|
PLATE 4.5 CVD BD LCP 18H 336M
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE 4.5 NAR LCP 10H 188MM
|
Facility
|
IP
|
$3,654.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$475.15 |
| Max. Negotiated Rate |
$3,508.79 |
| Rate for Payer: Aetna Commercial |
$2,814.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,850.89
|
| Rate for Payer: Cash Price |
$1,827.49
|
| Rate for Payer: Cigna Commercial |
$3,033.64
|
| Rate for Payer: First Health Commercial |
$3,472.24
|
| Rate for Payer: Humana Commercial |
$3,106.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,997.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,697.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,096.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,216.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,741.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$731.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,133.05
|
| Rate for Payer: PHCS Commercial |
$3,508.79
|
| Rate for Payer: United Healthcare All Payer |
$3,216.39
|
|
|
PLATE 4.5 NAR LCP 10H 188MM
|
Facility
|
OP
|
$3,654.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$475.15 |
| Max. Negotiated Rate |
$3,508.79 |
| Rate for Payer: Aetna Commercial |
$2,814.34
|
| Rate for Payer: Anthem Medicaid |
$1,256.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,850.89
|
| Rate for Payer: Cash Price |
$1,827.49
|
| Rate for Payer: Cigna Commercial |
$3,033.64
|
| Rate for Payer: First Health Commercial |
$3,472.24
|
| Rate for Payer: Humana Commercial |
$3,106.74
|
| Rate for Payer: Humana KY Medicaid |
$1,256.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,269.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,997.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,697.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,096.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,282.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,216.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,741.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$731.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,133.05
|
| Rate for Payer: PHCS Commercial |
$3,508.79
|
| Rate for Payer: United Healthcare All Payer |
$3,216.39
|
|
|
PLATE 4.5 NAR LCP 11H 206MM
|
Facility
|
IP
|
$3,768.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.96 |
| Max. Negotiated Rate |
$3,618.15 |
| Rate for Payer: Aetna Commercial |
$2,902.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,939.75
|
| Rate for Payer: Cash Price |
$1,884.45
|
| Rate for Payer: Cigna Commercial |
$3,128.20
|
| Rate for Payer: First Health Commercial |
$3,580.46
|
| Rate for Payer: Humana Commercial |
$3,203.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,090.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,781.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,130.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,316.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,826.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$753.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$489.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,168.36
|
| Rate for Payer: PHCS Commercial |
$3,618.15
|
| Rate for Payer: United Healthcare All Payer |
$3,316.64
|
|
|
PLATE 4.5 NAR LCP 11H 206MM
|
Facility
|
OP
|
$3,768.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.96 |
| Max. Negotiated Rate |
$3,618.15 |
| Rate for Payer: Aetna Commercial |
$2,902.06
|
| Rate for Payer: Anthem Medicaid |
$1,296.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,939.75
|
| Rate for Payer: Cash Price |
$1,884.45
|
| Rate for Payer: Cigna Commercial |
$3,128.20
|
| Rate for Payer: First Health Commercial |
$3,580.46
|
| Rate for Payer: Humana Commercial |
$3,203.57
|
| Rate for Payer: Humana KY Medicaid |
$1,296.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,309.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,090.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,781.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,130.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,322.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,316.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,826.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$753.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$489.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,168.36
|
| Rate for Payer: PHCS Commercial |
$3,618.15
|
| Rate for Payer: United Healthcare All Payer |
$3,316.64
|
|
|
PLATE 4.5 NAR LCP 12H 224MM
|
Facility
|
IP
|
$3,882.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.77 |
| Max. Negotiated Rate |
$3,727.53 |
| Rate for Payer: Aetna Commercial |
$2,989.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,028.62
|
| Rate for Payer: Cash Price |
$1,941.42
|
| Rate for Payer: Cigna Commercial |
$3,222.76
|
| Rate for Payer: First Health Commercial |
$3,688.70
|
| Rate for Payer: Humana Commercial |
$3,300.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,183.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,416.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,203.68
|
| Rate for Payer: PHCS Commercial |
$3,727.53
|
| Rate for Payer: United Healthcare All Payer |
$3,416.90
|
|
|
PLATE 4.5 NAR LCP 12H 224MM
|
Facility
|
OP
|
$3,882.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.77 |
| Max. Negotiated Rate |
$3,727.53 |
| Rate for Payer: Humana Commercial |
$3,300.41
|
| Rate for Payer: Humana KY Medicaid |
$1,335.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,348.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,183.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,362.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,416.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,203.68
|
| Rate for Payer: PHCS Commercial |
$3,727.53
|
| Rate for Payer: United Healthcare All Payer |
$3,416.90
|
| Rate for Payer: Aetna Commercial |
$2,989.79
|
| Rate for Payer: Anthem Medicaid |
$1,335.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,028.62
|
| Rate for Payer: Cash Price |
$1,941.42
|
| Rate for Payer: Cigna Commercial |
$3,222.76
|
| Rate for Payer: First Health Commercial |
$3,688.70
|
|
|
PLATE 4.5 NAR LCP 14H 260MM
|
Facility
|
OP
|
$3,882.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.77 |
| Max. Negotiated Rate |
$3,727.53 |
| Rate for Payer: Aetna Commercial |
$2,989.79
|
| Rate for Payer: Anthem Medicaid |
$1,335.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,028.62
|
| Rate for Payer: Cash Price |
$1,941.42
|
| Rate for Payer: Cigna Commercial |
$3,222.76
|
| Rate for Payer: First Health Commercial |
$3,688.70
|
| Rate for Payer: Humana Commercial |
$3,300.41
|
| Rate for Payer: Humana KY Medicaid |
$1,335.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,348.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,183.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,362.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,416.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,203.68
|
| Rate for Payer: PHCS Commercial |
$3,727.53
|
| Rate for Payer: United Healthcare All Payer |
$3,416.90
|
|
|
PLATE 4.5 NAR LCP 14H 260MM
|
Facility
|
IP
|
$3,882.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.77 |
| Max. Negotiated Rate |
$3,727.53 |
| Rate for Payer: Aetna Commercial |
$2,989.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,028.62
|
| Rate for Payer: Cash Price |
$1,941.42
|
| Rate for Payer: Cigna Commercial |
$3,222.76
|
| Rate for Payer: First Health Commercial |
$3,688.70
|
| Rate for Payer: Humana Commercial |
$3,300.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,183.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,416.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,203.68
|
| Rate for Payer: PHCS Commercial |
$3,727.53
|
| Rate for Payer: United Healthcare All Payer |
$3,416.90
|
|
|
PLATE 4.5 NAR LCP 16H 296MM
|
Facility
|
OP
|
$4,110.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.39 |
| Max. Negotiated Rate |
$3,946.26 |
| Rate for Payer: Aetna Commercial |
$3,165.23
|
| Rate for Payer: Anthem Medicaid |
$1,413.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,206.34
|
| Rate for Payer: Cash Price |
$2,055.34
|
| Rate for Payer: Cigna Commercial |
$3,411.87
|
| Rate for Payer: First Health Commercial |
$3,905.16
|
| Rate for Payer: Humana Commercial |
$3,494.09
|
| Rate for Payer: Humana KY Medicaid |
$1,413.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,428.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,370.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,033.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,233.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,442.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,617.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,083.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$822.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$534.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,274.31
|
| Rate for Payer: PHCS Commercial |
$3,946.26
|
| Rate for Payer: United Healthcare All Payer |
$3,617.41
|
|
|
PLATE 4.5 NAR LCP 16H 296MM
|
Facility
|
IP
|
$4,110.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.39 |
| Max. Negotiated Rate |
$3,946.26 |
| Rate for Payer: Aetna Commercial |
$3,165.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,206.34
|
| Rate for Payer: Cash Price |
$2,055.34
|
| Rate for Payer: Cigna Commercial |
$3,411.87
|
| Rate for Payer: First Health Commercial |
$3,905.16
|
| Rate for Payer: Humana Commercial |
$3,494.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,370.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,033.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,233.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,617.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,083.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$822.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$534.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,274.31
|
| Rate for Payer: PHCS Commercial |
$3,946.26
|
| Rate for Payer: United Healthcare All Payer |
$3,617.41
|
|
|
PLATE 4.5 NAR LCP 4H 80MM
|
Facility
|
OP
|
$3,114.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.91 |
| Max. Negotiated Rate |
$2,990.07 |
| Rate for Payer: Aetna Commercial |
$2,398.29
|
| Rate for Payer: Anthem Medicaid |
$1,071.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,429.43
|
| Rate for Payer: Cash Price |
$1,557.33
|
| Rate for Payer: Cigna Commercial |
$2,585.17
|
| Rate for Payer: First Health Commercial |
$2,958.93
|
| Rate for Payer: Humana Commercial |
$2,647.46
|
| Rate for Payer: Humana KY Medicaid |
$1,071.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,082.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,554.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,298.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$934.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,092.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,740.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,336.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$965.54
|
| Rate for Payer: PHCS Commercial |
$2,990.07
|
| Rate for Payer: United Healthcare All Payer |
$2,740.90
|
|
|
PLATE 4.5 NAR LCP 4H 80MM
|
Facility
|
IP
|
$3,114.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.91 |
| Max. Negotiated Rate |
$2,990.07 |
| Rate for Payer: Aetna Commercial |
$2,398.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,429.43
|
| Rate for Payer: Cash Price |
$1,557.33
|
| Rate for Payer: Cigna Commercial |
$2,585.17
|
| Rate for Payer: First Health Commercial |
$2,958.93
|
| Rate for Payer: Humana Commercial |
$2,647.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,554.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,298.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$934.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,740.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,336.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$965.54
|
| Rate for Payer: PHCS Commercial |
$2,990.07
|
| Rate for Payer: United Healthcare All Payer |
$2,740.90
|
|
|
PLATE 4.5 NAR LCP 5H 98MM
|
Facility
|
IP
|
$3,183.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.79 |
| Max. Negotiated Rate |
$3,055.69 |
| Rate for Payer: Aetna Commercial |
$2,450.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,482.75
|
| Rate for Payer: Cash Price |
$1,591.51
|
| Rate for Payer: Cigna Commercial |
$2,641.90
|
| Rate for Payer: First Health Commercial |
$3,023.86
|
| Rate for Payer: Humana Commercial |
$2,705.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,610.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,349.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$954.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,801.05
|
| Rate for Payer: Ohio Health Group HMO |
$2,387.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$986.73
|
| Rate for Payer: PHCS Commercial |
$3,055.69
|
| Rate for Payer: United Healthcare All Payer |
$2,801.05
|
|
|
PLATE 4.5 NAR LCP 5H 98MM
|
Facility
|
OP
|
$3,183.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.79 |
| Max. Negotiated Rate |
$3,055.69 |
| Rate for Payer: Aetna Commercial |
$2,450.92
|
| Rate for Payer: Anthem Medicaid |
$1,094.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,482.75
|
| Rate for Payer: Cash Price |
$1,591.51
|
| Rate for Payer: Cigna Commercial |
$2,641.90
|
| Rate for Payer: First Health Commercial |
$3,023.86
|
| Rate for Payer: Humana Commercial |
$2,705.56
|
| Rate for Payer: Humana KY Medicaid |
$1,094.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,105.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,610.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,349.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$954.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,116.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,801.05
|
| Rate for Payer: Ohio Health Group HMO |
$2,387.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$986.73
|
| Rate for Payer: PHCS Commercial |
$3,055.69
|
| Rate for Payer: United Healthcare All Payer |
$2,801.05
|
|
|
PLATE 4.5 NAR LCP 6H 116MM
|
Facility
|
IP
|
$3,244.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.83 |
| Max. Negotiated Rate |
$3,115.07 |
| Rate for Payer: Aetna Commercial |
$2,498.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,530.99
|
| Rate for Payer: Cash Price |
$1,622.43
|
| Rate for Payer: Cigna Commercial |
$2,693.23
|
| Rate for Payer: First Health Commercial |
$3,082.62
|
| Rate for Payer: Humana Commercial |
$2,758.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,660.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,394.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,855.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,433.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$648.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$421.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,005.91
|
| Rate for Payer: PHCS Commercial |
$3,115.07
|
| Rate for Payer: United Healthcare All Payer |
$2,855.48
|
|
|
PLATE 4.5 NAR LCP 6H 116MM
|
Facility
|
OP
|
$3,244.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.83 |
| Max. Negotiated Rate |
$3,115.07 |
| Rate for Payer: Aetna Commercial |
$2,498.54
|
| Rate for Payer: Anthem Medicaid |
$1,115.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,530.99
|
| Rate for Payer: Cash Price |
$1,622.43
|
| Rate for Payer: Cigna Commercial |
$2,693.23
|
| Rate for Payer: First Health Commercial |
$3,082.62
|
| Rate for Payer: Humana Commercial |
$2,758.13
|
| Rate for Payer: Humana KY Medicaid |
$1,115.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,127.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,660.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,394.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,138.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,855.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,433.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$648.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$421.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,005.91
|
| Rate for Payer: PHCS Commercial |
$3,115.07
|
| Rate for Payer: United Healthcare All Payer |
$2,855.48
|
|
|
PLATE 4.5 NAR LCP 7H 134MM
|
Facility
|
IP
|
$3,410.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$443.41 |
| Max. Negotiated Rate |
$3,274.43 |
| Rate for Payer: Aetna Commercial |
$2,626.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,660.47
|
| Rate for Payer: Cash Price |
$1,705.43
|
| Rate for Payer: Cigna Commercial |
$2,831.01
|
| Rate for Payer: First Health Commercial |
$3,240.32
|
| Rate for Payer: Humana Commercial |
$2,899.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,796.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,517.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,001.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,558.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$682.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$443.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,057.37
|
| Rate for Payer: PHCS Commercial |
$3,274.43
|
| Rate for Payer: United Healthcare All Payer |
$3,001.56
|
|
|
PLATE 4.5 NAR LCP 7H 134MM
|
Facility
|
OP
|
$3,410.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$443.41 |
| Max. Negotiated Rate |
$3,274.43 |
| Rate for Payer: Aetna Commercial |
$2,626.36
|
| Rate for Payer: Anthem Medicaid |
$1,172.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,660.47
|
| Rate for Payer: Cash Price |
$1,705.43
|
| Rate for Payer: Cigna Commercial |
$2,831.01
|
| Rate for Payer: First Health Commercial |
$3,240.32
|
| Rate for Payer: Humana Commercial |
$2,899.23
|
| Rate for Payer: Humana KY Medicaid |
$1,172.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,184.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,796.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,517.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,196.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,001.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,558.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$682.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$443.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,057.37
|
| Rate for Payer: PHCS Commercial |
$3,274.43
|
| Rate for Payer: United Healthcare All Payer |
$3,001.56
|
|
|
PLATE 4.5 NAR LCP 8H 152MM
|
Facility
|
IP
|
$3,472.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.45 |
| Max. Negotiated Rate |
$3,333.79 |
| Rate for Payer: Aetna Commercial |
$2,673.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,708.71
|
| Rate for Payer: Cash Price |
$1,736.35
|
| Rate for Payer: Cigna Commercial |
$2,882.34
|
| Rate for Payer: First Health Commercial |
$3,299.06
|
| Rate for Payer: Humana Commercial |
$2,951.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,847.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,562.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,041.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,055.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,604.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$694.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$451.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,076.54
|
| Rate for Payer: PHCS Commercial |
$3,333.79
|
| Rate for Payer: United Healthcare All Payer |
$3,055.98
|
|
|
PLATE 4.5 NAR LCP 8H 152MM
|
Facility
|
OP
|
$3,472.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.45 |
| Max. Negotiated Rate |
$3,333.79 |
| Rate for Payer: Aetna Commercial |
$2,673.98
|
| Rate for Payer: Anthem Medicaid |
$1,194.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,708.71
|
| Rate for Payer: Cash Price |
$1,736.35
|
| Rate for Payer: Cigna Commercial |
$2,882.34
|
| Rate for Payer: First Health Commercial |
$3,299.06
|
| Rate for Payer: Humana Commercial |
$2,951.80
|
| Rate for Payer: Humana KY Medicaid |
$1,194.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,206.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,847.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,562.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,041.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,218.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,055.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,604.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$694.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$451.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,076.54
|
| Rate for Payer: PHCS Commercial |
$3,333.79
|
| Rate for Payer: United Healthcare All Payer |
$3,055.98
|
|
|
PLATE 4.5 NAR LCP 9H 170MM
|
Facility
|
OP
|
$3,541.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.34 |
| Max. Negotiated Rate |
$3,399.42 |
| Rate for Payer: Aetna Commercial |
$2,726.62
|
| Rate for Payer: Anthem Medicaid |
$1,217.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,762.03
|
| Rate for Payer: Cash Price |
$1,770.53
|
| Rate for Payer: Cigna Commercial |
$2,939.08
|
| Rate for Payer: First Health Commercial |
$3,364.01
|
| Rate for Payer: Humana Commercial |
$3,009.90
|
| Rate for Payer: Humana KY Medicaid |
$1,217.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,230.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,903.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,613.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,062.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,242.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,116.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,655.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$708.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$460.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,097.73
|
| Rate for Payer: PHCS Commercial |
$3,399.42
|
| Rate for Payer: United Healthcare All Payer |
$3,116.13
|
|
|
PLATE 4.5 NAR LCP 9H 170MM
|
Facility
|
IP
|
$3,541.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.34 |
| Max. Negotiated Rate |
$3,399.42 |
| Rate for Payer: Aetna Commercial |
$2,726.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,762.03
|
| Rate for Payer: Cash Price |
$1,770.53
|
| Rate for Payer: Cigna Commercial |
$2,939.08
|
| Rate for Payer: First Health Commercial |
$3,364.01
|
| Rate for Payer: Humana Commercial |
$3,009.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,903.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,613.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,062.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,116.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,655.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$708.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$460.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,097.73
|
| Rate for Payer: PHCS Commercial |
$3,399.42
|
| Rate for Payer: United Healthcare All Payer |
$3,116.13
|
|
|
PLATE 4.5 TIBD LC-DCP 10H 178M
|
Facility
|
OP
|
$2,189.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.67 |
| Max. Negotiated Rate |
$2,102.20 |
| Rate for Payer: Anthem Medicaid |
$753.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,708.04
|
| Rate for Payer: Cash Price |
$1,094.89
|
| Rate for Payer: Cigna Commercial |
$1,817.53
|
| Rate for Payer: First Health Commercial |
$2,080.30
|
| Rate for Payer: Humana Commercial |
$1,861.32
|
| Rate for Payer: Humana KY Medicaid |
$753.07
|
| Rate for Payer: Kentucky WC Medicaid |
$760.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,795.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,616.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$656.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$768.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,927.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,642.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.83
|
| Rate for Payer: PHCS Commercial |
$2,102.20
|
| Rate for Payer: United Healthcare All Payer |
$1,927.02
|
| Rate for Payer: Aetna Commercial |
$1,686.14
|
|
|
PLATE 4.5 TIBD LC-DCP 10H 178M
|
Facility
|
IP
|
$2,189.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.67 |
| Max. Negotiated Rate |
$2,102.20 |
| Rate for Payer: Aetna Commercial |
$1,686.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,708.04
|
| Rate for Payer: Cash Price |
$1,094.89
|
| Rate for Payer: Cigna Commercial |
$1,817.53
|
| Rate for Payer: First Health Commercial |
$2,080.30
|
| Rate for Payer: Humana Commercial |
$1,861.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,795.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,616.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$656.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,927.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,642.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.83
|
| Rate for Payer: PHCS Commercial |
$2,102.20
|
| Rate for Payer: United Healthcare All Payer |
$1,927.02
|
|
