|
PLATE NARROW 4.5MM 5X87MM
|
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 6H 124MM
|
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 4.5MM 6H 124MM
|
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 4.5MM 6X103MM
|
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 6X103MM
|
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 7H 142MM
|
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 4.5MM 7H 142MM
|
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 4.5MM 7X119MM
|
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 7X119MM
|
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 8H 160MM
|
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 4.5MM 8H 160MM
|
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 4.5MM 8X135MM
|
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 8X135MM
|
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 9H 178MM
|
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 4.5MM 9H 178MM
|
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 4.5MM 9X151MM
|
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 9X151MM
|
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 CP 4.5MM 10X180MM
|
Facility
|
IP
|
$2,227.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.10 |
| Max. Negotiated Rate |
$2,137.93 |
| Rate for Payer: Aetna Commercial |
$1,714.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,737.07
|
| Rate for Payer: Cash Price |
$1,113.51
|
| Rate for Payer: Cigna Commercial |
$1,848.42
|
| Rate for Payer: First Health Commercial |
$2,115.66
|
| Rate for Payer: Humana Commercial |
$1,892.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,826.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,643.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$668.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,959.77
|
| Rate for Payer: Ohio Health Group HMO |
$1,670.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,781.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,937.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,536.64
|
| Rate for Payer: PHCS Commercial |
$2,137.93
|
| Rate for Payer: United Healthcare All Payer |
$1,959.77
|
|
|
PLATE NARROW CP 4.5MM 10X180MM
|
Facility
|
OP
|
$2,227.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.10 |
| Max. Negotiated Rate |
$2,137.93 |
| Rate for Payer: Aetna Commercial |
$1,714.80
|
| Rate for Payer: Anthem Medicaid |
$765.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,737.07
|
| Rate for Payer: Cash Price |
$1,113.51
|
| Rate for Payer: Cigna Commercial |
$1,848.42
|
| Rate for Payer: First Health Commercial |
$2,115.66
|
| Rate for Payer: Humana Commercial |
$1,892.96
|
| Rate for Payer: Humana KY Medicaid |
$765.87
|
| Rate for Payer: Kentucky WC Medicaid |
$773.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,826.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,643.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$668.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$781.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,959.77
|
| Rate for Payer: Ohio Health Group HMO |
$1,670.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,781.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,937.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,536.64
|
| Rate for Payer: PHCS Commercial |
$2,137.93
|
| Rate for Payer: United Healthcare All Payer |
$1,959.77
|
|
|
PLATE NARROW CP 4.5MM 11X198MM
|
Facility
|
OP
|
$2,227.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.10 |
| Max. Negotiated Rate |
$2,137.93 |
| Rate for Payer: Aetna Commercial |
$1,714.80
|
| Rate for Payer: Anthem Medicaid |
$765.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,737.07
|
| Rate for Payer: Cash Price |
$1,113.51
|
| Rate for Payer: Cigna Commercial |
$1,848.42
|
| Rate for Payer: First Health Commercial |
$2,115.66
|
| Rate for Payer: Humana Commercial |
$1,892.96
|
| Rate for Payer: Humana KY Medicaid |
$765.87
|
| Rate for Payer: Kentucky WC Medicaid |
$773.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,826.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,643.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$668.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$781.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,959.77
|
| Rate for Payer: Ohio Health Group HMO |
$1,670.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,781.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,937.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,536.64
|
| Rate for Payer: PHCS Commercial |
$2,137.93
|
| Rate for Payer: United Healthcare All Payer |
$1,959.77
|
|
|
PLATE NARROW CP 4.5MM 11X198MM
|
Facility
|
IP
|
$2,227.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.10 |
| Max. Negotiated Rate |
$2,137.93 |
| Rate for Payer: Aetna Commercial |
$1,714.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,737.07
|
| Rate for Payer: Cash Price |
$1,113.51
|
| Rate for Payer: Cigna Commercial |
$1,848.42
|
| Rate for Payer: First Health Commercial |
$2,115.66
|
| Rate for Payer: Humana Commercial |
$1,892.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,826.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,643.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$668.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,959.77
|
| Rate for Payer: Ohio Health Group HMO |
$1,670.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,781.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,937.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,536.64
|
| Rate for Payer: PHCS Commercial |
$2,137.93
|
| Rate for Payer: United Healthcare All Payer |
$1,959.77
|
|
|
PLATE NARROW CP 4.5MM 12X216MM
|
Facility
|
OP
|
$2,227.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.10 |
| Max. Negotiated Rate |
$2,137.93 |
| Rate for Payer: Aetna Commercial |
$1,714.80
|
| Rate for Payer: Anthem Medicaid |
$765.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,737.07
|
| Rate for Payer: Cash Price |
$1,113.51
|
| Rate for Payer: Cigna Commercial |
$1,848.42
|
| Rate for Payer: First Health Commercial |
$2,115.66
|
| Rate for Payer: Humana Commercial |
$1,892.96
|
| Rate for Payer: Humana KY Medicaid |
$765.87
|
| Rate for Payer: Kentucky WC Medicaid |
$773.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,826.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,643.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$668.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$781.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,959.77
|
| Rate for Payer: Ohio Health Group HMO |
$1,670.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,781.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,937.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,536.64
|
| Rate for Payer: PHCS Commercial |
$2,137.93
|
| Rate for Payer: United Healthcare All Payer |
$1,959.77
|
|
|
PLATE NARROW CP 4.5MM 12X216MM
|
Facility
|
IP
|
$2,227.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.10 |
| Max. Negotiated Rate |
$2,137.93 |
| Rate for Payer: Aetna Commercial |
$1,714.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,737.07
|
| Rate for Payer: Cash Price |
$1,113.51
|
| Rate for Payer: Cigna Commercial |
$1,848.42
|
| Rate for Payer: First Health Commercial |
$2,115.66
|
| Rate for Payer: Humana Commercial |
$1,892.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,826.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,643.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$668.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,959.77
|
| Rate for Payer: Ohio Health Group HMO |
$1,670.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,781.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,937.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,536.64
|
| Rate for Payer: PHCS Commercial |
$2,137.93
|
| Rate for Payer: United Healthcare All Payer |
$1,959.77
|
|
|
PLATE NARROW CP 4.5MM 13X234MM
|
Facility
|
OP
|
$3,322.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.67 |
| Max. Negotiated Rate |
$3,189.36 |
| Rate for Payer: Aetna Commercial |
$2,558.13
|
| Rate for Payer: Anthem Medicaid |
$1,142.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,591.36
|
| Rate for Payer: Cash Price |
$1,661.12
|
| Rate for Payer: Cigna Commercial |
$2,757.47
|
| Rate for Payer: First Health Commercial |
$3,156.14
|
| Rate for Payer: Humana Commercial |
$2,823.91
|
| Rate for Payer: Humana KY Medicaid |
$1,142.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,154.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,724.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,451.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,165.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,923.58
|
| Rate for Payer: Ohio Health Group HMO |
$2,491.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,657.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,890.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,292.35
|
| Rate for Payer: PHCS Commercial |
$3,189.36
|
| Rate for Payer: United Healthcare All Payer |
$2,923.58
|
|
|
PLATE NARROW CP 4.5MM 13X234MM
|
Facility
|
IP
|
$3,322.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.67 |
| Max. Negotiated Rate |
$3,189.36 |
| Rate for Payer: Aetna Commercial |
$2,558.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,591.36
|
| Rate for Payer: Cash Price |
$1,661.12
|
| Rate for Payer: Cigna Commercial |
$2,757.47
|
| Rate for Payer: First Health Commercial |
$3,156.14
|
| Rate for Payer: Humana Commercial |
$2,823.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,724.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,451.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,923.58
|
| Rate for Payer: Ohio Health Group HMO |
$2,491.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,657.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,890.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,292.35
|
| Rate for Payer: PHCS Commercial |
$3,189.36
|
| Rate for Payer: United Healthcare All Payer |
$2,923.58
|
|
