|
PLATE 4.5 NAR LCP 16H 296MM
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE 4.5 NAR LCP 4H 80MM
|
Facility
|
IP
|
$2,979.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$894.00 |
| Max. Negotiated Rate |
$2,860.79 |
| Rate for Payer: Aetna Commercial |
$2,294.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,324.39
|
| Rate for Payer: Cash Price |
$1,489.99
|
| Rate for Payer: Cigna Commercial |
$2,473.39
|
| Rate for Payer: First Health Commercial |
$2,830.99
|
| Rate for Payer: Humana Commercial |
$2,532.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,443.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,199.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$894.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,622.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,383.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,592.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.19
|
| Rate for Payer: PHCS Commercial |
$2,860.79
|
| Rate for Payer: United Healthcare All Payer |
$2,622.39
|
|
|
PLATE 4.5 NAR LCP 4H 80MM
|
Facility
|
OP
|
$2,979.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$894.00 |
| Max. Negotiated Rate |
$2,860.79 |
| Rate for Payer: Aetna Commercial |
$2,294.59
|
| Rate for Payer: Anthem Medicaid |
$1,024.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,324.39
|
| Rate for Payer: Cash Price |
$1,489.99
|
| Rate for Payer: Cigna Commercial |
$2,473.39
|
| Rate for Payer: First Health Commercial |
$2,830.99
|
| Rate for Payer: Humana Commercial |
$2,532.99
|
| Rate for Payer: Humana KY Medicaid |
$1,024.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,035.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,443.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,199.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$894.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,045.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,622.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,383.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,592.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.19
|
| Rate for Payer: PHCS Commercial |
$2,860.79
|
| Rate for Payer: United Healthcare All Payer |
$2,622.39
|
|
|
PLATE 4.5 NAR LCP 5H 98MM
|
Facility
|
OP
|
$3,053.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.97 |
| Max. Negotiated Rate |
$2,931.09 |
| Rate for Payer: Aetna Commercial |
$2,350.98
|
| Rate for Payer: Anthem Medicaid |
$1,050.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,381.51
|
| Rate for Payer: Cash Price |
$1,526.61
|
| Rate for Payer: Cigna Commercial |
$2,534.17
|
| Rate for Payer: First Health Commercial |
$2,900.56
|
| Rate for Payer: Humana Commercial |
$2,595.24
|
| Rate for Payer: Humana KY Medicaid |
$1,050.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,060.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,503.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,253.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$915.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,071.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,686.83
|
| Rate for Payer: Ohio Health Group HMO |
$2,289.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,442.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,656.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,106.72
|
| Rate for Payer: PHCS Commercial |
$2,931.09
|
| Rate for Payer: United Healthcare All Payer |
$2,686.83
|
|
|
PLATE 4.5 NAR LCP 5H 98MM
|
Facility
|
IP
|
$3,053.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.97 |
| Max. Negotiated Rate |
$2,931.09 |
| Rate for Payer: Aetna Commercial |
$2,350.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,381.51
|
| Rate for Payer: Cash Price |
$1,526.61
|
| Rate for Payer: Cigna Commercial |
$2,534.17
|
| Rate for Payer: First Health Commercial |
$2,900.56
|
| Rate for Payer: Humana Commercial |
$2,595.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,503.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,253.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$915.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,686.83
|
| Rate for Payer: Ohio Health Group HMO |
$2,289.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,442.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,656.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,106.72
|
| Rate for Payer: PHCS Commercial |
$2,931.09
|
| Rate for Payer: United Healthcare All Payer |
$2,686.83
|
|
|
PLATE 4.5 NAR LCP 6H 116MM
|
Facility
|
IP
|
$3,119.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$935.85 |
| Max. Negotiated Rate |
$2,994.71 |
| Rate for Payer: Aetna Commercial |
$2,402.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,433.20
|
| Rate for Payer: Cash Price |
$1,559.74
|
| Rate for Payer: Cigna Commercial |
$2,589.18
|
| Rate for Payer: First Health Commercial |
$2,963.52
|
| Rate for Payer: Humana Commercial |
$2,651.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,557.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,302.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$935.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,745.15
|
| Rate for Payer: Ohio Health Group HMO |
$2,339.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,495.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,713.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,152.45
|
| Rate for Payer: PHCS Commercial |
$2,994.71
|
| Rate for Payer: United Healthcare All Payer |
$2,745.15
|
|
|
PLATE 4.5 NAR LCP 6H 116MM
|
Facility
|
OP
|
$3,119.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$935.85 |
| Max. Negotiated Rate |
$2,994.71 |
| Rate for Payer: Aetna Commercial |
$2,402.01
|
| Rate for Payer: Anthem Medicaid |
$1,072.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,433.20
|
| Rate for Payer: Cash Price |
$1,559.74
|
| Rate for Payer: Cigna Commercial |
$2,589.18
|
| Rate for Payer: First Health Commercial |
$2,963.52
|
| Rate for Payer: Humana Commercial |
$2,651.57
|
| Rate for Payer: Humana KY Medicaid |
$1,072.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,083.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,557.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,302.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$935.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,094.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,745.15
|
| Rate for Payer: Ohio Health Group HMO |
$2,339.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,495.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,713.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,152.45
|
| Rate for Payer: PHCS Commercial |
$2,994.71
|
| Rate for Payer: United Healthcare All Payer |
$2,745.15
|
|
|
PLATE 4.5 NAR LCP 7H 134MM
|
Facility
|
IP
|
$3,297.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.21 |
| Max. Negotiated Rate |
$3,165.46 |
| Rate for Payer: Aetna Commercial |
$2,538.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,571.93
|
| Rate for Payer: Cash Price |
$1,648.67
|
| Rate for Payer: Cigna Commercial |
$2,736.80
|
| Rate for Payer: First Health Commercial |
$3,132.48
|
| Rate for Payer: Humana Commercial |
$2,802.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,703.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,433.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$989.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,901.67
|
| Rate for Payer: Ohio Health Group HMO |
$2,473.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,637.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,868.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,275.17
|
| Rate for Payer: PHCS Commercial |
$3,165.46
|
| Rate for Payer: United Healthcare All Payer |
$2,901.67
|
|
|
PLATE 4.5 NAR LCP 7H 134MM
|
Facility
|
OP
|
$3,297.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.21 |
| Max. Negotiated Rate |
$3,165.46 |
| Rate for Payer: Aetna Commercial |
$2,538.96
|
| Rate for Payer: Anthem Medicaid |
$1,133.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,571.93
|
| Rate for Payer: Cash Price |
$1,648.67
|
| Rate for Payer: Cigna Commercial |
$2,736.80
|
| Rate for Payer: First Health Commercial |
$3,132.48
|
| Rate for Payer: Humana Commercial |
$2,802.75
|
| Rate for Payer: Humana KY Medicaid |
$1,133.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,145.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,703.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,433.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$989.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,156.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,901.67
|
| Rate for Payer: Ohio Health Group HMO |
$2,473.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,637.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,868.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,275.17
|
| Rate for Payer: PHCS Commercial |
$3,165.46
|
| Rate for Payer: United Healthcare All Payer |
$2,901.67
|
|
|
PLATE 4.5 NAR LCP 8H 152MM
|
Facility
|
IP
|
$3,363.61
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.08 |
| Max. Negotiated Rate |
$3,229.07 |
| Rate for Payer: Aetna Commercial |
$2,589.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,623.62
|
| Rate for Payer: Cash Price |
$1,681.81
|
| Rate for Payer: Cigna Commercial |
$2,791.80
|
| Rate for Payer: First Health Commercial |
$3,195.43
|
| Rate for Payer: Humana Commercial |
$2,859.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,758.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,482.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,009.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,959.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,522.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,690.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,320.89
|
| Rate for Payer: PHCS Commercial |
$3,229.07
|
| Rate for Payer: United Healthcare All Payer |
$2,959.98
|
|
|
PLATE 4.5 NAR LCP 8H 152MM
|
Facility
|
OP
|
$3,363.61
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.08 |
| Max. Negotiated Rate |
$3,229.07 |
| Rate for Payer: Aetna Commercial |
$2,589.98
|
| Rate for Payer: Anthem Medicaid |
$1,156.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,623.62
|
| Rate for Payer: Cash Price |
$1,681.81
|
| Rate for Payer: Cigna Commercial |
$2,791.80
|
| Rate for Payer: First Health Commercial |
$3,195.43
|
| Rate for Payer: Humana Commercial |
$2,859.07
|
| Rate for Payer: Humana KY Medicaid |
$1,156.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,168.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,758.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,482.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,009.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,179.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,959.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,522.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,690.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,320.89
|
| Rate for Payer: PHCS Commercial |
$3,229.07
|
| Rate for Payer: United Healthcare All Payer |
$2,959.98
|
|
|
PLATE 4.5 NAR LCP 9H 170MM
|
Facility
|
IP
|
$3,436.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.06 |
| Max. Negotiated Rate |
$3,299.38 |
| Rate for Payer: Aetna Commercial |
$2,646.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,680.74
|
| Rate for Payer: Cash Price |
$1,718.42
|
| Rate for Payer: Cigna Commercial |
$2,852.59
|
| Rate for Payer: First Health Commercial |
$3,265.01
|
| Rate for Payer: Humana Commercial |
$2,921.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,818.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,536.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,024.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,577.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,749.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,990.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,371.43
|
| Rate for Payer: PHCS Commercial |
$3,299.38
|
| Rate for Payer: United Healthcare All Payer |
$3,024.43
|
|
|
PLATE 4.5 NAR LCP 9H 170MM
|
Facility
|
OP
|
$3,436.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.06 |
| Max. Negotiated Rate |
$3,299.38 |
| Rate for Payer: Aetna Commercial |
$2,646.37
|
| Rate for Payer: Anthem Medicaid |
$1,181.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,680.74
|
| Rate for Payer: Cash Price |
$1,718.42
|
| Rate for Payer: Cigna Commercial |
$2,852.59
|
| Rate for Payer: First Health Commercial |
$3,265.01
|
| Rate for Payer: Humana Commercial |
$2,921.32
|
| Rate for Payer: Humana KY Medicaid |
$1,181.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,193.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,818.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,536.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,205.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,024.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,577.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,749.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,990.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,371.43
|
| Rate for Payer: PHCS Commercial |
$3,299.38
|
| Rate for Payer: United Healthcare All Payer |
$3,024.43
|
|
|
PLATE 4.5 TIBD LC-DCP 10H 178M
|
Facility
|
IP
|
$2,211.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.53 |
| Max. Negotiated Rate |
$2,123.30 |
| Rate for Payer: Aetna Commercial |
$1,703.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,725.18
|
| Rate for Payer: Cash Price |
$1,105.89
|
| Rate for Payer: Cigna Commercial |
$1,835.77
|
| Rate for Payer: First Health Commercial |
$2,101.18
|
| Rate for Payer: Humana Commercial |
$1,880.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,813.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,632.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,946.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,658.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,769.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,924.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,526.12
|
| Rate for Payer: PHCS Commercial |
$2,123.30
|
| Rate for Payer: United Healthcare All Payer |
$1,946.36
|
|
|
PLATE 4.5 TIBD LC-DCP 10H 178M
|
Facility
|
OP
|
$2,211.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.53 |
| Max. Negotiated Rate |
$2,123.30 |
| Rate for Payer: Aetna Commercial |
$1,703.06
|
| Rate for Payer: Anthem Medicaid |
$760.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,725.18
|
| Rate for Payer: Cash Price |
$1,105.89
|
| Rate for Payer: Cigna Commercial |
$1,835.77
|
| Rate for Payer: First Health Commercial |
$2,101.18
|
| Rate for Payer: Humana Commercial |
$1,880.00
|
| Rate for Payer: Humana KY Medicaid |
$760.63
|
| Rate for Payer: Kentucky WC Medicaid |
$768.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,813.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,632.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$775.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,946.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,658.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,769.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,924.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,526.12
|
| Rate for Payer: PHCS Commercial |
$2,123.30
|
| Rate for Payer: United Healthcare All Payer |
$1,946.36
|
|
|
PLATE 4.5 TIBD LC-DCP 11H 196M
|
Facility
|
OP
|
$2,969.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.86 |
| Max. Negotiated Rate |
$2,850.74 |
| Rate for Payer: Aetna Commercial |
$2,286.53
|
| Rate for Payer: Anthem Medicaid |
$1,021.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,316.23
|
| Rate for Payer: Cash Price |
$1,484.76
|
| Rate for Payer: Cigna Commercial |
$2,464.70
|
| Rate for Payer: First Health Commercial |
$2,821.04
|
| Rate for Payer: Humana Commercial |
$2,524.09
|
| Rate for Payer: Humana KY Medicaid |
$1,021.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,031.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,435.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,191.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$890.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,041.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,613.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,227.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,048.97
|
| Rate for Payer: PHCS Commercial |
$2,850.74
|
| Rate for Payer: United Healthcare All Payer |
$2,613.18
|
|
|
PLATE 4.5 TIBD LC-DCP 11H 196M
|
Facility
|
IP
|
$2,969.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.86 |
| Max. Negotiated Rate |
$2,850.74 |
| Rate for Payer: Aetna Commercial |
$2,286.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,316.23
|
| Rate for Payer: Cash Price |
$1,484.76
|
| Rate for Payer: Cigna Commercial |
$2,464.70
|
| Rate for Payer: First Health Commercial |
$2,821.04
|
| Rate for Payer: Humana Commercial |
$2,524.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,435.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,191.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$890.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,613.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,227.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,048.97
|
| Rate for Payer: PHCS Commercial |
$2,850.74
|
| Rate for Payer: United Healthcare All Payer |
$2,613.18
|
|
|
PLATE 4.5 TIBD LC-DCP 12H 214M
|
Facility
|
IP
|
$2,969.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.86 |
| Max. Negotiated Rate |
$2,850.74 |
| Rate for Payer: Aetna Commercial |
$2,286.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,316.23
|
| Rate for Payer: Cash Price |
$1,484.76
|
| Rate for Payer: Cigna Commercial |
$2,464.70
|
| Rate for Payer: First Health Commercial |
$2,821.04
|
| Rate for Payer: Humana Commercial |
$2,524.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,435.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,191.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$890.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,613.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,227.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,048.97
|
| Rate for Payer: PHCS Commercial |
$2,850.74
|
| Rate for Payer: United Healthcare All Payer |
$2,613.18
|
|
|
PLATE 4.5 TIBD LC-DCP 12H 214M
|
Facility
|
OP
|
$2,969.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.86 |
| Max. Negotiated Rate |
$2,850.74 |
| Rate for Payer: Aetna Commercial |
$2,286.53
|
| Rate for Payer: Anthem Medicaid |
$1,021.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,316.23
|
| Rate for Payer: Cash Price |
$1,484.76
|
| Rate for Payer: Cigna Commercial |
$2,464.70
|
| Rate for Payer: First Health Commercial |
$2,821.04
|
| Rate for Payer: Humana Commercial |
$2,524.09
|
| Rate for Payer: Humana KY Medicaid |
$1,021.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,031.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,435.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,191.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$890.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,041.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,613.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,227.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,048.97
|
| Rate for Payer: PHCS Commercial |
$2,850.74
|
| Rate for Payer: United Healthcare All Payer |
$2,613.18
|
|
|
PLATE 4.5 TIBD LC-DCP 14H 250M
|
Facility
|
OP
|
$2,969.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.86 |
| Max. Negotiated Rate |
$2,850.74 |
| Rate for Payer: Aetna Commercial |
$2,286.53
|
| Rate for Payer: Anthem Medicaid |
$1,021.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,316.23
|
| Rate for Payer: Cash Price |
$1,484.76
|
| Rate for Payer: Cigna Commercial |
$2,464.70
|
| Rate for Payer: First Health Commercial |
$2,821.04
|
| Rate for Payer: Humana Commercial |
$2,524.09
|
| Rate for Payer: Humana KY Medicaid |
$1,021.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,031.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,435.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,191.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$890.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,041.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,613.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,227.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,048.97
|
| Rate for Payer: PHCS Commercial |
$2,850.74
|
| Rate for Payer: United Healthcare All Payer |
$2,613.18
|
|
|
PLATE 4.5 TIBD LC-DCP 14H 250M
|
Facility
|
IP
|
$2,969.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.86 |
| Max. Negotiated Rate |
$2,850.74 |
| Rate for Payer: Aetna Commercial |
$2,286.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,316.23
|
| Rate for Payer: Cash Price |
$1,484.76
|
| Rate for Payer: Cigna Commercial |
$2,464.70
|
| Rate for Payer: First Health Commercial |
$2,821.04
|
| Rate for Payer: Humana Commercial |
$2,524.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,435.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,191.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$890.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,613.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,227.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,048.97
|
| Rate for Payer: PHCS Commercial |
$2,850.74
|
| Rate for Payer: United Healthcare All Payer |
$2,613.18
|
|
|
PLATE 4.5 TI BD LC-DCP 6H 106M
|
Facility
|
IP
|
$2,056.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$616.88 |
| Max. Negotiated Rate |
$1,974.03 |
| Rate for Payer: Aetna Commercial |
$1,583.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,603.90
|
| Rate for Payer: Cash Price |
$1,028.14
|
| Rate for Payer: Cigna Commercial |
$1,706.71
|
| Rate for Payer: First Health Commercial |
$1,953.47
|
| Rate for Payer: Humana Commercial |
$1,747.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,686.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,517.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,809.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,542.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,645.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,788.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.83
|
| Rate for Payer: PHCS Commercial |
$1,974.03
|
| Rate for Payer: United Healthcare All Payer |
$1,809.53
|
|
|
PLATE 4.5 TI BD LC-DCP 6H 106M
|
Facility
|
OP
|
$2,056.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$616.88 |
| Max. Negotiated Rate |
$1,974.03 |
| Rate for Payer: Aetna Commercial |
$1,583.34
|
| Rate for Payer: Anthem Medicaid |
$707.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,603.90
|
| Rate for Payer: Cash Price |
$1,028.14
|
| Rate for Payer: Cigna Commercial |
$1,706.71
|
| Rate for Payer: First Health Commercial |
$1,953.47
|
| Rate for Payer: Humana Commercial |
$1,747.84
|
| Rate for Payer: Humana KY Medicaid |
$707.15
|
| Rate for Payer: Kentucky WC Medicaid |
$714.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,686.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,517.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$721.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,809.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,542.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,645.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,788.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.83
|
| Rate for Payer: PHCS Commercial |
$1,974.03
|
| Rate for Payer: United Healthcare All Payer |
$1,809.53
|
|
|
PLATE 4.5 TI BD LC-DCP 7H 124M
|
Facility
|
OP
|
$2,056.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$616.88 |
| Max. Negotiated Rate |
$1,974.03 |
| Rate for Payer: Aetna Commercial |
$1,583.34
|
| Rate for Payer: Anthem Medicaid |
$707.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,603.90
|
| Rate for Payer: Cash Price |
$1,028.14
|
| Rate for Payer: Cigna Commercial |
$1,706.71
|
| Rate for Payer: First Health Commercial |
$1,953.47
|
| Rate for Payer: Humana Commercial |
$1,747.84
|
| Rate for Payer: Humana KY Medicaid |
$707.15
|
| Rate for Payer: Kentucky WC Medicaid |
$714.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,686.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,517.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$721.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,809.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,542.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,645.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,788.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.83
|
| Rate for Payer: PHCS Commercial |
$1,974.03
|
| Rate for Payer: United Healthcare All Payer |
$1,809.53
|
|
|
PLATE 4.5 TI BD LC-DCP 7H 124M
|
Facility
|
IP
|
$2,056.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$616.88 |
| Max. Negotiated Rate |
$1,974.03 |
| Rate for Payer: Aetna Commercial |
$1,583.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,603.90
|
| Rate for Payer: Cash Price |
$1,028.14
|
| Rate for Payer: Cigna Commercial |
$1,706.71
|
| Rate for Payer: First Health Commercial |
$1,953.47
|
| Rate for Payer: Humana Commercial |
$1,747.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,686.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,517.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,809.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,542.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,645.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,788.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.83
|
| Rate for Payer: PHCS Commercial |
$1,974.03
|
| Rate for Payer: United Healthcare All Payer |
$1,809.53
|
|
