|
PLATE 4.5 BROAD LCP 14H 260MM
|
Facility
|
OP
|
$4,351.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.70 |
| Max. Negotiated Rate |
$4,177.50 |
| Rate for Payer: Aetna Commercial |
$3,350.70
|
| Rate for Payer: Anthem Medicaid |
$1,496.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,394.22
|
| Rate for Payer: Cash Price |
$2,175.78
|
| Rate for Payer: Cigna Commercial |
$3,611.79
|
| Rate for Payer: First Health Commercial |
$4,133.98
|
| Rate for Payer: Humana Commercial |
$3,698.83
|
| Rate for Payer: Humana KY Medicaid |
$1,496.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,511.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,568.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,211.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,305.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,526.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,829.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,263.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$870.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,348.98
|
| Rate for Payer: PHCS Commercial |
$4,177.50
|
| Rate for Payer: United Healthcare All Payer |
$3,829.37
|
|
|
PLATE 4.5 BROAD LCP 14H 260MM
|
Facility
|
IP
|
$4,351.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.70 |
| Max. Negotiated Rate |
$4,177.50 |
| Rate for Payer: Aetna Commercial |
$3,350.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,394.22
|
| Rate for Payer: Cash Price |
$2,175.78
|
| Rate for Payer: Cigna Commercial |
$3,611.79
|
| Rate for Payer: First Health Commercial |
$4,133.98
|
| Rate for Payer: Humana Commercial |
$3,698.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,568.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,211.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,305.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,829.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,263.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$870.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,348.98
|
| Rate for Payer: PHCS Commercial |
$4,177.50
|
| Rate for Payer: United Healthcare All Payer |
$3,829.37
|
|
|
PLATE 4.5 BROAD LCP 16H 296MM
|
Facility
|
IP
|
$4,820.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$626.64 |
| Max. Negotiated Rate |
$4,627.46 |
| Rate for Payer: Aetna Commercial |
$3,711.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,759.81
|
| Rate for Payer: Cash Price |
$2,410.14
|
| Rate for Payer: Cigna Commercial |
$4,000.82
|
| Rate for Payer: First Health Commercial |
$4,579.26
|
| Rate for Payer: Humana Commercial |
$4,097.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,952.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,557.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,446.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,241.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,615.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$626.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,494.28
|
| Rate for Payer: PHCS Commercial |
$4,627.46
|
| Rate for Payer: United Healthcare All Payer |
$4,241.84
|
|
|
PLATE 4.5 BROAD LCP 16H 296MM
|
Facility
|
OP
|
$4,820.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$626.64 |
| Max. Negotiated Rate |
$4,627.46 |
| Rate for Payer: Aetna Commercial |
$3,711.61
|
| Rate for Payer: Anthem Medicaid |
$1,657.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,759.81
|
| Rate for Payer: Cash Price |
$2,410.14
|
| Rate for Payer: Cigna Commercial |
$4,000.82
|
| Rate for Payer: First Health Commercial |
$4,579.26
|
| Rate for Payer: Humana Commercial |
$4,097.23
|
| Rate for Payer: Humana KY Medicaid |
$1,657.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,674.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,952.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,557.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,446.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,690.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,241.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,615.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$626.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,494.28
|
| Rate for Payer: PHCS Commercial |
$4,627.46
|
| Rate for Payer: United Healthcare All Payer |
$4,241.84
|
|
|
PLATE 4.5 BROAD LCP 6H 116MM
|
Facility
|
OP
|
$3,404.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.57 |
| Max. Negotiated Rate |
$3,268.18 |
| Rate for Payer: Aetna Commercial |
$2,621.35
|
| Rate for Payer: Anthem Medicaid |
$1,170.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,655.39
|
| Rate for Payer: Cash Price |
$1,702.17
|
| Rate for Payer: Cigna Commercial |
$2,825.61
|
| Rate for Payer: First Health Commercial |
$3,234.13
|
| Rate for Payer: Humana Commercial |
$2,893.70
|
| Rate for Payer: Humana KY Medicaid |
$1,170.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,182.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,791.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,512.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,194.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,995.83
|
| Rate for Payer: Ohio Health Group HMO |
$2,553.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.35
|
| Rate for Payer: PHCS Commercial |
$3,268.18
|
| Rate for Payer: United Healthcare All Payer |
$2,995.83
|
|
|
PLATE 4.5 BROAD LCP 6H 116MM
|
Facility
|
IP
|
$3,404.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.57 |
| Max. Negotiated Rate |
$3,268.18 |
| Rate for Payer: Aetna Commercial |
$2,621.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,655.39
|
| Rate for Payer: Cash Price |
$1,702.17
|
| Rate for Payer: Cigna Commercial |
$2,825.61
|
| Rate for Payer: First Health Commercial |
$3,234.13
|
| Rate for Payer: Humana Commercial |
$2,893.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,791.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,512.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,995.83
|
| Rate for Payer: Ohio Health Group HMO |
$2,553.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.35
|
| Rate for Payer: PHCS Commercial |
$3,268.18
|
| Rate for Payer: United Healthcare All Payer |
$2,995.83
|
|
|
PLATE 4.5 BROAD LCP 7H 134MM
|
Facility
|
OP
|
$3,475.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.87 |
| Max. Negotiated Rate |
$3,336.92 |
| Rate for Payer: Aetna Commercial |
$2,676.49
|
| Rate for Payer: Anthem Medicaid |
$1,195.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,711.25
|
| Rate for Payer: Cash Price |
$1,737.98
|
| Rate for Payer: Cigna Commercial |
$2,885.05
|
| Rate for Payer: First Health Commercial |
$3,302.16
|
| Rate for Payer: Humana Commercial |
$2,954.57
|
| Rate for Payer: Humana KY Medicaid |
$1,195.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,207.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,850.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,565.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,042.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,219.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,058.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,606.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$695.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$451.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.55
|
| Rate for Payer: PHCS Commercial |
$3,336.92
|
| Rate for Payer: United Healthcare All Payer |
$3,058.84
|
|
|
PLATE 4.5 BROAD LCP 7H 134MM
|
Facility
|
IP
|
$3,475.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.87 |
| Max. Negotiated Rate |
$3,336.92 |
| Rate for Payer: Aetna Commercial |
$2,676.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,711.25
|
| Rate for Payer: Cash Price |
$1,737.98
|
| Rate for Payer: Cigna Commercial |
$2,885.05
|
| Rate for Payer: First Health Commercial |
$3,302.16
|
| Rate for Payer: Humana Commercial |
$2,954.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,850.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,565.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,042.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,058.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,606.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$695.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$451.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.55
|
| Rate for Payer: PHCS Commercial |
$3,336.92
|
| Rate for Payer: United Healthcare All Payer |
$3,058.84
|
|
|
PLATE 4.5 BROAD LCP 8H 152MM
|
Facility
|
OP
|
$3,664.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$476.42 |
| Max. Negotiated Rate |
$3,518.16 |
| Rate for Payer: Anthem Medicaid |
$1,260.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,858.50
|
| Rate for Payer: Cash Price |
$1,832.38
|
| Rate for Payer: Cigna Commercial |
$3,041.74
|
| Rate for Payer: First Health Commercial |
$3,481.51
|
| Rate for Payer: Humana Commercial |
$3,115.04
|
| Rate for Payer: Humana KY Medicaid |
$1,260.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,273.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,005.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,704.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,099.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,285.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,224.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,748.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$732.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,136.07
|
| Rate for Payer: PHCS Commercial |
$3,518.16
|
| Rate for Payer: United Healthcare All Payer |
$3,224.98
|
| Rate for Payer: Aetna Commercial |
$2,821.86
|
|
|
PLATE 4.5 BROAD LCP 8H 152MM
|
Facility
|
IP
|
$3,664.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$476.42 |
| Max. Negotiated Rate |
$3,518.16 |
| Rate for Payer: Aetna Commercial |
$2,821.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,858.50
|
| Rate for Payer: Cash Price |
$1,832.38
|
| Rate for Payer: Cigna Commercial |
$3,041.74
|
| Rate for Payer: First Health Commercial |
$3,481.51
|
| Rate for Payer: Humana Commercial |
$3,115.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,005.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,704.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,099.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,224.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,748.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$732.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,136.07
|
| Rate for Payer: PHCS Commercial |
$3,518.16
|
| Rate for Payer: United Healthcare All Payer |
$3,224.98
|
|
|
PLATE 4.5 BROAD LCP 9H 170MM
|
Facility
|
IP
|
$3,788.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$492.50 |
| Max. Negotiated Rate |
$3,636.90 |
| Rate for Payer: Aetna Commercial |
$2,917.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,954.98
|
| Rate for Payer: Cash Price |
$1,894.22
|
| Rate for Payer: Cigna Commercial |
$3,144.41
|
| Rate for Payer: First Health Commercial |
$3,599.02
|
| Rate for Payer: Humana Commercial |
$3,220.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,106.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,795.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,136.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,333.83
|
| Rate for Payer: Ohio Health Group HMO |
$2,841.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$757.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$492.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,174.42
|
| Rate for Payer: PHCS Commercial |
$3,636.90
|
| Rate for Payer: United Healthcare All Payer |
$3,333.83
|
|
|
PLATE 4.5 BROAD LCP 9H 170MM
|
Facility
|
OP
|
$3,788.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$492.50 |
| Max. Negotiated Rate |
$3,636.90 |
| Rate for Payer: Aetna Commercial |
$2,917.10
|
| Rate for Payer: Anthem Medicaid |
$1,302.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,954.98
|
| Rate for Payer: Cash Price |
$1,894.22
|
| Rate for Payer: Cigna Commercial |
$3,144.41
|
| Rate for Payer: First Health Commercial |
$3,599.02
|
| Rate for Payer: Humana Commercial |
$3,220.17
|
| Rate for Payer: Humana KY Medicaid |
$1,302.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,316.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,106.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,795.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,136.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,328.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,333.83
|
| Rate for Payer: Ohio Health Group HMO |
$2,841.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$757.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$492.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,174.42
|
| Rate for Payer: PHCS Commercial |
$3,636.90
|
| Rate for Payer: United Healthcare All Payer |
$3,333.83
|
|
|
PLATE 4.5 CVD BD LCP 12H 229M
|
Facility
|
OP
|
$4,126.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.50 |
| Max. Negotiated Rate |
$3,961.88 |
| Rate for Payer: Aetna Commercial |
$3,177.76
|
| Rate for Payer: Anthem Medicaid |
$1,419.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,219.03
|
| Rate for Payer: Cash Price |
$2,063.48
|
| Rate for Payer: Cigna Commercial |
$3,425.38
|
| Rate for Payer: First Health Commercial |
$3,920.61
|
| Rate for Payer: Humana Commercial |
$3,507.92
|
| Rate for Payer: Humana KY Medicaid |
$1,419.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,433.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,384.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,045.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,238.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,447.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,631.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,095.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,279.36
|
| Rate for Payer: PHCS Commercial |
$3,961.88
|
| Rate for Payer: United Healthcare All Payer |
$3,631.72
|
|
|
PLATE 4.5 CVD BD LCP 12H 229M
|
Facility
|
IP
|
$4,126.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.50 |
| Max. Negotiated Rate |
$3,961.88 |
| Rate for Payer: Aetna Commercial |
$3,177.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,219.03
|
| Rate for Payer: Cash Price |
$2,063.48
|
| Rate for Payer: Cigna Commercial |
$3,425.38
|
| Rate for Payer: First Health Commercial |
$3,920.61
|
| Rate for Payer: Humana Commercial |
$3,507.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,384.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,045.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,238.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,631.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,095.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,279.36
|
| Rate for Payer: PHCS Commercial |
$3,961.88
|
| Rate for Payer: United Healthcare All Payer |
$3,631.72
|
|
|
PLATE 4.5 CVD BD LCP 13H 247M
|
Facility
|
OP
|
$4,233.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$550.37 |
| Max. Negotiated Rate |
$4,064.29 |
| Rate for Payer: Aetna Commercial |
$3,259.90
|
| Rate for Payer: Anthem Medicaid |
$1,455.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,302.24
|
| Rate for Payer: Cash Price |
$2,116.82
|
| Rate for Payer: Cigna Commercial |
$3,513.92
|
| Rate for Payer: First Health Commercial |
$4,021.96
|
| Rate for Payer: Humana Commercial |
$3,598.59
|
| Rate for Payer: Humana KY Medicaid |
$1,455.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,470.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,471.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,124.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,270.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,485.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,725.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,175.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$846.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$550.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,312.43
|
| Rate for Payer: PHCS Commercial |
$4,064.29
|
| Rate for Payer: United Healthcare All Payer |
$3,725.60
|
|
|
PLATE 4.5 CVD BD LCP 13H 247M
|
Facility
|
IP
|
$4,233.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$550.37 |
| Max. Negotiated Rate |
$4,064.29 |
| Rate for Payer: Aetna Commercial |
$3,259.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,302.24
|
| Rate for Payer: Cash Price |
$2,116.82
|
| Rate for Payer: Cigna Commercial |
$3,513.92
|
| Rate for Payer: First Health Commercial |
$4,021.96
|
| Rate for Payer: Humana Commercial |
$3,598.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,471.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,124.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,270.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,725.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,175.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$846.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$550.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,312.43
|
| Rate for Payer: PHCS Commercial |
$4,064.29
|
| Rate for Payer: United Healthcare All Payer |
$3,725.60
|
|
|
PLATE 4.5 CVD BD LCP 14H 265M
|
Facility
|
IP
|
$4,351.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.70 |
| Max. Negotiated Rate |
$4,177.50 |
| Rate for Payer: Aetna Commercial |
$3,350.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,394.22
|
| Rate for Payer: Cash Price |
$2,175.78
|
| Rate for Payer: Cigna Commercial |
$3,611.79
|
| Rate for Payer: First Health Commercial |
$4,133.98
|
| Rate for Payer: Humana Commercial |
$3,698.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,568.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,211.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,305.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,829.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,263.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$870.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,348.98
|
| Rate for Payer: PHCS Commercial |
$4,177.50
|
| Rate for Payer: United Healthcare All Payer |
$3,829.37
|
|
|
PLATE 4.5 CVD BD LCP 14H 265M
|
Facility
|
OP
|
$4,351.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.70 |
| Max. Negotiated Rate |
$4,177.50 |
| Rate for Payer: Aetna Commercial |
$3,350.70
|
| Rate for Payer: Anthem Medicaid |
$1,496.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,394.22
|
| Rate for Payer: Cash Price |
$2,175.78
|
| Rate for Payer: Cigna Commercial |
$3,611.79
|
| Rate for Payer: First Health Commercial |
$4,133.98
|
| Rate for Payer: Humana Commercial |
$3,698.83
|
| Rate for Payer: Humana KY Medicaid |
$1,496.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,511.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,568.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,211.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,305.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,526.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,829.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,263.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$870.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,348.98
|
| Rate for Payer: PHCS Commercial |
$4,177.50
|
| Rate for Payer: United Healthcare All Payer |
$3,829.37
|
|
|
PLATE 4.5 CVD BD LCP 15H 282M
|
Facility
|
IP
|
$4,613.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.77 |
| Max. Negotiated Rate |
$4,429.09 |
| Rate for Payer: Aetna Commercial |
$3,552.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,598.64
|
| Rate for Payer: Cash Price |
$2,306.82
|
| Rate for Payer: Cigna Commercial |
$3,829.32
|
| Rate for Payer: First Health Commercial |
$4,382.96
|
| Rate for Payer: Humana Commercial |
$3,921.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,783.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,404.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,060.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,460.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$922.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.23
|
| Rate for Payer: PHCS Commercial |
$4,429.09
|
| Rate for Payer: United Healthcare All Payer |
$4,060.00
|
|
|
PLATE 4.5 CVD BD LCP 15H 282M
|
Facility
|
OP
|
$4,613.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.77 |
| Max. Negotiated Rate |
$4,429.09 |
| Rate for Payer: Aetna Commercial |
$3,552.50
|
| Rate for Payer: Anthem Medicaid |
$1,586.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,598.64
|
| Rate for Payer: Cash Price |
$2,306.82
|
| Rate for Payer: Cigna Commercial |
$3,829.32
|
| Rate for Payer: First Health Commercial |
$4,382.96
|
| Rate for Payer: Humana Commercial |
$3,921.59
|
| Rate for Payer: Humana KY Medicaid |
$1,586.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1,602.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,783.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,404.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,618.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,060.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,460.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$922.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.23
|
| Rate for Payer: PHCS Commercial |
$4,429.09
|
| Rate for Payer: United Healthcare All Payer |
$4,060.00
|
|
|
PLATE 4.5 CVD BD LCP 16H 300M
|
Facility
|
OP
|
$4,820.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$626.64 |
| Max. Negotiated Rate |
$4,627.46 |
| Rate for Payer: Aetna Commercial |
$3,711.61
|
| Rate for Payer: Anthem Medicaid |
$1,657.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,759.81
|
| Rate for Payer: Cash Price |
$2,410.14
|
| Rate for Payer: Cigna Commercial |
$4,000.82
|
| Rate for Payer: First Health Commercial |
$4,579.26
|
| Rate for Payer: Humana Commercial |
$4,097.23
|
| Rate for Payer: Humana KY Medicaid |
$1,657.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,674.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,952.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,557.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,446.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,690.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,241.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,615.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$626.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,494.28
|
| Rate for Payer: PHCS Commercial |
$4,627.46
|
| Rate for Payer: United Healthcare All Payer |
$4,241.84
|
|
|
PLATE 4.5 CVD BD LCP 16H 300M
|
Facility
|
IP
|
$4,820.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$626.64 |
| Max. Negotiated Rate |
$4,627.46 |
| Rate for Payer: Aetna Commercial |
$3,711.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,759.81
|
| Rate for Payer: Cash Price |
$2,410.14
|
| Rate for Payer: Cigna Commercial |
$4,000.82
|
| Rate for Payer: First Health Commercial |
$4,579.26
|
| Rate for Payer: Humana Commercial |
$4,097.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,952.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,557.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,446.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,241.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,615.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$626.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,494.28
|
| Rate for Payer: PHCS Commercial |
$4,627.46
|
| Rate for Payer: United Healthcare All Payer |
$4,241.84
|
|
|
PLATE 4.5 CVD BD LCP 17H 318M
|
Facility
|
IP
|
$5,002.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.33 |
| Max. Negotiated Rate |
$4,802.46 |
| Rate for Payer: Humana Commercial |
$4,252.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,102.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,691.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,402.25
|
| Rate for Payer: Ohio Health Group HMO |
$3,751.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.79
|
| Rate for Payer: PHCS Commercial |
$4,802.46
|
| Rate for Payer: United Healthcare All Payer |
$4,402.25
|
| Rate for Payer: Aetna Commercial |
$3,851.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,902.00
|
| Rate for Payer: Cash Price |
$2,501.28
|
| Rate for Payer: Cigna Commercial |
$4,152.12
|
| Rate for Payer: First Health Commercial |
$4,752.43
|
|
|
PLATE 4.5 CVD BD LCP 17H 318M
|
Facility
|
OP
|
$5,002.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.33 |
| Max. Negotiated Rate |
$4,802.46 |
| Rate for Payer: Aetna Commercial |
$3,851.97
|
| Rate for Payer: Anthem Medicaid |
$1,720.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,902.00
|
| Rate for Payer: Cash Price |
$2,501.28
|
| Rate for Payer: Cigna Commercial |
$4,152.12
|
| Rate for Payer: First Health Commercial |
$4,752.43
|
| Rate for Payer: Humana Commercial |
$4,252.18
|
| Rate for Payer: Humana KY Medicaid |
$1,720.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,102.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,691.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,402.25
|
| Rate for Payer: Ohio Health Group HMO |
$3,751.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.79
|
| Rate for Payer: PHCS Commercial |
$4,802.46
|
| Rate for Payer: United Healthcare All Payer |
$4,402.25
|
|
|
PLATE 4.5 CVD BD LCP 18H 336M
|
Facility
|
OP
|
$5,181.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.61 |
| Max. Negotiated Rate |
$4,974.32 |
| Rate for Payer: Aetna Commercial |
$3,989.82
|
| Rate for Payer: Anthem Medicaid |
$1,781.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,041.63
|
| Rate for Payer: Cash Price |
$2,590.79
|
| Rate for Payer: Cigna Commercial |
$4,300.71
|
| Rate for Payer: First Health Commercial |
$4,922.50
|
| Rate for Payer: Humana Commercial |
$4,404.34
|
| Rate for Payer: Humana KY Medicaid |
$1,781.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,800.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,248.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,824.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,554.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,817.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,559.79
|
| Rate for Payer: Ohio Health Group HMO |
$3,886.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,036.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$673.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,606.29
|
| Rate for Payer: PHCS Commercial |
$4,974.32
|
| Rate for Payer: United Healthcare All Payer |
$4,559.79
|
|
