Health Commercial |
$2,071.26
|
| Rate for Payer: Humana Commercial |
$1,853.23
|
| Rate for Payer: Humana KY Medicaid |
$749.79
|
| Rate for Payer: Kentucky WC Medicaid |
$757.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,787.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,609.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$764.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,918.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,635.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,744.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,896.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.39
|
| Rate for Payer: PHCS Commercial |
$2,093.06
|
| Rate for Payer: United Healthcare All Payer |
$1,918.64
|
|
|
PLATE NARROW 4.5MM 14X231MM
|
Facility
|
OP
|
$3,230.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$969.00 |
| Max. Negotiated Rate |
$3,100.80 |
| Rate for Payer: Aetna Commercial |
$2,487.10
|
| Rate for Payer: Anthem Medicaid |
$1,110.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,519.40
|
| Rate for Payer: Cash Price |
$1,615.00
|
| Rate for Payer: Cigna Commercial |
$2,680.90
|
| Rate for Payer: First Health Commercial |
$3,068.50
|
| Rate for Payer: Humana Commercial |
$2,745.50
|
| Rate for Payer: Humana KY Medicaid |
$1,110.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,122.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,648.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,383.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,133.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,842.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,422.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,810.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,228.70
|
| Rate for Payer: PHCS Commercial |
$3,100.80
|
| Rate for Payer: United Healthcare All Payer |
$2,842.40
|
|
|
PLATE NARROW 4.5MM 14X231MM
|
Facility
|
IP
|
$3,230.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$969.00 |
| Max. Negotiated Rate |
$3,100.80 |
| Rate for Payer: Aetna Commercial |
$2,487.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,519.40
|
| Rate for Payer: Cash Price |
$1,615.00
|
| Rate for Payer: Cigna Commercial |
$2,680.90
|
| Rate for Payer: First Health Commercial |
$3,068.50
|
| Rate for Payer: Humana Commercial |
$2,745.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,648.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,383.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,842.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,422.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,810.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,228.70
|
| Rate for Payer: PHCS Commercial |
$3,100.80
|
| Rate for Payer: United Healthcare All Payer |
$2,842.40
|
|
