|
PLATE NARROW 4.5MM 15X247MM
|
Facility
|
IP
|
$3,299.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.76 |
| Max. Negotiated Rate |
$3,167.22 |
| Rate for Payer: Aetna Commercial |
$2,540.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,573.37
|
| Rate for Payer: Cash Price |
$1,649.59
|
| Rate for Payer: Cigna Commercial |
$2,738.33
|
| Rate for Payer: First Health Commercial |
$3,134.23
|
| Rate for Payer: Humana Commercial |
$2,804.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,705.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,434.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$989.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,903.29
|
| Rate for Payer: Ohio Health Group HMO |
$2,474.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,639.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,870.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,276.44
|
| Rate for Payer: PHCS Commercial |
$3,167.22
|
| Rate for Payer: United Healthcare All Payer |
$2,903.29
|
|
|
PLATE NARROW 4.5MM 15X247MM
|
Facility
|
OP
|
$3,299.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.76 |
| Max. Negotiated Rate |
$3,167.22 |
| Rate for Payer: Aetna Commercial |
$2,540.38
|
| Rate for Payer: Anthem Medicaid |
$1,134.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,573.37
|
| Rate for Payer: Cash Price |
$1,649.59
|
| Rate for Payer: Cigna Commercial |
$2,738.33
|
| Rate for Payer: First Health Commercial |
$3,134.23
|
| Rate for Payer: Humana Commercial |
$2,804.31
|
| Rate for Payer: Humana KY Medicaid |
$1,134.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,146.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,705.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,434.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$989.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,157.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,903.29
|
| Rate for Payer: Ohio Health Group HMO |
$2,474.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,639.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,870.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,276.44
|
| Rate for Payer: PHCS Commercial |
$3,167.22
|
| Rate for Payer: United Healthcare All Payer |
$2,903.29
|
|
|
PLATE NARROW 4.5MM 16X263MM
|
Facility
|
IP
|
$3,299.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.76 |
| Max. Negotiated Rate |
$3,167.22 |
| Rate for Payer: Aetna Commercial |
$2,540.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,573.37
|
| Rate for Payer: Cash Price |
$1,649.59
|
| Rate for Payer: Cigna Commercial |
$2,738.33
|
| Rate for Payer: First Health Commercial |
$3,134.23
|
| Rate for Payer: Humana Commercial |
$2,804.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,705.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,434.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$989.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,903.29
|
| Rate for Payer: Ohio Health Group HMO |
$2,474.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,639.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,870.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,276.44
|
| Rate for Payer: PHCS Commercial |
$3,167.22
|
| Rate for Payer: United Healthcare All Payer |
$2,903.29
|
|
|
PLATE NARROW 4.5MM 16X263MM
|
Facility
|
OP
|
$3,299.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.76 |
| Max. Negotiated Rate |
$3,167.22 |
| Rate for Payer: Aetna Commercial |
$2,540.38
|
| Rate for Payer: Anthem Medicaid |
$1,134.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,573.37
|
| Rate for Payer: Cash Price |
$1,649.59
|
| Rate for Payer: Cigna Commercial |
$2,738.33
|
| Rate for Payer: First Health Commercial |
$3,134.23
|
| Rate for Payer: Humana Commercial |
$2,804.31
|
| Rate for Payer: Humana KY Medicaid |
$1,134.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,146.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,705.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,434.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$989.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,157.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,903.29
|
| Rate for Payer: Ohio Health Group HMO |
$2,474.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,639.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,870.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,276.44
|
| Rate for Payer: PHCS Commercial |
$3,167.22
|
| Rate for Payer: United Healthcare All Payer |
$2,903.29
|
|
|
PLATE NARROW 4.5MM 18X295MM
|
Facility
|
OP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem Medicaid |
$1,327.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Humana KY Medicaid |
$1,327.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE NARROW 4.5MM 18X295MM
|
Facility
|
IP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE NARROW 4.5MM 20X326MM
|
Facility
|
OP
|
$3,675.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.76 |
| Max. Negotiated Rate |
$3,528.84 |
| Rate for Payer: Aetna Commercial |
$2,830.43
|
| Rate for Payer: Anthem Medicaid |
$1,264.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,867.19
|
| Rate for Payer: Cash Price |
$1,837.94
|
| Rate for Payer: Cigna Commercial |
$3,050.98
|
| Rate for Payer: First Health Commercial |
$3,492.09
|
| Rate for Payer: Humana Commercial |
$3,124.50
|
| Rate for Payer: Humana KY Medicaid |
$1,264.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,277.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,014.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,712.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,102.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,234.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,756.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,940.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,198.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,536.36
|
| Rate for Payer: PHCS Commercial |
$3,528.84
|
| Rate for Payer: United Healthcare All Payer |
$3,234.77
|
|
|
PLATE NARROW 4.5MM 20X326MM
|
Facility
|
IP
|
$3,675.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.76 |
| Max. Negotiated Rate |
$3,528.84 |
| Rate for Payer: Aetna Commercial |
$2,830.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,867.19
|
| Rate for Payer: Cash Price |
$1,837.94
|
| Rate for Payer: Cigna Commercial |
$3,050.98
|
| Rate for Payer: First Health Commercial |
$3,492.09
|
| Rate for Payer: Humana Commercial |
$3,124.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,014.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,712.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,102.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,234.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,756.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,940.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,198.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,536.36
|
| Rate for Payer: PHCS Commercial |
$3,528.84
|
| Rate for Payer: United Healthcare All Payer |
$3,234.77
|
|
|
PLATE NARROW 4.5MM 22X358MM
|
Facility
|
IP
|
$4,260.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.04 |
| Max. Negotiated Rate |
$4,089.72 |
| Rate for Payer: Aetna Commercial |
$3,280.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.89
|
| Rate for Payer: Cash Price |
$2,130.06
|
| Rate for Payer: Cigna Commercial |
$3,535.90
|
| Rate for Payer: First Health Commercial |
$4,047.11
|
| Rate for Payer: Humana Commercial |
$3,621.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,493.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,748.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,408.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,706.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,939.48
|
| Rate for Payer: PHCS Commercial |
$4,089.72
|
| Rate for Payer: United Healthcare All Payer |
$3,748.91
|
|
|
PLATE NARROW 4.5MM 22X358MM
|
Facility
|
OP
|
$4,260.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.04 |
| Max. Negotiated Rate |
$4,089.72 |
| Rate for Payer: Aetna Commercial |
$3,280.29
|
| Rate for Payer: Anthem Medicaid |
$1,465.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.89
|
| Rate for Payer: Cash Price |
$2,130.06
|
| Rate for Payer: Cigna Commercial |
$3,535.90
|
| Rate for Payer: First Health Commercial |
$4,047.11
|
| Rate for Payer: Humana Commercial |
$3,621.10
|
| Rate for Payer: Humana KY Medicaid |
$1,465.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,479.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,493.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,494.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,748.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,408.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,706.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,939.48
|
| Rate for Payer: PHCS Commercial |
$4,089.72
|
| Rate for Payer: United Healthcare All Payer |
$3,748.91
|
|
|
PLATE NARROW 4.5MM 24X390MM
|
Facility
|
IP
|
$4,444.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,333.39 |
| Max. Negotiated Rate |
$4,266.84 |
| Rate for Payer: Aetna Commercial |
$3,422.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,466.80
|
| Rate for Payer: Cash Price |
$2,222.31
|
| Rate for Payer: Cigna Commercial |
$3,689.03
|
| Rate for Payer: First Health Commercial |
$4,222.39
|
| Rate for Payer: Humana Commercial |
$3,777.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,644.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,280.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,333.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,911.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,333.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,555.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,866.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,066.79
|
| Rate for Payer: PHCS Commercial |
$4,266.84
|
| Rate for Payer: United Healthcare All Payer |
$3,911.27
|
|
|
PLATE NARROW 4.5MM 24X390MM
|
Facility
|
OP
|
$4,444.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,333.39 |
| Max. Negotiated Rate |
$4,266.84 |
| Rate for Payer: Aetna Commercial |
$3,422.36
|
| Rate for Payer: Anthem Medicaid |
$1,528.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,466.80
|
| Rate for Payer: Cash Price |
$2,222.31
|
| Rate for Payer: Cigna Commercial |
$3,689.03
|
| Rate for Payer: First Health Commercial |
$4,222.39
|
| Rate for Payer: Humana Commercial |
$3,777.93
|
| Rate for Payer: Humana KY Medicaid |
$1,528.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,544.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,644.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,280.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,333.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,559.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,911.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,333.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,555.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,866.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,066.79
|
| Rate for Payer: PHCS Commercial |
$4,266.84
|
| Rate for Payer: United Healthcare All Payer |
$3,911.27
|
|
|
PLATE NARROW 4.5MM 2X39MM
|
Facility
|
OP
|
$1,876.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.94 |
| Max. Negotiated Rate |
$1,801.40 |
| Rate for Payer: Aetna Commercial |
$1,444.87
|
| Rate for Payer: Anthem Medicaid |
$645.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,463.64
|
| Rate for Payer: Cash Price |
$938.23
|
| Rate for Payer: Cigna Commercial |
$1,557.46
|
| Rate for Payer: First Health Commercial |
$1,782.64
|
| Rate for Payer: Humana Commercial |
$1,594.99
|
| Rate for Payer: Humana KY Medicaid |
$645.31
|
| Rate for Payer: Kentucky WC Medicaid |
$651.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,538.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,384.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$658.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,651.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,407.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,501.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,632.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,294.76
|
| Rate for Payer: PHCS Commercial |
$1,801.40
|
| Rate for Payer: United Healthcare All Payer |
$1,651.28
|
|
|
PLATE NARROW 4.5MM 2X39MM
|
Facility
|
IP
|
$1,876.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.94 |
| Max. Negotiated Rate |
$1,801.40 |
| Rate for Payer: Aetna Commercial |
$1,444.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,463.64
|
| Rate for Payer: Cash Price |
$938.23
|
| Rate for Payer: Cigna Commercial |
$1,557.46
|
| Rate for Payer: First Health Commercial |
$1,782.64
|
| Rate for Payer: Humana Commercial |
$1,594.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,538.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,384.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,651.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,407.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,501.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,632.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,294.76
|
| Rate for Payer: PHCS Commercial |
$1,801.40
|
| Rate for Payer: United Healthcare All Payer |
$1,651.28
|
|
|
PLATE NARROW 4.5MM 3H 70MM
|
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 3H 70MM
|
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 4.5MM 3X55MM
|
Facility
|
IP
|
$1,899.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.95 |
| Max. Negotiated Rate |
$1,823.84 |
| Rate for Payer: Aetna Commercial |
$1,462.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,481.87
|
| Rate for Payer: Cash Price |
$949.92
|
| Rate for Payer: Cigna Commercial |
$1,576.86
|
| Rate for Payer: First Health Commercial |
$1,804.84
|
| Rate for Payer: Humana Commercial |
$1,614.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,557.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,671.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,424.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,519.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,652.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,310.88
|
| Rate for Payer: PHCS Commercial |
$1,823.84
|
| Rate for Payer: United Healthcare All Payer |
$1,671.85
|
|
|
PLATE NARROW 4.5MM 3X55MM
|
Facility
|
OP
|
$1,899.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.95 |
| Max. Negotiated Rate |
$1,823.84 |
| Rate for Payer: Aetna Commercial |
$1,462.87
|
| Rate for Payer: Anthem Medicaid |
$653.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,481.87
|
| Rate for Payer: Cash Price |
$949.92
|
| Rate for Payer: Cigna Commercial |
$1,576.86
|
| Rate for Payer: First Health Commercial |
$1,804.84
|
| Rate for Payer: Humana Commercial |
$1,614.86
|
| Rate for Payer: Humana KY Medicaid |
$653.35
|
| Rate for Payer: Kentucky WC Medicaid |
$660.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,557.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,671.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,424.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,519.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,652.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,310.88
|
| Rate for Payer: PHCS Commercial |
$1,823.84
|
| Rate for Payer: United Healthcare All Payer |
$1,671.85
|
|
|
PLATE NARROW 4.5MM 4H 88MM
|
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 4H 88MM
|
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 4.5MM 4X71MM
|
Facility
|
IP
|
$1,899.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.95 |
| Max. Negotiated Rate |
$1,823.84 |
| Rate for Payer: Aetna Commercial |
$1,462.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,481.87
|
| Rate for Payer: Cash Price |
$949.92
|
| Rate for Payer: Cigna Commercial |
$1,576.86
|
| Rate for Payer: First Health Commercial |
$1,804.84
|
| Rate for Payer: Humana Commercial |
$1,614.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,557.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,671.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,424.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,519.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,652.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,310.88
|
| Rate for Payer: PHCS Commercial |
$1,823.84
|
| Rate for Payer: United Healthcare All Payer |
$1,671.85
|
|
|
PLATE NARROW 4.5MM 4X71MM
|
Facility
|
OP
|
$1,899.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.95 |
| Max. Negotiated Rate |
$1,823.84 |
| Rate for Payer: Aetna Commercial |
$1,462.87
|
| Rate for Payer: Anthem Medicaid |
$653.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,481.87
|
| Rate for Payer: Cash Price |
$949.92
|
| Rate for Payer: Cigna Commercial |
$1,576.86
|
| Rate for Payer: First Health Commercial |
$1,804.84
|
| Rate for Payer: Humana Commercial |
$1,614.86
|
| Rate for Payer: Humana KY Medicaid |
$653.35
|
| Rate for Payer: Kentucky WC Medicaid |
$660.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,557.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,671.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,424.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,519.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,652.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,310.88
|
| Rate for Payer: PHCS Commercial |
$1,823.84
|
| Rate for Payer: United Healthcare All Payer |
$1,671.85
|
|
|
PLATE NARROW 4.5MM 5H 106MM
|
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 4.5MM 5H 106MM
|
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 5X87MM
|
Facility
|
OP
|
$1,899.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.95 |
| Max. Negotiated Rate |
$1,823.84 |
| Rate for Payer: Aetna Commercial |
$1,462.87
|
| Rate for Payer: Anthem Medicaid |
$653.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,481.87
|
| Rate for Payer: Cash Price |
$949.92
|
| Rate for Payer: Cigna Commercial |
$1,576.86
|
| Rate for Payer: First Health Commercial |
$1,804.84
|
| Rate for Payer: Humana Commercial |
$1,614.86
|
| Rate for Payer: Humana KY Medicaid |
$653.35
|
| Rate for Payer: Kentucky WC Medicaid |
$660.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,557.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,671.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,424.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,519.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,652.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,310.88
|
| Rate for Payer: PHCS Commercial |
$1,823.84
|
| Rate for Payer: United Healthcare All Payer |
$1,671.85
|
|
