|
PLASMAX CONCENTRATOR C-BAL
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem Medicaid |
$2,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Humana KY Medicaid |
$2,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
PLASMAX CONCENTRATOR C-BAL
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
PLASMAX MINI KIT W/30M ACDA
|
Facility
|
IP
|
$8,085.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.08 |
| Max. Negotiated Rate |
$7,761.79 |
| Rate for Payer: Aetna Commercial |
$6,225.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,306.46
|
| Rate for Payer: Cash Price |
$4,042.60
|
| Rate for Payer: Cigna Commercial |
$6,710.72
|
| Rate for Payer: First Health Commercial |
$7,680.94
|
| Rate for Payer: Humana Commercial |
$6,872.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,629.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,966.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,425.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,114.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,063.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,506.41
|
| Rate for Payer: PHCS Commercial |
$7,761.79
|
| Rate for Payer: United Healthcare All Payer |
$7,114.98
|
|
|
PLASMAX MINI KIT W/30M ACDA
|
Facility
|
OP
|
$8,085.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.08 |
| Max. Negotiated Rate |
$7,761.79 |
| Rate for Payer: Aetna Commercial |
$6,225.60
|
| Rate for Payer: Anthem Medicaid |
$2,780.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,306.46
|
| Rate for Payer: Cash Price |
$4,042.60
|
| Rate for Payer: Cigna Commercial |
$6,710.72
|
| Rate for Payer: First Health Commercial |
$7,680.94
|
| Rate for Payer: Humana Commercial |
$6,872.42
|
| Rate for Payer: Humana KY Medicaid |
$2,780.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,808.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,629.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,966.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,425.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,836.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,114.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,063.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,506.41
|
| Rate for Payer: PHCS Commercial |
$7,761.79
|
| Rate for Payer: United Healthcare All Payer |
$7,114.98
|
|
|
PLASMAX PLUS KIT W/30M ACDA
|
Facility
|
IP
|
$8,085.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.08 |
| Max. Negotiated Rate |
$7,761.79 |
| Rate for Payer: Aetna Commercial |
$6,225.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,306.46
|
| Rate for Payer: Cash Price |
$4,042.60
|
| Rate for Payer: Cigna Commercial |
$6,710.72
|
| Rate for Payer: First Health Commercial |
$7,680.94
|
| Rate for Payer: Humana Commercial |
$6,872.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,629.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,966.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,425.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,114.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,063.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,506.41
|
| Rate for Payer: PHCS Commercial |
$7,761.79
|
| Rate for Payer: United Healthcare All Payer |
$7,114.98
|
|
|
PLASMAX PLUS KIT W/30M ACDA
|
Facility
|
OP
|
$8,085.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.08 |
| Max. Negotiated Rate |
$7,761.79 |
| Rate for Payer: Aetna Commercial |
$6,225.60
|
| Rate for Payer: Anthem Medicaid |
$2,780.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,306.46
|
| Rate for Payer: Cash Price |
$4,042.60
|
| Rate for Payer: Cigna Commercial |
$6,710.72
|
| Rate for Payer: First Health Commercial |
$7,680.94
|
| Rate for Payer: Humana Commercial |
$6,872.42
|
| Rate for Payer: Humana KY Medicaid |
$2,780.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,808.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,629.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,966.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,425.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,836.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,114.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,063.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,506.41
|
| Rate for Payer: PHCS Commercial |
$7,761.79
|
| Rate for Payer: United Healthcare All Payer |
$7,114.98
|
|
|
PLAS RPR PENIS EPISP DST SNCTR
|
Professional
|
Both
|
$3,547.00
|
|
|
Service Code
|
HCPCS 54380
|
| Hospital Charge Code |
76102135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$640.32 |
| Max. Negotiated Rate |
$3,547.00 |
| Rate for Payer: Aetna Commercial |
$1,315.06
|
| Rate for Payer: Anthem Medicaid |
$640.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,547.00
|
| Rate for Payer: Cash Price |
$1,773.50
|
| Rate for Payer: Cash Price |
$1,773.50
|
| Rate for Payer: Cigna Commercial |
$1,149.04
|
| Rate for Payer: Healthspan PPO |
$1,273.31
|
| Rate for Payer: Humana Medicaid |
$640.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,094.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$653.13
|
| Rate for Payer: Molina Healthcare Passport |
$640.32
|
| Rate for Payer: Multiplan PHCS |
$2,128.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,482.90
|
| Rate for Payer: UHCCP Medicaid |
$1,241.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$646.72
|
|
|
PLAS RPR PENIS EPISP DST SNCTR
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
HCPCS 54380
|
| Hospital Charge Code |
761T2135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.81 |
| Max. Negotiated Rate |
$2,465.88 |
| Rate for Payer: Aetna Commercial |
$1,953.49
|
| Rate for Payer: Anthem Medicaid |
$872.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,978.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cigna Commercial |
$2,105.71
|
| Rate for Payer: First Health Commercial |
$2,410.15
|
| Rate for Payer: Humana Commercial |
$2,156.45
|
| Rate for Payer: Humana KY Medicaid |
$872.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$881.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,080.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,872.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$889.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,232.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,902.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$507.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.47
|
| Rate for Payer: PHCS Commercial |
$2,435.52
|
| Rate for Payer: United Healthcare All Payer |
$2,232.56
|
|
|
PLAS RPR PENIS EPISP DST SNCTR
|
Professional
|
Both
|
$1,010.00
|
|
|
Service Code
|
HCPCS 54380
|
| Hospital Charge Code |
761P2135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$353.50 |
| Max. Negotiated Rate |
$1,315.06 |
| Rate for Payer: Aetna Commercial |
$1,315.06
|
| Rate for Payer: Anthem Medicaid |
$640.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,010.00
|
| Rate for Payer: Cash Price |
$505.00
|
| Rate for Payer: Cash Price |
$505.00
|
| Rate for Payer: Cigna Commercial |
$1,149.04
|
| Rate for Payer: Healthspan PPO |
$1,273.31
|
| Rate for Payer: Humana Medicaid |
$640.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,094.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$653.13
|
| Rate for Payer: Molina Healthcare Passport |
$640.32
|
| Rate for Payer: Multiplan PHCS |
$606.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$707.00
|
| Rate for Payer: UHCCP Medicaid |
$353.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$646.72
|
|
|
PLAS RPR PENIS EPISP DST SNCTR
|
Facility
|
OP
|
$3,547.00
|
|
|
Service Code
|
HCPCS 54380
|
| Hospital Charge Code |
76102135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$461.11 |
| Max. Negotiated Rate |
$3,405.12 |
| Rate for Payer: Aetna Commercial |
$2,731.19
|
| Rate for Payer: Anthem Medicaid |
$1,219.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,766.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$1,773.50
|
| Rate for Payer: Cash Price |
$1,773.50
|
| Rate for Payer: Cigna Commercial |
$2,944.01
|
| Rate for Payer: First Health Commercial |
$3,369.65
|
| Rate for Payer: Humana Commercial |
$3,014.95
|
| Rate for Payer: Humana KY Medicaid |
$1,219.81
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,232.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,908.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,617.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,244.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,121.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,660.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$709.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,099.57
|
| Rate for Payer: PHCS Commercial |
$3,405.12
|
| Rate for Payer: United Healthcare All Payer |
$3,121.36
|
|
|
PLAS RPR PENIS EPISP DST SNCTR
|
Facility
|
IP
|
$3,547.00
|
|
|
Service Code
|
HCPCS 54380
|
| Hospital Charge Code |
76102135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$461.11 |
| Max. Negotiated Rate |
$3,405.12 |
| Rate for Payer: Aetna Commercial |
$2,731.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,766.66
|
| Rate for Payer: Cash Price |
$1,773.50
|
| Rate for Payer: Cigna Commercial |
$2,944.01
|
| Rate for Payer: First Health Commercial |
$3,369.65
|
| Rate for Payer: Humana Commercial |
$3,014.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,908.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,617.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,064.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,121.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,660.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$709.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,099.57
|
| Rate for Payer: PHCS Commercial |
$3,405.12
|
| Rate for Payer: United Healthcare All Payer |
$3,121.36
|
|
|
PLAS RPR PENIS EPISP DST SNCTR
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
HCPCS 54380
|
| Hospital Charge Code |
761T2135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.81 |
| Max. Negotiated Rate |
$2,435.52 |
| Rate for Payer: Aetna Commercial |
$1,953.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,978.86
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cigna Commercial |
$2,105.71
|
| Rate for Payer: First Health Commercial |
$2,410.15
|
| Rate for Payer: Humana Commercial |
$2,156.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,080.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,872.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$761.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,232.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,902.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$507.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.47
|
| Rate for Payer: PHCS Commercial |
$2,435.52
|
| Rate for Payer: United Healthcare All Payer |
$2,232.56
|
|
|
PLAT CONDYLR LCP 4.5 6H 170M L
|
Facility
|
OP
|
$7,460.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$969.88 |
| Max. Negotiated Rate |
$7,162.22 |
| Rate for Payer: Aetna Commercial |
$5,744.70
|
| Rate for Payer: Anthem Medicaid |
$2,565.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,819.31
|
| Rate for Payer: Cash Price |
$3,730.32
|
| Rate for Payer: Cigna Commercial |
$6,192.34
|
| Rate for Payer: First Health Commercial |
$7,087.62
|
| Rate for Payer: Humana Commercial |
$6,341.55
|
| Rate for Payer: Humana KY Medicaid |
$2,565.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,591.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,117.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,505.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,617.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,565.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,595.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$969.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,312.80
|
| Rate for Payer: PHCS Commercial |
$7,162.22
|
| Rate for Payer: United Healthcare All Payer |
$6,565.37
|
|
|
PLAT CONDYLR LCP 4.5 6H 170M L
|
Facility
|
IP
|
$7,460.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$969.88 |
| Max. Negotiated Rate |
$7,162.22 |
| Rate for Payer: Humana Commercial |
$6,341.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,117.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,505.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,565.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,595.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$969.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,312.80
|
| Rate for Payer: PHCS Commercial |
$7,162.22
|
| Rate for Payer: United Healthcare All Payer |
$6,565.37
|
| Rate for Payer: Aetna Commercial |
$5,744.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,819.31
|
| Rate for Payer: Cash Price |
$3,730.32
|
| Rate for Payer: Cigna Commercial |
$6,192.34
|
| Rate for Payer: First Health Commercial |
$7,087.62
|
|
|
PLATE 0.8 AVULSION HOOK
|
Facility
|
IP
|
$1,931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.03 |
| Max. Negotiated Rate |
$1,853.76 |
| Rate for Payer: Aetna Commercial |
$1,486.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.18
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.73
|
| Rate for Payer: First Health Commercial |
$1,834.45
|
| Rate for Payer: Humana Commercial |
$1,641.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.61
|
| Rate for Payer: PHCS Commercial |
$1,853.76
|
| Rate for Payer: United Healthcare All Payer |
$1,699.28
|
|
|
PLATE 0.8 AVULSION HOOK
|
Facility
|
OP
|
$1,931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.03 |
| Max. Negotiated Rate |
$1,853.76 |
| Rate for Payer: Aetna Commercial |
$1,486.87
|
| Rate for Payer: Anthem Medicaid |
$664.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.18
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.73
|
| Rate for Payer: First Health Commercial |
$1,834.45
|
| Rate for Payer: Humana Commercial |
$1,641.35
|
| Rate for Payer: Humana KY Medicaid |
$664.07
|
| Rate for Payer: Kentucky WC Medicaid |
$670.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.61
|
| Rate for Payer: PHCS Commercial |
$1,853.76
|
| Rate for Payer: United Healthcare All Payer |
$1,699.28
|
|
|
PLATE 0.8 COMPRESSION 6H
|
Facility
|
OP
|
$3,169.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.04 |
| Max. Negotiated Rate |
$3,042.72 |
| Rate for Payer: Aetna Commercial |
$2,440.52
|
| Rate for Payer: Anthem Medicaid |
$1,089.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,472.21
|
| Rate for Payer: Cash Price |
$1,584.75
|
| Rate for Payer: Cigna Commercial |
$2,630.68
|
| Rate for Payer: First Health Commercial |
$3,011.02
|
| Rate for Payer: Humana Commercial |
$2,694.08
|
| Rate for Payer: Humana KY Medicaid |
$1,089.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,101.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,598.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,339.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$950.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,111.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,789.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,377.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$412.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$982.54
|
| Rate for Payer: PHCS Commercial |
$3,042.72
|
| Rate for Payer: United Healthcare All Payer |
$2,789.16
|
|
|
PLATE 0.8 COMPRESSION 6H
|
Facility
|
IP
|
$3,169.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.04 |
| Max. Negotiated Rate |
$3,042.72 |
| Rate for Payer: Aetna Commercial |
$2,440.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,472.21
|
| Rate for Payer: Cash Price |
$1,584.75
|
| Rate for Payer: Cigna Commercial |
$2,630.68
|
| Rate for Payer: First Health Commercial |
$3,011.02
|
| Rate for Payer: Humana Commercial |
$2,694.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,598.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,339.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$950.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,789.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,377.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$412.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$982.54
|
| Rate for Payer: PHCS Commercial |
$3,042.72
|
| Rate for Payer: United Healthcare All Payer |
$2,789.16
|
|
|
PLATE 0.8 CVD MED/LAT
|
Facility
|
OP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem Medicaid |
$1,175.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Humana KY Medicaid |
$1,175.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,187.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,199.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE 0.8 CVD MED/LAT
|
Facility
|
IP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE 0.8 OFFSET
|
Facility
|
IP
|
$3,292.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$427.96 |
| Max. Negotiated Rate |
$3,160.32 |
| Rate for Payer: Aetna Commercial |
$2,534.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,567.76
|
| Rate for Payer: Cash Price |
$1,646.00
|
| Rate for Payer: Cigna Commercial |
$2,732.36
|
| Rate for Payer: First Health Commercial |
$3,127.40
|
| Rate for Payer: Humana Commercial |
$2,798.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,699.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,429.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,896.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,469.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$658.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$427.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,020.52
|
| Rate for Payer: PHCS Commercial |
$3,160.32
|
| Rate for Payer: United Healthcare All Payer |
$2,896.96
|
|
|
PLATE 0.8 OFFSET
|
Facility
|
OP
|
$3,292.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$427.96 |
| Max. Negotiated Rate |
$3,160.32 |
| Rate for Payer: Humana Commercial |
$2,798.20
|
| Rate for Payer: Humana KY Medicaid |
$1,132.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,143.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,699.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,429.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,154.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,896.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,469.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$658.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$427.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,020.52
|
| Rate for Payer: PHCS Commercial |
$3,160.32
|
| Rate for Payer: United Healthcare All Payer |
$2,896.96
|
| Rate for Payer: Aetna Commercial |
$2,534.84
|
| Rate for Payer: Anthem Medicaid |
$1,132.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,567.76
|
| Rate for Payer: Cash Price |
$1,646.00
|
| Rate for Payer: Cigna Commercial |
$2,732.36
|
| Rate for Payer: First Health Commercial |
$3,127.40
|
|
|
PLATE 0.8 STR 10H
|
Facility
|
OP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem Medicaid |
$1,175.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Humana KY Medicaid |
$1,175.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,187.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,199.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE 0.8 STR 10H
|
Facility
|
IP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE 0.8 T
|
Facility
|
IP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
