|
PLATE LD FM LK 4.5M 13H 286M R
|
Facility
|
IP
|
$8,424.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,095.23 |
| Max. Negotiated Rate |
$8,087.84 |
| Rate for Payer: Aetna Commercial |
$6,487.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,571.37
|
| Rate for Payer: Cash Price |
$4,212.42
|
| Rate for Payer: Cigna Commercial |
$6,992.61
|
| Rate for Payer: First Health Commercial |
$8,003.59
|
| Rate for Payer: Humana Commercial |
$7,161.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,908.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,217.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,527.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,413.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,318.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,095.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,611.70
|
| Rate for Payer: PHCS Commercial |
$8,087.84
|
| Rate for Payer: United Healthcare All Payer |
$7,413.85
|
|
|
PLATE LD FM LK 4.5M 13H 286M R
|
Facility
|
OP
|
$8,424.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,095.23 |
| Max. Negotiated Rate |
$8,087.84 |
| Rate for Payer: Aetna Commercial |
$6,487.12
|
| Rate for Payer: Anthem Medicaid |
$2,897.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,571.37
|
| Rate for Payer: Cash Price |
$4,212.42
|
| Rate for Payer: Cigna Commercial |
$6,992.61
|
| Rate for Payer: First Health Commercial |
$8,003.59
|
| Rate for Payer: Humana Commercial |
$7,161.11
|
| Rate for Payer: Humana KY Medicaid |
$2,897.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,926.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,908.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,217.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,527.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,955.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,413.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,318.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,095.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,611.70
|
| Rate for Payer: PHCS Commercial |
$8,087.84
|
| Rate for Payer: United Healthcare All Payer |
$7,413.85
|
|
|
PLATE LD FM LK 4.5M 16H 342M L
|
Facility
|
IP
|
$8,526.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.40 |
| Max. Negotiated Rate |
$8,185.08 |
| Rate for Payer: Aetna Commercial |
$6,565.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,650.37
|
| Rate for Payer: Cash Price |
$4,263.06
|
| Rate for Payer: Cigna Commercial |
$7,076.68
|
| Rate for Payer: First Health Commercial |
$8,099.81
|
| Rate for Payer: Humana Commercial |
$7,247.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,991.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,292.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,502.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,394.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,705.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,643.10
|
| Rate for Payer: PHCS Commercial |
$8,185.08
|
| Rate for Payer: United Healthcare All Payer |
$7,502.99
|
|
|
PLATE LD FM LK 4.5M 16H 342M L
|
Facility
|
OP
|
$8,526.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.40 |
| Max. Negotiated Rate |
$8,185.08 |
| Rate for Payer: Aetna Commercial |
$6,565.11
|
| Rate for Payer: Anthem Medicaid |
$2,932.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,650.37
|
| Rate for Payer: Cash Price |
$4,263.06
|
| Rate for Payer: Cigna Commercial |
$7,076.68
|
| Rate for Payer: First Health Commercial |
$8,099.81
|
| Rate for Payer: Humana Commercial |
$7,247.20
|
| Rate for Payer: Humana KY Medicaid |
$2,932.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,961.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,991.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,292.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,990.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,502.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,394.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,705.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,643.10
|
| Rate for Payer: PHCS Commercial |
$8,185.08
|
| Rate for Payer: United Healthcare All Payer |
$7,502.99
|
|
|
PLATE LD FM LK 4.5M 16H 342M R
|
Facility
|
IP
|
$8,526.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.40 |
| Max. Negotiated Rate |
$8,185.08 |
| Rate for Payer: Aetna Commercial |
$6,565.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,650.37
|
| Rate for Payer: Cash Price |
$4,263.06
|
| Rate for Payer: Cigna Commercial |
$7,076.68
|
| Rate for Payer: First Health Commercial |
$8,099.81
|
| Rate for Payer: Humana Commercial |
$7,247.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,991.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,292.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,502.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,394.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,705.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,643.10
|
| Rate for Payer: PHCS Commercial |
$8,185.08
|
| Rate for Payer: United Healthcare All Payer |
$7,502.99
|
|
|
PLATE LD FM LK 4.5M 16H 342M R
|
Facility
|
OP
|
$8,526.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.40 |
| Max. Negotiated Rate |
$8,185.08 |
| Rate for Payer: Aetna Commercial |
$6,565.11
|
| Rate for Payer: Anthem Medicaid |
$2,932.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,650.37
|
| Rate for Payer: Cash Price |
$4,263.06
|
| Rate for Payer: Cigna Commercial |
$7,076.68
|
| Rate for Payer: First Health Commercial |
$8,099.81
|
| Rate for Payer: Humana Commercial |
$7,247.20
|
| Rate for Payer: Humana KY Medicaid |
$2,932.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,961.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,991.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,292.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,990.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,502.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,394.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,705.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,643.10
|
| Rate for Payer: PHCS Commercial |
$8,185.08
|
| Rate for Payer: United Healthcare All Payer |
$7,502.99
|
|
|
PLATE LD FM LK 4.5M 19H 399M L
|
Facility
|
IP
|
$8,715.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.97 |
| Max. Negotiated Rate |
$8,366.58 |
| Rate for Payer: Aetna Commercial |
$6,710.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,797.85
|
| Rate for Payer: Cash Price |
$4,357.60
|
| Rate for Payer: Cigna Commercial |
$7,233.61
|
| Rate for Payer: First Health Commercial |
$8,279.43
|
| Rate for Payer: Humana Commercial |
$7,407.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,146.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,431.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,614.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,669.37
|
| Rate for Payer: Ohio Health Group HMO |
$6,536.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,743.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.71
|
| Rate for Payer: PHCS Commercial |
$8,366.58
|
| Rate for Payer: United Healthcare All Payer |
$7,669.37
|
|
|
PLATE LD FM LK 4.5M 19H 399M L
|
Facility
|
OP
|
$8,715.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.97 |
| Max. Negotiated Rate |
$8,366.58 |
| Rate for Payer: Aetna Commercial |
$6,710.70
|
| Rate for Payer: Anthem Medicaid |
$2,997.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,797.85
|
| Rate for Payer: Cash Price |
$4,357.60
|
| Rate for Payer: Cigna Commercial |
$7,233.61
|
| Rate for Payer: First Health Commercial |
$8,279.43
|
| Rate for Payer: Humana Commercial |
$7,407.91
|
| Rate for Payer: Humana KY Medicaid |
$2,997.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,027.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,146.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,431.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,614.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,057.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,669.37
|
| Rate for Payer: Ohio Health Group HMO |
$6,536.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,743.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.71
|
| Rate for Payer: PHCS Commercial |
$8,366.58
|
| Rate for Payer: United Healthcare All Payer |
$7,669.37
|
|
|
PLATE LD FM LK 4.5M 19H 399M R
|
Facility
|
OP
|
$8,715.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.97 |
| Max. Negotiated Rate |
$8,366.58 |
| Rate for Payer: Aetna Commercial |
$6,710.70
|
| Rate for Payer: Anthem Medicaid |
$2,997.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,797.85
|
| Rate for Payer: Cash Price |
$4,357.60
|
| Rate for Payer: Cigna Commercial |
$7,233.61
|
| Rate for Payer: First Health Commercial |
$8,279.43
|
| Rate for Payer: Humana Commercial |
$7,407.91
|
| Rate for Payer: Humana KY Medicaid |
$2,997.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,027.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,146.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,431.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,614.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,057.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,669.37
|
| Rate for Payer: Ohio Health Group HMO |
$6,536.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,743.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.71
|
| Rate for Payer: PHCS Commercial |
$8,366.58
|
| Rate for Payer: United Healthcare All Payer |
$7,669.37
|
|
|
PLATE LD FM LK 4.5M 19H 399M R
|
Facility
|
IP
|
$8,715.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.97 |
| Max. Negotiated Rate |
$8,366.58 |
| Rate for Payer: Aetna Commercial |
$6,710.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,797.85
|
| Rate for Payer: Cash Price |
$4,357.60
|
| Rate for Payer: Cigna Commercial |
$7,233.61
|
| Rate for Payer: First Health Commercial |
$8,279.43
|
| Rate for Payer: Humana Commercial |
$7,407.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,146.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,431.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,614.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,669.37
|
| Rate for Payer: Ohio Health Group HMO |
$6,536.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,743.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.71
|
| Rate for Payer: PHCS Commercial |
$8,366.58
|
| Rate for Payer: United Healthcare All Payer |
$7,669.37
|
|
|
PLATE LD FM LK 4.5M 6H 155M L
|
Facility
|
IP
|
$7,790.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.71 |
| Max. Negotiated Rate |
$7,478.50 |
| Rate for Payer: Aetna Commercial |
$5,998.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,076.28
|
| Rate for Payer: Cash Price |
$3,895.05
|
| Rate for Payer: Cigna Commercial |
$6,465.78
|
| Rate for Payer: First Health Commercial |
$7,400.60
|
| Rate for Payer: Humana Commercial |
$6,621.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,387.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,749.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,337.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,855.29
|
| Rate for Payer: Ohio Health Group HMO |
$5,842.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,558.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,012.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,414.93
|
| Rate for Payer: PHCS Commercial |
$7,478.50
|
| Rate for Payer: United Healthcare All Payer |
$6,855.29
|
|
|
PLATE LD FM LK 4.5M 6H 155M L
|
Facility
|
OP
|
$7,790.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.71 |
| Max. Negotiated Rate |
$7,478.50 |
| Rate for Payer: Aetna Commercial |
$5,998.38
|
| Rate for Payer: Anthem Medicaid |
$2,679.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,076.28
|
| Rate for Payer: Cash Price |
$3,895.05
|
| Rate for Payer: Cigna Commercial |
$6,465.78
|
| Rate for Payer: First Health Commercial |
$7,400.60
|
| Rate for Payer: Humana Commercial |
$6,621.58
|
| Rate for Payer: Humana KY Medicaid |
$2,679.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,706.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,387.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,749.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,337.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,732.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,855.29
|
| Rate for Payer: Ohio Health Group HMO |
$5,842.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,558.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,012.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,414.93
|
| Rate for Payer: PHCS Commercial |
$7,478.50
|
| Rate for Payer: United Healthcare All Payer |
$6,855.29
|
|
|
PLATE LD FM LK 4.5M 6H 155M R
|
Facility
|
OP
|
$7,790.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.71 |
| Max. Negotiated Rate |
$7,478.50 |
| Rate for Payer: Anthem Medicaid |
$2,679.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,076.28
|
| Rate for Payer: Cash Price |
$3,895.05
|
| Rate for Payer: Cigna Commercial |
$6,465.78
|
| Rate for Payer: First Health Commercial |
$7,400.60
|
| Rate for Payer: Humana Commercial |
$6,621.58
|
| Rate for Payer: Humana KY Medicaid |
$2,679.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,706.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,387.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,749.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,337.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,732.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,855.29
|
| Rate for Payer: Ohio Health Group HMO |
$5,842.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,558.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,012.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,414.93
|
| Rate for Payer: PHCS Commercial |
$7,478.50
|
| Rate for Payer: United Healthcare All Payer |
$6,855.29
|
| Rate for Payer: Aetna Commercial |
$5,998.38
|
|
|
PLATE LD FM LK 4.5M 6H 155M R
|
Facility
|
IP
|
$7,790.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.71 |
| Max. Negotiated Rate |
$7,478.50 |
| Rate for Payer: Aetna Commercial |
$5,998.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,076.28
|
| Rate for Payer: Cash Price |
$3,895.05
|
| Rate for Payer: Cigna Commercial |
$6,465.78
|
| Rate for Payer: First Health Commercial |
$7,400.60
|
| Rate for Payer: Humana Commercial |
$6,621.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,387.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,749.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,337.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,855.29
|
| Rate for Payer: Ohio Health Group HMO |
$5,842.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,558.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,012.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,414.93
|
| Rate for Payer: PHCS Commercial |
$7,478.50
|
| Rate for Payer: United Healthcare All Payer |
$6,855.29
|
|
|
PLATE LD FM LK 4.5M 8H 193M L
|
Facility
|
IP
|
$8,080.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.46 |
| Max. Negotiated Rate |
$7,757.24 |
| Rate for Payer: Aetna Commercial |
$6,221.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,302.76
|
| Rate for Payer: Cash Price |
$4,040.23
|
| Rate for Payer: Cigna Commercial |
$6,706.78
|
| Rate for Payer: First Health Commercial |
$7,676.44
|
| Rate for Payer: Humana Commercial |
$6,868.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,625.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,963.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,110.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,060.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,616.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,050.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,504.94
|
| Rate for Payer: PHCS Commercial |
$7,757.24
|
| Rate for Payer: United Healthcare All Payer |
$7,110.80
|
|
|
PLATE LD FM LK 4.5M 8H 193M L
|
Facility
|
OP
|
$8,080.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.46 |
| Max. Negotiated Rate |
$7,757.24 |
| Rate for Payer: Aetna Commercial |
$6,221.95
|
| Rate for Payer: Anthem Medicaid |
$2,778.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,302.76
|
| Rate for Payer: Cash Price |
$4,040.23
|
| Rate for Payer: Cigna Commercial |
$6,706.78
|
| Rate for Payer: First Health Commercial |
$7,676.44
|
| Rate for Payer: Humana Commercial |
$6,868.39
|
| Rate for Payer: Humana KY Medicaid |
$2,778.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,807.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,625.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,963.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,834.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,110.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,060.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,616.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,050.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,504.94
|
| Rate for Payer: PHCS Commercial |
$7,757.24
|
| Rate for Payer: United Healthcare All Payer |
$7,110.80
|
|
|
PLATE LD FM LK 4.5M 8H 193M R
|
Facility
|
OP
|
$8,080.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.46 |
| Max. Negotiated Rate |
$7,757.24 |
| Rate for Payer: Aetna Commercial |
$6,221.95
|
| Rate for Payer: Anthem Medicaid |
$2,778.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,302.76
|
| Rate for Payer: Cash Price |
$4,040.23
|
| Rate for Payer: Cigna Commercial |
$6,706.78
|
| Rate for Payer: First Health Commercial |
$7,676.44
|
| Rate for Payer: Humana Commercial |
$6,868.39
|
| Rate for Payer: Humana KY Medicaid |
$2,778.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,807.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,625.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,963.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,834.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,110.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,060.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,616.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,050.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,504.94
|
| Rate for Payer: PHCS Commercial |
$7,757.24
|
| Rate for Payer: United Healthcare All Payer |
$7,110.80
|
|
|
PLATE LD FM LK 4.5M 8H 193M R
|
Facility
|
IP
|
$8,080.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.46 |
| Max. Negotiated Rate |
$7,757.24 |
| Rate for Payer: Aetna Commercial |
$6,221.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,302.76
|
| Rate for Payer: Cash Price |
$4,040.23
|
| Rate for Payer: Cigna Commercial |
$6,706.78
|
| Rate for Payer: First Health Commercial |
$7,676.44
|
| Rate for Payer: Humana Commercial |
$6,868.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,625.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,963.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,110.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,060.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,616.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,050.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,504.94
|
| Rate for Payer: PHCS Commercial |
$7,757.24
|
| Rate for Payer: United Healthcare All Payer |
$7,110.80
|
|
|
PLATELET COUNT AUTOMATED
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 85049
|
| Hospital Charge Code |
30000574
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.73
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$34.86
|
| Rate for Payer: First Health Commercial |
$39.90
|
| Rate for Payer: Humana Commercial |
$35.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.96
|
| Rate for Payer: Ohio Health Group HMO |
$31.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.02
|
| Rate for Payer: PHCS Commercial |
$40.32
|
| Rate for Payer: United Healthcare All Payer |
$36.96
|
|
|
PLATELET COUNT AUTOMATED
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 85049
|
| Hospital Charge Code |
30000574
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Anthem Medicaid |
$4.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.48
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$34.86
|
| Rate for Payer: First Health Commercial |
$39.90
|
| Rate for Payer: Humana Commercial |
$35.70
|
| Rate for Payer: Humana KY Medicaid |
$4.48
|
| Rate for Payer: Humana Medicare Advantage |
$4.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.96
|
| Rate for Payer: Ohio Health Group HMO |
$31.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.02
|
| Rate for Payer: PHCS Commercial |
$40.32
|
| Rate for Payer: United Healthcare All Payer |
$36.96
|
|
|
Platelets pheresis path redu
|
Facility
|
OP
|
$1,445.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
30001923
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$187.85 |
| Max. Negotiated Rate |
$1,387.20 |
| Rate for Payer: Aetna Commercial |
$1,112.65
|
| Rate for Payer: Anthem Medicaid |
$496.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$500.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,127.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$700.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$675.46
|
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Cigna Commercial |
$1,199.35
|
| Rate for Payer: First Health Commercial |
$1,372.75
|
| Rate for Payer: Humana Commercial |
$1,228.25
|
| Rate for Payer: Humana KY Medicaid |
$496.94
|
| Rate for Payer: Humana Medicare Advantage |
$500.34
|
| Rate for Payer: Kentucky WC Medicaid |
$501.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,184.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,066.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$506.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,271.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,083.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$289.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$447.95
|
| Rate for Payer: PHCS Commercial |
$1,387.20
|
| Rate for Payer: United Healthcare All Payer |
$1,271.60
|
|
|
Platelets pheresis path redu
|
Facility
|
IP
|
$1,445.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
30001923
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$187.85 |
| Max. Negotiated Rate |
$1,387.20 |
| Rate for Payer: Aetna Commercial |
$1,112.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,127.10
|
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Cigna Commercial |
$1,199.35
|
| Rate for Payer: First Health Commercial |
$1,372.75
|
| Rate for Payer: Humana Commercial |
$1,228.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,184.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,066.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$433.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,271.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,083.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$289.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$447.95
|
| Rate for Payer: PHCS Commercial |
$1,387.20
|
| Rate for Payer: United Healthcare All Payer |
$1,271.60
|
|
|
PLATELETSPHESELEUKOREDUCED1UN
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
38000012
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$187.20 |
| Max. Negotiated Rate |
$1,382.40 |
| Rate for Payer: Aetna Commercial |
$1,108.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,123.20
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$1,195.20
|
| Rate for Payer: First Health Commercial |
$1,368.00
|
| Rate for Payer: Humana Commercial |
$1,224.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,180.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,062.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$432.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,267.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$446.40
|
| Rate for Payer: PHCS Commercial |
$1,382.40
|
| Rate for Payer: United Healthcare All Payer |
$1,267.20
|
|
|
PLATELETSPHESELEUKOREDUCED1UN
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
38000012
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$187.20 |
| Max. Negotiated Rate |
$1,382.40 |
| Rate for Payer: Aetna Commercial |
$1,108.80
|
| Rate for Payer: Anthem Medicaid |
$495.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$428.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,123.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$600.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$578.73
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$1,195.20
|
| Rate for Payer: First Health Commercial |
$1,368.00
|
| Rate for Payer: Humana Commercial |
$1,224.00
|
| Rate for Payer: Humana KY Medicaid |
$495.22
|
| Rate for Payer: Humana Medicare Advantage |
$428.69
|
| Rate for Payer: Kentucky WC Medicaid |
$500.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,180.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,062.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$514.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$505.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,267.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$446.40
|
| Rate for Payer: PHCS Commercial |
$1,382.40
|
| Rate for Payer: United Healthcare All Payer |
$1,267.20
|
|
|
PLATE L FRAGMENT 2.7*61 L
|
Facility
|
IP
|
$3,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.23 |
| Max. Negotiated Rate |
$3,140.16 |
| Rate for Payer: Aetna Commercial |
$2,518.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,551.38
|
| Rate for Payer: Cash Price |
$1,635.50
|
| Rate for Payer: Cigna Commercial |
$2,714.93
|
| Rate for Payer: First Health Commercial |
$3,107.45
|
| Rate for Payer: Humana Commercial |
$2,780.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,682.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,414.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$981.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,878.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,453.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,014.01
|
| Rate for Payer: PHCS Commercial |
$3,140.16
|
| Rate for Payer: United Healthcare All Payer |
$2,878.48
|
|
