|
PLATE 4.5 TIBD LC-DCP 11H 196M
|
Facility
|
IP
|
$3,104.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.64 |
| Max. Negotiated Rate |
$2,980.69 |
| Rate for Payer: Aetna Commercial |
$2,390.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,421.81
|
| Rate for Payer: Cash Price |
$1,552.44
|
| Rate for Payer: Cigna Commercial |
$2,577.06
|
| Rate for Payer: First Health Commercial |
$2,949.65
|
| Rate for Payer: Humana Commercial |
$2,639.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,546.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,291.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$931.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,732.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,328.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$962.52
|
| Rate for Payer: PHCS Commercial |
$2,980.69
|
| Rate for Payer: United Healthcare All Payer |
$2,732.30
|
|
|
PLATE 4.5 TIBD LC-DCP 11H 196M
|
Facility
|
OP
|
$3,104.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.64 |
| Max. Negotiated Rate |
$2,980.69 |
| Rate for Payer: Aetna Commercial |
$2,390.77
|
| Rate for Payer: Anthem Medicaid |
$1,067.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,421.81
|
| Rate for Payer: Cash Price |
$1,552.44
|
| Rate for Payer: Cigna Commercial |
$2,577.06
|
| Rate for Payer: First Health Commercial |
$2,949.65
|
| Rate for Payer: Humana Commercial |
$2,639.16
|
| Rate for Payer: Humana KY Medicaid |
$1,067.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,078.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,546.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,291.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$931.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,089.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,732.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,328.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$962.52
|
| Rate for Payer: PHCS Commercial |
$2,980.69
|
| Rate for Payer: United Healthcare All Payer |
$2,732.30
|
|
|
PLATE 4.5 TIBD LC-DCP 12H 214M
|
Facility
|
IP
|
$3,104.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.64 |
| Max. Negotiated Rate |
$2,980.69 |
| Rate for Payer: Aetna Commercial |
$2,390.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,421.81
|
| Rate for Payer: Cash Price |
$1,552.44
|
| Rate for Payer: Cigna Commercial |
$2,577.06
|
| Rate for Payer: First Health Commercial |
$2,949.65
|
| Rate for Payer: Humana Commercial |
$2,639.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,546.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,291.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$931.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,732.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,328.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$962.52
|
| Rate for Payer: PHCS Commercial |
$2,980.69
|
| Rate for Payer: United Healthcare All Payer |
$2,732.30
|
|
|
PLATE 4.5 TIBD LC-DCP 12H 214M
|
Facility
|
OP
|
$3,104.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.64 |
| Max. Negotiated Rate |
$2,980.69 |
| Rate for Payer: Aetna Commercial |
$2,390.77
|
| Rate for Payer: Anthem Medicaid |
$1,067.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,421.81
|
| Rate for Payer: Cash Price |
$1,552.44
|
| Rate for Payer: Cigna Commercial |
$2,577.06
|
| Rate for Payer: First Health Commercial |
$2,949.65
|
| Rate for Payer: Humana Commercial |
$2,639.16
|
| Rate for Payer: Humana KY Medicaid |
$1,067.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,078.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,546.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,291.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$931.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,089.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,732.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,328.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$962.52
|
| Rate for Payer: PHCS Commercial |
$2,980.69
|
| Rate for Payer: United Healthcare All Payer |
$2,732.30
|
|
|
PLATE 4.5 TIBD LC-DCP 14H 250M
|
Facility
|
IP
|
$3,104.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.64 |
| Max. Negotiated Rate |
$2,980.69 |
| Rate for Payer: Aetna Commercial |
$2,390.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,421.81
|
| Rate for Payer: Cash Price |
$1,552.44
|
| Rate for Payer: Cigna Commercial |
$2,577.06
|
| Rate for Payer: First Health Commercial |
$2,949.65
|
| Rate for Payer: Humana Commercial |
$2,639.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,546.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,291.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$931.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,732.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,328.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$962.52
|
| Rate for Payer: PHCS Commercial |
$2,980.69
|
| Rate for Payer: United Healthcare All Payer |
$2,732.30
|
|
|
PLATE 4.5 TIBD LC-DCP 14H 250M
|
Facility
|
OP
|
$3,104.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.64 |
| Max. Negotiated Rate |
$2,980.69 |
| Rate for Payer: Aetna Commercial |
$2,390.77
|
| Rate for Payer: Anthem Medicaid |
$1,067.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,421.81
|
| Rate for Payer: Cash Price |
$1,552.44
|
| Rate for Payer: Cigna Commercial |
$2,577.06
|
| Rate for Payer: First Health Commercial |
$2,949.65
|
| Rate for Payer: Humana Commercial |
$2,639.16
|
| Rate for Payer: Humana KY Medicaid |
$1,067.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,078.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,546.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,291.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$931.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,089.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,732.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,328.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$962.52
|
| Rate for Payer: PHCS Commercial |
$2,980.69
|
| Rate for Payer: United Healthcare All Payer |
$2,732.30
|
|
|
PLATE 4.5 TI BD LC-DCP 6H 106M
|
Facility
|
IP
|
$2,046.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.05 |
| Max. Negotiated Rate |
$1,964.71 |
| Rate for Payer: Aetna Commercial |
$1,575.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,596.32
|
| Rate for Payer: Cash Price |
$1,023.28
|
| Rate for Payer: Cigna Commercial |
$1,698.65
|
| Rate for Payer: First Health Commercial |
$1,944.24
|
| Rate for Payer: Humana Commercial |
$1,739.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,678.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,510.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$613.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,800.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,534.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$634.44
|
| Rate for Payer: PHCS Commercial |
$1,964.71
|
| Rate for Payer: United Healthcare All Payer |
$1,800.98
|
|
|
PLATE 4.5 TI BD LC-DCP 6H 106M
|
Facility
|
OP
|
$2,046.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.05 |
| Max. Negotiated Rate |
$1,964.71 |
| Rate for Payer: Aetna Commercial |
$1,575.86
|
| Rate for Payer: Anthem Medicaid |
$703.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,596.32
|
| Rate for Payer: Cash Price |
$1,023.28
|
| Rate for Payer: Cigna Commercial |
$1,698.65
|
| Rate for Payer: First Health Commercial |
$1,944.24
|
| Rate for Payer: Humana Commercial |
$1,739.58
|
| Rate for Payer: Humana KY Medicaid |
$703.82
|
| Rate for Payer: Kentucky WC Medicaid |
$710.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,678.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,510.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$613.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$717.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,800.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,534.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$634.44
|
| Rate for Payer: PHCS Commercial |
$1,964.71
|
| Rate for Payer: United Healthcare All Payer |
$1,800.98
|
|
|
PLATE 4.5 TI BD LC-DCP 7H 124M
|
Facility
|
IP
|
$2,046.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.05 |
| Max. Negotiated Rate |
$1,964.71 |
| Rate for Payer: Aetna Commercial |
$1,575.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,596.32
|
| Rate for Payer: Cash Price |
$1,023.28
|
| Rate for Payer: Cigna Commercial |
$1,698.65
|
| Rate for Payer: First Health Commercial |
$1,944.24
|
| Rate for Payer: Humana Commercial |
$1,739.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,678.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,510.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$613.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,800.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,534.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$634.44
|
| Rate for Payer: PHCS Commercial |
$1,964.71
|
| Rate for Payer: United Healthcare All Payer |
$1,800.98
|
|
|
PLATE 4.5 TI BD LC-DCP 7H 124M
|
Facility
|
OP
|
$2,046.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.05 |
| Max. Negotiated Rate |
$1,964.71 |
| Rate for Payer: Aetna Commercial |
$1,575.86
|
| Rate for Payer: Anthem Medicaid |
$703.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,596.32
|
| Rate for Payer: Cash Price |
$1,023.28
|
| Rate for Payer: Cigna Commercial |
$1,698.65
|
| Rate for Payer: First Health Commercial |
$1,944.24
|
| Rate for Payer: Humana Commercial |
$1,739.58
|
| Rate for Payer: Humana KY Medicaid |
$703.82
|
| Rate for Payer: Kentucky WC Medicaid |
$710.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,678.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,510.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$613.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$717.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,800.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,534.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$634.44
|
| Rate for Payer: PHCS Commercial |
$1,964.71
|
| Rate for Payer: United Healthcare All Payer |
$1,800.98
|
|
|
PLATE 4.5 TI BD LC-DCP 8H 142M
|
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: Aetna Commercial |
$1,686.14
|
| 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
|
|
|
PLATE 4.5 TI BD LC-DCP 8H 142M
|
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
|
|
|
PLATE 4.5 TI BD LC-DCP 9H 160M
|
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: Aetna Commercial |
$1,686.14
|
| 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
|
|
|
PLATE 4.5 TI BD LC-DCP 9H 160M
|
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: 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
|
| 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
|
|
|
PLATE 4.5 TI LC-DCP 10H 178MM
|
Facility
|
OP
|
$2,017.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.25 |
| Max. Negotiated Rate |
$1,936.59 |
| Rate for Payer: Aetna Commercial |
$1,553.31
|
| Rate for Payer: Anthem Medicaid |
$693.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,573.48
|
| Rate for Payer: Cash Price |
$1,008.64
|
| Rate for Payer: Cigna Commercial |
$1,674.34
|
| Rate for Payer: First Health Commercial |
$1,916.42
|
| Rate for Payer: Humana Commercial |
$1,714.69
|
| Rate for Payer: Humana KY Medicaid |
$693.74
|
| Rate for Payer: Kentucky WC Medicaid |
$700.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,654.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,488.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$707.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,775.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,512.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.36
|
| Rate for Payer: PHCS Commercial |
$1,936.59
|
| Rate for Payer: United Healthcare All Payer |
$1,775.21
|
|
|
PLATE 4.5 TI LC-DCP 10H 178MM
|
Facility
|
IP
|
$2,017.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.25 |
| Max. Negotiated Rate |
$1,936.59 |
| Rate for Payer: Aetna Commercial |
$1,553.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,573.48
|
| Rate for Payer: Cash Price |
$1,008.64
|
| Rate for Payer: Cigna Commercial |
$1,674.34
|
| Rate for Payer: First Health Commercial |
$1,916.42
|
| Rate for Payer: Humana Commercial |
$1,714.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,654.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,488.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,775.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,512.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.36
|
| Rate for Payer: PHCS Commercial |
$1,936.59
|
| Rate for Payer: United Healthcare All Payer |
$1,775.21
|
|
|
PLATE 4.5 TI LC-DCP 11H 196MM
|
Facility
|
IP
|
$2,017.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.25 |
| Max. Negotiated Rate |
$1,936.59 |
| Rate for Payer: Aetna Commercial |
$1,553.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,573.48
|
| Rate for Payer: Cash Price |
$1,008.64
|
| Rate for Payer: Cigna Commercial |
$1,674.34
|
| Rate for Payer: First Health Commercial |
$1,916.42
|
| Rate for Payer: Humana Commercial |
$1,714.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,654.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,488.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,775.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,512.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.36
|
| Rate for Payer: PHCS Commercial |
$1,936.59
|
| Rate for Payer: United Healthcare All Payer |
$1,775.21
|
|
|
PLATE 4.5 TI LC-DCP 11H 196MM
|
Facility
|
OP
|
$2,017.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.25 |
| Max. Negotiated Rate |
$1,936.59 |
| Rate for Payer: Aetna Commercial |
$1,553.31
|
| Rate for Payer: Anthem Medicaid |
$693.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,573.48
|
| Rate for Payer: Cash Price |
$1,008.64
|
| Rate for Payer: Cigna Commercial |
$1,674.34
|
| Rate for Payer: First Health Commercial |
$1,916.42
|
| Rate for Payer: Humana Commercial |
$1,714.69
|
| Rate for Payer: Humana KY Medicaid |
$693.74
|
| Rate for Payer: Kentucky WC Medicaid |
$700.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,654.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,488.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$707.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,775.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,512.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.36
|
| Rate for Payer: PHCS Commercial |
$1,936.59
|
| Rate for Payer: United Healthcare All Payer |
$1,775.21
|
|
|
PLATE 4.5 TI LC-DCP 12H 214MM
|
Facility
|
IP
|
$2,017.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.25 |
| Max. Negotiated Rate |
$1,936.59 |
| Rate for Payer: Aetna Commercial |
$1,553.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,573.48
|
| Rate for Payer: Cash Price |
$1,008.64
|
| Rate for Payer: Cigna Commercial |
$1,674.34
|
| Rate for Payer: First Health Commercial |
$1,916.42
|
| Rate for Payer: Humana Commercial |
$1,714.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,654.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,488.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,775.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,512.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.36
|
| Rate for Payer: PHCS Commercial |
$1,936.59
|
| Rate for Payer: United Healthcare All Payer |
$1,775.21
|
|
|
PLATE 4.5 TI LC-DCP 12H 214MM
|
Facility
|
OP
|
$2,017.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.25 |
| Max. Negotiated Rate |
$1,936.59 |
| Rate for Payer: Aetna Commercial |
$1,553.31
|
| Rate for Payer: Anthem Medicaid |
$693.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,573.48
|
| Rate for Payer: Cash Price |
$1,008.64
|
| Rate for Payer: Cigna Commercial |
$1,674.34
|
| Rate for Payer: First Health Commercial |
$1,916.42
|
| Rate for Payer: Humana Commercial |
$1,714.69
|
| Rate for Payer: Humana KY Medicaid |
$693.74
|
| Rate for Payer: Kentucky WC Medicaid |
$700.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,654.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,488.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$707.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,775.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,512.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.36
|
| Rate for Payer: PHCS Commercial |
$1,936.59
|
| Rate for Payer: United Healthcare All Payer |
$1,775.21
|
|
|
PLATE 4.5 TI LC-DCP 2H 34MM
|
Facility
|
OP
|
$1,857.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.51 |
| Max. Negotiated Rate |
$1,783.47 |
| Rate for Payer: Humana Commercial |
$1,579.11
|
| Rate for Payer: Humana KY Medicaid |
$638.89
|
| Rate for Payer: Kentucky WC Medicaid |
$645.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,371.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$651.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.91
|
| Rate for Payer: PHCS Commercial |
$1,783.47
|
| Rate for Payer: United Healthcare All Payer |
$1,634.85
|
| Rate for Payer: Aetna Commercial |
$1,430.49
|
| Rate for Payer: Anthem Medicaid |
$638.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,449.07
|
| Rate for Payer: Cash Price |
$928.89
|
| Rate for Payer: Cigna Commercial |
$1,541.96
|
| Rate for Payer: First Health Commercial |
$1,764.89
|
|
|
PLATE 4.5 TI LC-DCP 2H 34MM
|
Facility
|
IP
|
$1,857.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.51 |
| Max. Negotiated Rate |
$1,783.47 |
| Rate for Payer: Aetna Commercial |
$1,430.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,449.07
|
| Rate for Payer: Cash Price |
$928.89
|
| Rate for Payer: Cigna Commercial |
$1,541.96
|
| Rate for Payer: First Health Commercial |
$1,764.89
|
| Rate for Payer: Humana Commercial |
$1,579.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,371.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.91
|
| Rate for Payer: PHCS Commercial |
$1,783.47
|
| Rate for Payer: United Healthcare All Payer |
$1,634.85
|
|
|
PLATE 4.5 TI LC-DCP 3H 52MM
|
Facility
|
IP
|
$1,857.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.51 |
| Max. Negotiated Rate |
$1,783.47 |
| Rate for Payer: Aetna Commercial |
$1,430.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,449.07
|
| Rate for Payer: Cash Price |
$928.89
|
| Rate for Payer: Cigna Commercial |
$1,541.96
|
| Rate for Payer: First Health Commercial |
$1,764.89
|
| Rate for Payer: Humana Commercial |
$1,579.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,371.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.91
|
| Rate for Payer: PHCS Commercial |
$1,783.47
|
| Rate for Payer: United Healthcare All Payer |
$1,634.85
|
|
|
PLATE 4.5 TI LC-DCP 3H 52MM
|
Facility
|
OP
|
$1,857.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.51 |
| Max. Negotiated Rate |
$1,783.47 |
| Rate for Payer: Aetna Commercial |
$1,430.49
|
| Rate for Payer: Anthem Medicaid |
$638.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,449.07
|
| Rate for Payer: Cash Price |
$928.89
|
| Rate for Payer: Cigna Commercial |
$1,541.96
|
| Rate for Payer: First Health Commercial |
$1,764.89
|
| Rate for Payer: Humana Commercial |
$1,579.11
|
| Rate for Payer: Humana KY Medicaid |
$638.89
|
| Rate for Payer: Kentucky WC Medicaid |
$645.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,371.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$651.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.91
|
| Rate for Payer: PHCS Commercial |
$1,783.47
|
| Rate for Payer: United Healthcare All Payer |
$1,634.85
|
|
|
PLATE 4.5 TI LC-DCP 4H 70MM
|
Facility
|
OP
|
$1,857.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.51 |
| Max. Negotiated Rate |
$1,783.47 |
| Rate for Payer: Aetna Commercial |
$1,430.49
|
| Rate for Payer: Anthem Medicaid |
$638.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,449.07
|
| Rate for Payer: Cash Price |
$928.89
|
| Rate for Payer: Cigna Commercial |
$1,541.96
|
| Rate for Payer: First Health Commercial |
$1,764.89
|
| Rate for Payer: Humana Commercial |
$1,579.11
|
| Rate for Payer: Humana KY Medicaid |
$638.89
|
| Rate for Payer: Kentucky WC Medicaid |
$645.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,371.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$651.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.91
|
| Rate for Payer: PHCS Commercial |
$1,783.47
|
| Rate for Payer: United Healthcare All Payer |
$1,634.85
|
|
