|
PLATE 4.5 BROAD LCP 9H 170MM
|
Facility
|
IP
|
$3,701.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.57 |
| Max. Negotiated Rate |
$3,553.82 |
| Rate for Payer: Aetna Commercial |
$2,850.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,887.48
|
| Rate for Payer: Cash Price |
$1,850.95
|
| Rate for Payer: Cigna Commercial |
$3,072.58
|
| Rate for Payer: First Health Commercial |
$3,516.80
|
| Rate for Payer: Humana Commercial |
$3,146.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,035.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,732.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,110.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,257.67
|
| Rate for Payer: Ohio Health Group HMO |
$2,776.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,961.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,220.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,554.31
|
| Rate for Payer: PHCS Commercial |
$3,553.82
|
| Rate for Payer: United Healthcare All Payer |
$3,257.67
|
|
|
PLATE 4.5 BROAD LCP 9H 170MM
|
Facility
|
OP
|
$3,701.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.57 |
| Max. Negotiated Rate |
$3,553.82 |
| Rate for Payer: Aetna Commercial |
$2,850.46
|
| Rate for Payer: Anthem Medicaid |
$1,273.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,887.48
|
| Rate for Payer: Cash Price |
$1,850.95
|
| Rate for Payer: Cigna Commercial |
$3,072.58
|
| Rate for Payer: First Health Commercial |
$3,516.80
|
| Rate for Payer: Humana Commercial |
$3,146.61
|
| Rate for Payer: Humana KY Medicaid |
$1,273.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,286.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,035.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,732.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,110.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,298.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,257.67
|
| Rate for Payer: Ohio Health Group HMO |
$2,776.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,961.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,220.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,554.31
|
| Rate for Payer: PHCS Commercial |
$3,553.82
|
| Rate for Payer: United Healthcare All Payer |
$3,257.67
|
|
|
PLATE 4.5 CVD BD LCP 12H 229M
|
Facility
|
OP
|
$4,064.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.38 |
| Max. Negotiated Rate |
$3,902.02 |
| Rate for Payer: Aetna Commercial |
$3,129.74
|
| Rate for Payer: Anthem Medicaid |
$1,397.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,170.39
|
| Rate for Payer: Cash Price |
$2,032.30
|
| Rate for Payer: Cigna Commercial |
$3,373.62
|
| Rate for Payer: First Health Commercial |
$3,861.37
|
| Rate for Payer: Humana Commercial |
$3,454.91
|
| Rate for Payer: Humana KY Medicaid |
$1,397.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,412.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,332.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,999.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,219.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,425.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,576.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,048.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,251.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,536.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,804.57
|
| Rate for Payer: PHCS Commercial |
$3,902.02
|
| Rate for Payer: United Healthcare All Payer |
$3,576.85
|
|
|
PLATE 4.5 CVD BD LCP 12H 229M
|
Facility
|
IP
|
$4,064.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.38 |
| Max. Negotiated Rate |
$3,902.02 |
| Rate for Payer: Aetna Commercial |
$3,129.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,170.39
|
| Rate for Payer: Cash Price |
$2,032.30
|
| Rate for Payer: Cigna Commercial |
$3,373.62
|
| Rate for Payer: First Health Commercial |
$3,861.37
|
| Rate for Payer: Humana Commercial |
$3,454.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,332.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,999.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,219.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,576.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,048.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,251.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,536.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,804.57
|
| Rate for Payer: PHCS Commercial |
$3,902.02
|
| Rate for Payer: United Healthcare All Payer |
$3,576.85
|
|
|
PLATE 4.5 CVD BD LCP 13H 247M
|
Facility
|
IP
|
$4,178.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,253.67 |
| Max. Negotiated Rate |
$4,011.74 |
| Rate for Payer: Aetna Commercial |
$3,217.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,259.54
|
| Rate for Payer: Cash Price |
$2,089.45
|
| Rate for Payer: Cigna Commercial |
$3,468.49
|
| Rate for Payer: First Health Commercial |
$3,969.95
|
| Rate for Payer: Humana Commercial |
$3,552.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,426.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,084.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,253.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,677.43
|
| Rate for Payer: Ohio Health Group HMO |
$3,134.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,343.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,883.44
|
| Rate for Payer: PHCS Commercial |
$4,011.74
|
| Rate for Payer: United Healthcare All Payer |
$3,677.43
|
|
|
PLATE 4.5 CVD BD LCP 13H 247M
|
Facility
|
OP
|
$4,178.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,253.67 |
| Max. Negotiated Rate |
$4,011.74 |
| Rate for Payer: Aetna Commercial |
$3,217.75
|
| Rate for Payer: Anthem Medicaid |
$1,437.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,259.54
|
| Rate for Payer: Cash Price |
$2,089.45
|
| Rate for Payer: Cigna Commercial |
$3,468.49
|
| Rate for Payer: First Health Commercial |
$3,969.95
|
| Rate for Payer: Humana Commercial |
$3,552.07
|
| Rate for Payer: Humana KY Medicaid |
$1,437.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,451.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,426.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,084.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,253.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,465.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,677.43
|
| Rate for Payer: Ohio Health Group HMO |
$3,134.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,343.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,635.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,883.44
|
| Rate for Payer: PHCS Commercial |
$4,011.74
|
| Rate for Payer: United Healthcare All Payer |
$3,677.43
|
|
|
PLATE 4.5 CVD BD LCP 14H 265M
|
Facility
|
IP
|
$4,305.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,291.57 |
| Max. Negotiated Rate |
$4,133.03 |
| Rate for Payer: Aetna Commercial |
$3,315.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,358.09
|
| Rate for Payer: Cash Price |
$2,152.62
|
| Rate for Payer: Cigna Commercial |
$3,573.35
|
| Rate for Payer: First Health Commercial |
$4,089.98
|
| Rate for Payer: Humana Commercial |
$3,659.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,530.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,177.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,291.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,788.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,228.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,444.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,745.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,970.62
|
| Rate for Payer: PHCS Commercial |
$4,133.03
|
| Rate for Payer: United Healthcare All Payer |
$3,788.61
|
|
|
PLATE 4.5 CVD BD LCP 14H 265M
|
Facility
|
OP
|
$4,305.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,291.57 |
| Max. Negotiated Rate |
$4,133.03 |
| Rate for Payer: Aetna Commercial |
$3,315.03
|
| Rate for Payer: Anthem Medicaid |
$1,480.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,358.09
|
| Rate for Payer: Cash Price |
$2,152.62
|
| Rate for Payer: Cigna Commercial |
$3,573.35
|
| Rate for Payer: First Health Commercial |
$4,089.98
|
| Rate for Payer: Humana Commercial |
$3,659.45
|
| Rate for Payer: Humana KY Medicaid |
$1,480.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,495.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,530.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,177.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,291.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,510.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,788.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,228.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,444.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,745.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,970.62
|
| Rate for Payer: PHCS Commercial |
$4,133.03
|
| Rate for Payer: United Healthcare All Payer |
$3,788.61
|
|
|
PLATE 4.5 CVD BD LCP 15H 282M
|
Facility
|
OP
|
$4,586.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,375.81 |
| Max. Negotiated Rate |
$4,402.60 |
| Rate for Payer: Aetna Commercial |
$3,531.25
|
| Rate for Payer: Anthem Medicaid |
$1,577.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,577.11
|
| Rate for Payer: Cash Price |
$2,293.02
|
| Rate for Payer: Cigna Commercial |
$3,806.41
|
| Rate for Payer: First Health Commercial |
$4,356.74
|
| Rate for Payer: Humana Commercial |
$3,898.13
|
| Rate for Payer: Humana KY Medicaid |
$1,577.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,760.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,384.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,375.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,608.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,035.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,439.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,668.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,989.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,164.37
|
| Rate for Payer: PHCS Commercial |
$4,402.60
|
| Rate for Payer: United Healthcare All Payer |
$4,035.72
|
|
|
PLATE 4.5 CVD BD LCP 15H 282M
|
Facility
|
IP
|
$4,586.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,375.81 |
| Max. Negotiated Rate |
$4,402.60 |
| Rate for Payer: Aetna Commercial |
$3,531.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,577.11
|
| Rate for Payer: Cash Price |
$2,293.02
|
| Rate for Payer: Cigna Commercial |
$3,806.41
|
| Rate for Payer: First Health Commercial |
$4,356.74
|
| Rate for Payer: Humana Commercial |
$3,898.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,760.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,384.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,375.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,035.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,439.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,668.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,989.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,164.37
|
| Rate for Payer: PHCS Commercial |
$4,402.60
|
| Rate for Payer: United Healthcare All Payer |
$4,035.72
|
|
|
PLATE 4.5 CVD BD LCP 16H 300M
|
Facility
|
OP
|
$4,807.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,442.23 |
| Max. Negotiated Rate |
$4,615.14 |
| Rate for Payer: Aetna Commercial |
$3,701.73
|
| Rate for Payer: Anthem Medicaid |
$1,653.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.80
|
| Rate for Payer: Cash Price |
$2,403.72
|
| Rate for Payer: Cigna Commercial |
$3,990.18
|
| Rate for Payer: First Health Commercial |
$4,567.07
|
| Rate for Payer: Humana Commercial |
$4,086.32
|
| Rate for Payer: Humana KY Medicaid |
$1,653.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,670.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,942.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,442.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,686.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,230.55
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,845.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,317.13
|
| Rate for Payer: PHCS Commercial |
$4,615.14
|
| Rate for Payer: United Healthcare All Payer |
$4,230.55
|
|
|
PLATE 4.5 CVD BD LCP 16H 300M
|
Facility
|
IP
|
$4,807.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,442.23 |
| Max. Negotiated Rate |
$4,615.14 |
| Rate for Payer: Aetna Commercial |
$3,701.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.80
|
| Rate for Payer: Cash Price |
$2,403.72
|
| Rate for Payer: Cigna Commercial |
$3,990.18
|
| Rate for Payer: First Health Commercial |
$4,567.07
|
| Rate for Payer: Humana Commercial |
$4,086.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,942.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,442.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,230.55
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,845.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,317.13
|
| Rate for Payer: PHCS Commercial |
$4,615.14
|
| Rate for Payer: United Healthcare All Payer |
$4,230.55
|
|
|
PLATE 4.5 CVD BD LCP 17H 318M
|
Facility
|
OP
|
$5,002.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.82 |
| Max. Negotiated Rate |
$4,802.63 |
| Rate for Payer: Aetna Commercial |
$3,852.11
|
| Rate for Payer: Anthem Medicaid |
$1,720.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,902.14
|
| Rate for Payer: Cash Price |
$2,501.37
|
| Rate for Payer: Cigna Commercial |
$4,152.27
|
| Rate for Payer: First Health Commercial |
$4,752.60
|
| Rate for Payer: Humana Commercial |
$4,252.33
|
| Rate for Payer: Humana KY Medicaid |
$1,720.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,102.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,692.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,402.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,752.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,002.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,352.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,451.89
|
| Rate for Payer: PHCS Commercial |
$4,802.63
|
| Rate for Payer: United Healthcare All Payer |
$4,402.41
|
|
|
PLATE 4.5 CVD BD LCP 17H 318M
|
Facility
|
IP
|
$5,002.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.82 |
| Max. Negotiated Rate |
$4,802.63 |
| Rate for Payer: Aetna Commercial |
$3,852.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,902.14
|
| Rate for Payer: Cash Price |
$2,501.37
|
| Rate for Payer: Cigna Commercial |
$4,152.27
|
| Rate for Payer: First Health Commercial |
$4,752.60
|
| Rate for Payer: Humana Commercial |
$4,252.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,102.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,692.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,402.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,752.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,002.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,352.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,451.89
|
| Rate for Payer: PHCS Commercial |
$4,802.63
|
| Rate for Payer: United Healthcare All Payer |
$4,402.41
|
|
|
PLATE 4.5 CVD BD LCP 18H 336M
|
Facility
|
IP
|
$5,194.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,558.37 |
| Max. Negotiated Rate |
$4,986.77 |
| Rate for Payer: Aetna Commercial |
$3,999.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,051.75
|
| Rate for Payer: Cash Price |
$2,597.28
|
| Rate for Payer: Cigna Commercial |
$4,311.48
|
| Rate for Payer: First Health Commercial |
$4,934.82
|
| Rate for Payer: Humana Commercial |
$4,415.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,259.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,833.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,558.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,571.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,895.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,155.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,519.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,584.24
|
| Rate for Payer: PHCS Commercial |
$4,986.77
|
| Rate for Payer: United Healthcare All Payer |
$4,571.20
|
|
|
PLATE 4.5 CVD BD LCP 18H 336M
|
Facility
|
OP
|
$5,194.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,558.37 |
| Max. Negotiated Rate |
$4,986.77 |
| Rate for Payer: Aetna Commercial |
$3,999.80
|
| Rate for Payer: Anthem Medicaid |
$1,786.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,051.75
|
| Rate for Payer: Cash Price |
$2,597.28
|
| Rate for Payer: Cigna Commercial |
$4,311.48
|
| Rate for Payer: First Health Commercial |
$4,934.82
|
| Rate for Payer: Humana Commercial |
$4,415.37
|
| Rate for Payer: Humana KY Medicaid |
$1,786.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,804.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,259.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,833.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,558.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,822.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,571.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,895.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,155.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,519.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,584.24
|
| Rate for Payer: PHCS Commercial |
$4,986.77
|
| Rate for Payer: United Healthcare All Payer |
$4,571.20
|
|
|
PLATE 4.5 NAR LCP 10H 188MM
|
Facility
|
IP
|
$3,558.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,067.67 |
| Max. Negotiated Rate |
$3,416.55 |
| Rate for Payer: Aetna Commercial |
$2,740.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,775.95
|
| Rate for Payer: Cash Price |
$1,779.46
|
| Rate for Payer: Cigna Commercial |
$2,953.90
|
| Rate for Payer: First Health Commercial |
$3,380.96
|
| Rate for Payer: Humana Commercial |
$3,025.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,918.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,626.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,067.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,131.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,669.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,847.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,096.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,455.65
|
| Rate for Payer: PHCS Commercial |
$3,416.55
|
| Rate for Payer: United Healthcare All Payer |
$3,131.84
|
|
|
PLATE 4.5 NAR LCP 10H 188MM
|
Facility
|
OP
|
$3,558.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,067.67 |
| Max. Negotiated Rate |
$3,416.55 |
| Rate for Payer: Aetna Commercial |
$2,740.36
|
| Rate for Payer: Anthem Medicaid |
$1,223.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,775.95
|
| Rate for Payer: Cash Price |
$1,779.46
|
| Rate for Payer: Cigna Commercial |
$2,953.90
|
| Rate for Payer: First Health Commercial |
$3,380.96
|
| Rate for Payer: Humana Commercial |
$3,025.07
|
| Rate for Payer: Humana KY Medicaid |
$1,223.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,236.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,918.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,626.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,067.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,248.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,131.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,669.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,847.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,096.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,455.65
|
| Rate for Payer: PHCS Commercial |
$3,416.55
|
| Rate for Payer: United Healthcare All Payer |
$3,131.84
|
|
|
PLATE 4.5 NAR LCP 11H 206MM
|
Facility
|
IP
|
$3,680.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.29 |
| Max. Negotiated Rate |
$3,533.74 |
| Rate for Payer: Aetna Commercial |
$2,834.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,871.16
|
| Rate for Payer: Cash Price |
$1,840.49
|
| Rate for Payer: Cigna Commercial |
$3,055.21
|
| Rate for Payer: First Health Commercial |
$3,496.93
|
| Rate for Payer: Humana Commercial |
$3,128.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,018.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,716.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,104.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,239.26
|
| Rate for Payer: Ohio Health Group HMO |
$2,760.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,944.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,202.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,539.88
|
| Rate for Payer: PHCS Commercial |
$3,533.74
|
| Rate for Payer: United Healthcare All Payer |
$3,239.26
|
|
|
PLATE 4.5 NAR LCP 11H 206MM
|
Facility
|
OP
|
$3,680.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.29 |
| Max. Negotiated Rate |
$3,533.74 |
| Rate for Payer: Aetna Commercial |
$2,834.35
|
| Rate for Payer: Anthem Medicaid |
$1,265.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,871.16
|
| Rate for Payer: Cash Price |
$1,840.49
|
| Rate for Payer: Cigna Commercial |
$3,055.21
|
| Rate for Payer: First Health Commercial |
$3,496.93
|
| Rate for Payer: Humana Commercial |
$3,128.83
|
| Rate for Payer: Humana KY Medicaid |
$1,265.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,278.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,018.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,716.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,104.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,291.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,239.26
|
| Rate for Payer: Ohio Health Group HMO |
$2,760.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,944.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,202.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,539.88
|
| Rate for Payer: PHCS Commercial |
$3,533.74
|
| Rate for Payer: United Healthcare All Payer |
$3,239.26
|
|
|
PLATE 4.5 NAR LCP 12H 224MM
|
Facility
|
OP
|
$3,803.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,140.91 |
| Max. Negotiated Rate |
$3,650.92 |
| Rate for Payer: Aetna Commercial |
$2,928.34
|
| Rate for Payer: Anthem Medicaid |
$1,307.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,966.37
|
| Rate for Payer: Cash Price |
$1,901.52
|
| Rate for Payer: Cigna Commercial |
$3,156.52
|
| Rate for Payer: First Health Commercial |
$3,612.89
|
| Rate for Payer: Humana Commercial |
$3,232.58
|
| Rate for Payer: Humana KY Medicaid |
$1,307.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,321.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,118.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,806.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,334.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,346.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,042.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,308.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,624.10
|
| Rate for Payer: PHCS Commercial |
$3,650.92
|
| Rate for Payer: United Healthcare All Payer |
$3,346.68
|
|
|
PLATE 4.5 NAR LCP 12H 224MM
|
Facility
|
IP
|
$3,803.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,140.91 |
| Max. Negotiated Rate |
$3,650.92 |
| Rate for Payer: Aetna Commercial |
$2,928.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,966.37
|
| Rate for Payer: Cash Price |
$1,901.52
|
| Rate for Payer: Cigna Commercial |
$3,156.52
|
| Rate for Payer: First Health Commercial |
$3,612.89
|
| Rate for Payer: Humana Commercial |
$3,232.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,118.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,806.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,346.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,042.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,308.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,624.10
|
| Rate for Payer: PHCS Commercial |
$3,650.92
|
| Rate for Payer: United Healthcare All Payer |
$3,346.68
|
|
|
PLATE 4.5 NAR LCP 14H 260MM
|
Facility
|
IP
|
$3,803.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,140.91 |
| Max. Negotiated Rate |
$3,650.92 |
| Rate for Payer: Aetna Commercial |
$2,928.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,966.37
|
| Rate for Payer: Cash Price |
$1,901.52
|
| Rate for Payer: Cigna Commercial |
$3,156.52
|
| Rate for Payer: First Health Commercial |
$3,612.89
|
| Rate for Payer: Humana Commercial |
$3,232.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,118.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,806.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,346.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,042.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,308.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,624.10
|
| Rate for Payer: PHCS Commercial |
$3,650.92
|
| Rate for Payer: United Healthcare All Payer |
$3,346.68
|
|
|
PLATE 4.5 NAR LCP 14H 260MM
|
Facility
|
OP
|
$3,803.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,140.91 |
| Max. Negotiated Rate |
$3,650.92 |
| Rate for Payer: Aetna Commercial |
$2,928.34
|
| Rate for Payer: Anthem Medicaid |
$1,307.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,966.37
|
| Rate for Payer: Cash Price |
$1,901.52
|
| Rate for Payer: Cigna Commercial |
$3,156.52
|
| Rate for Payer: First Health Commercial |
$3,612.89
|
| Rate for Payer: Humana Commercial |
$3,232.58
|
| Rate for Payer: Humana KY Medicaid |
$1,307.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,321.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,118.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,806.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,334.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,346.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,042.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,308.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,624.10
|
| Rate for Payer: PHCS Commercial |
$3,650.92
|
| Rate for Payer: United Healthcare All Payer |
$3,346.68
|
|
|
PLATE 4.5 NAR LCP 16H 296MM
|
Facility
|
OP
|
$4,047.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,214.15 |
| Max. Negotiated Rate |
$3,885.27 |
| Rate for Payer: Aetna Commercial |
$3,116.31
|
| Rate for Payer: Anthem Medicaid |
$1,391.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,156.78
|
| Rate for Payer: Cash Price |
$2,023.58
|
| Rate for Payer: Cigna Commercial |
$3,359.14
|
| Rate for Payer: First Health Commercial |
$3,844.80
|
| Rate for Payer: Humana Commercial |
$3,440.09
|
| Rate for Payer: Humana KY Medicaid |
$1,391.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,405.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,318.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,986.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,214.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,419.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,561.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,035.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,237.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,521.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,792.54
|
| Rate for Payer: PHCS Commercial |
$3,885.27
|
| Rate for Payer: United Healthcare All Payer |
$3,561.50
|
|
