|
PLATE NARROW CP 4.5MM 14X252MM
|
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
|
|
|
PLATE NARROW CP 4.5MM 14X252MM
|
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 16X288MM
|
Facility
|
OP
|
$3,399.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,019.74 |
| Max. Negotiated Rate |
$3,263.16 |
| Rate for Payer: Aetna Commercial |
$2,617.32
|
| Rate for Payer: Anthem Medicaid |
$1,168.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,651.31
|
| Rate for Payer: Cash Price |
$1,699.56
|
| Rate for Payer: Cigna Commercial |
$2,821.27
|
| Rate for Payer: First Health Commercial |
$3,229.16
|
| Rate for Payer: Humana Commercial |
$2,889.25
|
| Rate for Payer: Humana KY Medicaid |
$1,168.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,180.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,787.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,508.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,019.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,192.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,991.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,549.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,719.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,957.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,345.39
|
| Rate for Payer: PHCS Commercial |
$3,263.16
|
| Rate for Payer: United Healthcare All Payer |
$2,991.23
|
|
|
PLATE NARROW CP 4.5MM 16X288MM
|
Facility
|
IP
|
$3,399.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,019.74 |
| Max. Negotiated Rate |
$3,263.16 |
| Rate for Payer: Aetna Commercial |
$2,617.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,651.31
|
| Rate for Payer: Cash Price |
$1,699.56
|
| Rate for Payer: Cigna Commercial |
$2,821.27
|
| Rate for Payer: First Health Commercial |
$3,229.16
|
| Rate for Payer: Humana Commercial |
$2,889.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,787.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,508.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,019.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,991.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,549.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,719.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,957.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,345.39
|
| Rate for Payer: PHCS Commercial |
$3,263.16
|
| Rate for Payer: United Healthcare All Payer |
$2,991.23
|
|
|
PLATE NARROW CP 4.5MM 18X329MM
|
Facility
|
IP
|
$4,052.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.77 |
| Max. Negotiated Rate |
$3,890.46 |
| Rate for Payer: Aetna Commercial |
$3,120.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,161.00
|
| Rate for Payer: Cash Price |
$2,026.28
|
| Rate for Payer: Cigna Commercial |
$3,363.62
|
| Rate for Payer: First Health Commercial |
$3,849.93
|
| Rate for Payer: Humana Commercial |
$3,444.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,323.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,990.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,215.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,566.25
|
| Rate for Payer: Ohio Health Group HMO |
$3,039.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,242.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,525.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,796.27
|
| Rate for Payer: PHCS Commercial |
$3,890.46
|
| Rate for Payer: United Healthcare All Payer |
$3,566.25
|
|
|
PLATE NARROW CP 4.5MM 18X329MM
|
Facility
|
OP
|
$4,052.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.77 |
| Max. Negotiated Rate |
$3,890.46 |
| Rate for Payer: Aetna Commercial |
$3,120.47
|
| Rate for Payer: Anthem Medicaid |
$1,393.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,161.00
|
| Rate for Payer: Cash Price |
$2,026.28
|
| Rate for Payer: Cigna Commercial |
$3,363.62
|
| Rate for Payer: First Health Commercial |
$3,849.93
|
| Rate for Payer: Humana Commercial |
$3,444.68
|
| Rate for Payer: Humana KY Medicaid |
$1,393.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,407.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,323.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,990.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,215.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,421.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,566.25
|
| Rate for Payer: Ohio Health Group HMO |
$3,039.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,242.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,525.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,796.27
|
| Rate for Payer: PHCS Commercial |
$3,890.46
|
| Rate for Payer: United Healthcare All Payer |
$3,566.25
|
|
|
PLATE NARROW CP 4.5MM 2X36MM
|
Facility
|
OP
|
$2,079.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.70 |
| Max. Negotiated Rate |
$1,995.84 |
| Rate for Payer: Aetna Commercial |
$1,600.83
|
| Rate for Payer: Anthem Medicaid |
$714.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,621.62
|
| Rate for Payer: Cash Price |
$1,039.50
|
| Rate for Payer: Cigna Commercial |
$1,725.57
|
| Rate for Payer: First Health Commercial |
$1,975.05
|
| Rate for Payer: Humana Commercial |
$1,767.15
|
| Rate for Payer: Humana KY Medicaid |
$714.97
|
| Rate for Payer: Kentucky WC Medicaid |
$722.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,704.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,534.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$623.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$729.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,829.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,559.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,663.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,808.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,434.51
|
| Rate for Payer: PHCS Commercial |
$1,995.84
|
| Rate for Payer: United Healthcare All Payer |
$1,829.52
|
|
|
PLATE NARROW CP 4.5MM 2X36MM
|
Facility
|
IP
|
$2,079.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.70 |
| Max. Negotiated Rate |
$1,995.84 |
| Rate for Payer: Aetna Commercial |
$1,600.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,621.62
|
| Rate for Payer: Cash Price |
$1,039.50
|
| Rate for Payer: Cigna Commercial |
$1,725.57
|
| Rate for Payer: First Health Commercial |
$1,975.05
|
| Rate for Payer: Humana Commercial |
$1,767.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,704.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,534.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$623.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,829.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,559.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,663.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,808.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,434.51
|
| Rate for Payer: PHCS Commercial |
$1,995.84
|
| Rate for Payer: United Healthcare All Payer |
$1,829.52
|
|
|
PLATE NARROW CP 4.5MM 3X54MM
|
Facility
|
OP
|
$1,930.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.30 |
| Max. Negotiated Rate |
$1,853.75 |
| Rate for Payer: Aetna Commercial |
$1,486.86
|
| Rate for Payer: Anthem Medicaid |
$664.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.17
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.72
|
| Rate for Payer: First Health Commercial |
$1,834.44
|
| Rate for Payer: Humana Commercial |
$1,641.34
|
| Rate for Payer: Humana KY Medicaid |
$664.07
|
| Rate for Payer: Kentucky WC Medicaid |
$670.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.38
|
| Rate for Payer: PHCS Commercial |
$1,853.75
|
| Rate for Payer: United Healthcare All Payer |
$1,699.27
|
|
|
PLATE NARROW CP 4.5MM 3X54MM
|
Facility
|
IP
|
$1,930.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.30 |
| Max. Negotiated Rate |
$1,853.75 |
| Rate for Payer: Aetna Commercial |
$1,486.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.17
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.72
|
| Rate for Payer: First Health Commercial |
$1,834.44
|
| Rate for Payer: Humana Commercial |
$1,641.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.38
|
| Rate for Payer: PHCS Commercial |
$1,853.75
|
| Rate for Payer: United Healthcare All Payer |
$1,699.27
|
|
|
PLATE NARROW CP 4.5MM 4X72MM
|
Facility
|
OP
|
$1,930.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.30 |
| Max. Negotiated Rate |
$1,853.75 |
| Rate for Payer: Aetna Commercial |
$1,486.86
|
| Rate for Payer: Anthem Medicaid |
$664.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.17
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.72
|
| Rate for Payer: First Health Commercial |
$1,834.44
|
| Rate for Payer: Humana Commercial |
$1,641.34
|
| Rate for Payer: Humana KY Medicaid |
$664.07
|
| Rate for Payer: Kentucky WC Medicaid |
$670.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.38
|
| Rate for Payer: PHCS Commercial |
$1,853.75
|
| Rate for Payer: United Healthcare All Payer |
$1,699.27
|
|
|
PLATE NARROW CP 4.5MM 4X72MM
|
Facility
|
IP
|
$1,930.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.30 |
| Max. Negotiated Rate |
$1,853.75 |
| Rate for Payer: Aetna Commercial |
$1,486.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.17
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.72
|
| Rate for Payer: First Health Commercial |
$1,834.44
|
| Rate for Payer: Humana Commercial |
$1,641.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.38
|
| Rate for Payer: PHCS Commercial |
$1,853.75
|
| Rate for Payer: United Healthcare All Payer |
$1,699.27
|
|
|
PLATE NARROW CP 4.5MM 5X90MM
|
Facility
|
OP
|
$1,930.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.30 |
| Max. Negotiated Rate |
$1,853.75 |
| Rate for Payer: Aetna Commercial |
$1,486.86
|
| Rate for Payer: Anthem Medicaid |
$664.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.17
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.72
|
| Rate for Payer: First Health Commercial |
$1,834.44
|
| Rate for Payer: Humana Commercial |
$1,641.34
|
| Rate for Payer: Humana KY Medicaid |
$664.07
|
| Rate for Payer: Kentucky WC Medicaid |
$670.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.38
|
| Rate for Payer: PHCS Commercial |
$1,853.75
|
| Rate for Payer: United Healthcare All Payer |
$1,699.27
|
|
|
PLATE NARROW CP 4.5MM 5X90MM
|
Facility
|
IP
|
$1,930.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.30 |
| Max. Negotiated Rate |
$1,853.75 |
| Rate for Payer: Aetna Commercial |
$1,486.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.17
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.72
|
| Rate for Payer: First Health Commercial |
$1,834.44
|
| Rate for Payer: Humana Commercial |
$1,641.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.38
|
| Rate for Payer: PHCS Commercial |
$1,853.75
|
| Rate for Payer: United Healthcare All Payer |
$1,699.27
|
|
|
PLATE NARROW CP 4.5MM 6X108MM
|
Facility
|
OP
|
$2,024.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.34 |
| Max. Negotiated Rate |
$1,943.49 |
| Rate for Payer: Aetna Commercial |
$1,558.84
|
| Rate for Payer: Anthem Medicaid |
$696.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,579.09
|
| Rate for Payer: Cash Price |
$1,012.24
|
| Rate for Payer: Cigna Commercial |
$1,680.31
|
| Rate for Payer: First Health Commercial |
$1,923.25
|
| Rate for Payer: Humana Commercial |
$1,720.80
|
| Rate for Payer: Humana KY Medicaid |
$696.22
|
| Rate for Payer: Kentucky WC Medicaid |
$703.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,660.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,494.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,761.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.88
|
| Rate for Payer: PHCS Commercial |
$1,943.49
|
| Rate for Payer: United Healthcare All Payer |
$1,781.53
|
|
|
PLATE NARROW CP 4.5MM 6X108MM
|
Facility
|
IP
|
$2,024.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.34 |
| Max. Negotiated Rate |
$1,943.49 |
| Rate for Payer: Aetna Commercial |
$1,558.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,579.09
|
| Rate for Payer: Cash Price |
$1,012.24
|
| Rate for Payer: Cigna Commercial |
$1,680.31
|
| Rate for Payer: First Health Commercial |
$1,923.25
|
| Rate for Payer: Humana Commercial |
$1,720.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,660.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,494.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,761.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.88
|
| Rate for Payer: PHCS Commercial |
$1,943.49
|
| Rate for Payer: United Healthcare All Payer |
$1,781.53
|
|
|
PLATE NARROW CP 4.5MM 7X126MM
|
Facility
|
IP
|
$2,024.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.34 |
| Max. Negotiated Rate |
$1,943.49 |
| Rate for Payer: Aetna Commercial |
$1,558.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,579.09
|
| Rate for Payer: Cash Price |
$1,012.24
|
| Rate for Payer: Cigna Commercial |
$1,680.31
|
| Rate for Payer: First Health Commercial |
$1,923.25
|
| Rate for Payer: Humana Commercial |
$1,720.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,660.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,494.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,761.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.88
|
| Rate for Payer: PHCS Commercial |
$1,943.49
|
| Rate for Payer: United Healthcare All Payer |
$1,781.53
|
|
|
PLATE NARROW CP 4.5MM 7X126MM
|
Facility
|
OP
|
$2,024.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.34 |
| Max. Negotiated Rate |
$1,943.49 |
| Rate for Payer: Aetna Commercial |
$1,558.84
|
| Rate for Payer: Anthem Medicaid |
$696.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,579.09
|
| Rate for Payer: Cash Price |
$1,012.24
|
| Rate for Payer: Cigna Commercial |
$1,680.31
|
| Rate for Payer: First Health Commercial |
$1,923.25
|
| Rate for Payer: Humana Commercial |
$1,720.80
|
| Rate for Payer: Humana KY Medicaid |
$696.22
|
| Rate for Payer: Kentucky WC Medicaid |
$703.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,660.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,494.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,761.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.88
|
| Rate for Payer: PHCS Commercial |
$1,943.49
|
| Rate for Payer: United Healthcare All Payer |
$1,781.53
|
|
|
PLATE NARROW CP 4.5MM 8X144MM
|
Facility
|
IP
|
$2,024.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.34 |
| Max. Negotiated Rate |
$1,943.49 |
| Rate for Payer: Aetna Commercial |
$1,558.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,579.09
|
| Rate for Payer: Cash Price |
$1,012.24
|
| Rate for Payer: Cigna Commercial |
$1,680.31
|
| Rate for Payer: First Health Commercial |
$1,923.25
|
| Rate for Payer: Humana Commercial |
$1,720.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,660.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,494.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,761.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.88
|
| Rate for Payer: PHCS Commercial |
$1,943.49
|
| Rate for Payer: United Healthcare All Payer |
$1,781.53
|
|
|
PLATE NARROW CP 4.5MM 8X144MM
|
Facility
|
OP
|
$2,024.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.34 |
| Max. Negotiated Rate |
$1,943.49 |
| Rate for Payer: Aetna Commercial |
$1,558.84
|
| Rate for Payer: Anthem Medicaid |
$696.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,579.09
|
| Rate for Payer: Cash Price |
$1,012.24
|
| Rate for Payer: Cigna Commercial |
$1,680.31
|
| Rate for Payer: First Health Commercial |
$1,923.25
|
| Rate for Payer: Humana Commercial |
$1,720.80
|
| Rate for Payer: Humana KY Medicaid |
$696.22
|
| Rate for Payer: Kentucky WC Medicaid |
$703.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,660.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,494.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,761.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.88
|
| Rate for Payer: PHCS Commercial |
$1,943.49
|
| Rate for Payer: United Healthcare All Payer |
$1,781.53
|
|
|
PLATE NARROW CP 4.5MM 9X162MM
|
Facility
|
IP
|
$2,024.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.34 |
| Max. Negotiated Rate |
$1,943.49 |
| Rate for Payer: Aetna Commercial |
$1,558.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,579.09
|
| Rate for Payer: Cash Price |
$1,012.24
|
| Rate for Payer: Cigna Commercial |
$1,680.31
|
| Rate for Payer: First Health Commercial |
$1,923.25
|
| Rate for Payer: Humana Commercial |
$1,720.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,660.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,494.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,761.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.88
|
| Rate for Payer: PHCS Commercial |
$1,943.49
|
| Rate for Payer: United Healthcare All Payer |
$1,781.53
|
|
|
PLATE NARROW CP 4.5MM 9X162MM
|
Facility
|
OP
|
$2,024.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.34 |
| Max. Negotiated Rate |
$1,943.49 |
| Rate for Payer: Aetna Commercial |
$1,558.84
|
| Rate for Payer: Anthem Medicaid |
$696.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,579.09
|
| Rate for Payer: Cash Price |
$1,012.24
|
| Rate for Payer: Cigna Commercial |
$1,680.31
|
| Rate for Payer: First Health Commercial |
$1,923.25
|
| Rate for Payer: Humana Commercial |
$1,720.80
|
| Rate for Payer: Humana KY Medicaid |
$696.22
|
| Rate for Payer: Kentucky WC Medicaid |
$703.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,660.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,494.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,761.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.88
|
| Rate for Payer: PHCS Commercial |
$1,943.49
|
| Rate for Payer: United Healthcare All Payer |
$1,781.53
|
|
|
PLATE NARROW LCK CMP 4.5 10H
|
Facility
|
OP
|
$3,410.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.00 |
| Max. Negotiated Rate |
$3,273.60 |
| Rate for Payer: Aetna Commercial |
$2,625.70
|
| Rate for Payer: Anthem Medicaid |
$1,172.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,659.80
|
| Rate for Payer: Cash Price |
$1,705.00
|
| Rate for Payer: Cigna Commercial |
$2,830.30
|
| Rate for Payer: First Health Commercial |
$3,239.50
|
| Rate for Payer: Humana Commercial |
$2,898.50
|
| Rate for Payer: Humana KY Medicaid |
$1,172.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,184.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,796.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,516.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,196.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,000.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,557.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,966.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,352.90
|
| Rate for Payer: PHCS Commercial |
$3,273.60
|
| Rate for Payer: United Healthcare All Payer |
$3,000.80
|
|
|
PLATE NARROW LCK CMP 4.5 10H
|
Facility
|
IP
|
$3,410.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.00 |
| Max. Negotiated Rate |
$3,273.60 |
| Rate for Payer: Aetna Commercial |
$2,625.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,659.80
|
| Rate for Payer: Cash Price |
$1,705.00
|
| Rate for Payer: Cigna Commercial |
$2,830.30
|
| Rate for Payer: First Health Commercial |
$3,239.50
|
| Rate for Payer: Humana Commercial |
$2,898.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,796.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,516.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,000.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,557.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,966.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,352.90
|
| Rate for Payer: PHCS Commercial |
$3,273.60
|
| Rate for Payer: United Healthcare All Payer |
$3,000.80
|
|
|
PLATE NARROW LCK CMP 4.5 12H
|
Facility
|
IP
|
$3,650.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,095.00 |
| Max. Negotiated Rate |
$3,504.00 |
| Rate for Payer: Aetna Commercial |
$2,810.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,847.00
|
| Rate for Payer: Cash Price |
$1,825.00
|
| Rate for Payer: Cigna Commercial |
$3,029.50
|
| Rate for Payer: First Health Commercial |
$3,467.50
|
| Rate for Payer: Humana Commercial |
$3,102.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,993.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,693.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,212.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,737.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,518.50
|
| Rate for Payer: PHCS Commercial |
$3,504.00
|
| Rate for Payer: United Healthcare All Payer |
$3,212.00
|
|
