|
PLATE LD FM LK 4.5M 16H 342M L
|
Facility
|
IP
|
$8,726.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.84 |
| Max. Negotiated Rate |
$8,377.08 |
| Rate for Payer: Aetna Commercial |
$6,719.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,806.37
|
| Rate for Payer: Cash Price |
$4,363.06
|
| Rate for Payer: Cigna Commercial |
$7,242.68
|
| Rate for Payer: First Health Commercial |
$8,289.81
|
| Rate for Payer: Humana Commercial |
$7,417.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,155.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,439.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,678.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,544.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,980.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,591.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,021.02
|
| Rate for Payer: PHCS Commercial |
$8,377.08
|
| Rate for Payer: United Healthcare All Payer |
$7,678.99
|
|
|
PLATE LD FM LK 4.5M 16H 342M L
|
Facility
|
OP
|
$8,726.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.84 |
| Max. Negotiated Rate |
$8,377.08 |
| Rate for Payer: Aetna Commercial |
$6,719.11
|
| Rate for Payer: Anthem Medicaid |
$3,000.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,806.37
|
| Rate for Payer: Cash Price |
$4,363.06
|
| Rate for Payer: Cigna Commercial |
$7,242.68
|
| Rate for Payer: First Health Commercial |
$8,289.81
|
| Rate for Payer: Humana Commercial |
$7,417.20
|
| Rate for Payer: Humana KY Medicaid |
$3,000.91
|
| Rate for Payer: Kentucky WC Medicaid |
$3,031.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,155.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,439.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,061.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,678.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,544.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,980.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,591.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,021.02
|
| Rate for Payer: PHCS Commercial |
$8,377.08
|
| Rate for Payer: United Healthcare All Payer |
$7,678.99
|
|
|
PLATE LD FM LK 4.5M 16H 342M R
|
Facility
|
OP
|
$8,726.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.84 |
| Max. Negotiated Rate |
$8,377.08 |
| Rate for Payer: Aetna Commercial |
$6,719.11
|
| Rate for Payer: Anthem Medicaid |
$3,000.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,806.37
|
| Rate for Payer: Cash Price |
$4,363.06
|
| Rate for Payer: Cigna Commercial |
$7,242.68
|
| Rate for Payer: First Health Commercial |
$8,289.81
|
| Rate for Payer: Humana Commercial |
$7,417.20
|
| Rate for Payer: Humana KY Medicaid |
$3,000.91
|
| Rate for Payer: Kentucky WC Medicaid |
$3,031.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,155.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,439.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,061.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,678.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,544.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,980.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,591.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,021.02
|
| Rate for Payer: PHCS Commercial |
$8,377.08
|
| Rate for Payer: United Healthcare All Payer |
$7,678.99
|
|
|
PLATE LD FM LK 4.5M 16H 342M R
|
Facility
|
IP
|
$8,726.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.84 |
| Max. Negotiated Rate |
$8,377.08 |
| Rate for Payer: Aetna Commercial |
$6,719.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,806.37
|
| Rate for Payer: Cash Price |
$4,363.06
|
| Rate for Payer: Cigna Commercial |
$7,242.68
|
| Rate for Payer: First Health Commercial |
$8,289.81
|
| Rate for Payer: Humana Commercial |
$7,417.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,155.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,439.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,678.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,544.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,980.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,591.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,021.02
|
| Rate for Payer: PHCS Commercial |
$8,377.08
|
| Rate for Payer: United Healthcare All Payer |
$7,678.99
|
|
|
PLATE LD FM LK 4.5M 19H 399M L
|
Facility
|
IP
|
$8,915.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,674.56 |
| Max. Negotiated Rate |
$8,558.58 |
| Rate for Payer: Aetna Commercial |
$6,864.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.85
|
| Rate for Payer: Cash Price |
$4,457.60
|
| Rate for Payer: Cigna Commercial |
$7,399.61
|
| Rate for Payer: First Health Commercial |
$8,469.43
|
| Rate for Payer: Humana Commercial |
$7,577.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,310.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,579.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,845.37
|
| Rate for Payer: Ohio Health Group HMO |
$6,686.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,132.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,756.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,151.48
|
| Rate for Payer: PHCS Commercial |
$8,558.58
|
| Rate for Payer: United Healthcare All Payer |
$7,845.37
|
|
|
PLATE LD FM LK 4.5M 19H 399M L
|
Facility
|
OP
|
$8,915.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,674.56 |
| Max. Negotiated Rate |
$8,558.58 |
| Rate for Payer: Aetna Commercial |
$6,864.70
|
| Rate for Payer: Anthem Medicaid |
$3,065.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.85
|
| Rate for Payer: Cash Price |
$4,457.60
|
| Rate for Payer: Cigna Commercial |
$7,399.61
|
| Rate for Payer: First Health Commercial |
$8,469.43
|
| Rate for Payer: Humana Commercial |
$7,577.91
|
| Rate for Payer: Humana KY Medicaid |
$3,065.93
|
| Rate for Payer: Kentucky WC Medicaid |
$3,097.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,310.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,579.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,127.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,845.37
|
| Rate for Payer: Ohio Health Group HMO |
$6,686.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,132.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,756.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,151.48
|
| Rate for Payer: PHCS Commercial |
$8,558.58
|
| Rate for Payer: United Healthcare All Payer |
$7,845.37
|
|
|
PLATE LD FM LK 4.5M 19H 399M R
|
Facility
|
IP
|
$8,915.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,674.56 |
| Max. Negotiated Rate |
$8,558.58 |
| Rate for Payer: Aetna Commercial |
$6,864.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.85
|
| Rate for Payer: Cash Price |
$4,457.60
|
| Rate for Payer: Cigna Commercial |
$7,399.61
|
| Rate for Payer: First Health Commercial |
$8,469.43
|
| Rate for Payer: Humana Commercial |
$7,577.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,310.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,579.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,845.37
|
| Rate for Payer: Ohio Health Group HMO |
$6,686.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,132.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,756.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,151.48
|
| Rate for Payer: PHCS Commercial |
$8,558.58
|
| Rate for Payer: United Healthcare All Payer |
$7,845.37
|
|
|
PLATE LD FM LK 4.5M 19H 399M R
|
Facility
|
OP
|
$8,915.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,674.56 |
| Max. Negotiated Rate |
$8,558.58 |
| Rate for Payer: Aetna Commercial |
$6,864.70
|
| Rate for Payer: Anthem Medicaid |
$3,065.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,953.85
|
| Rate for Payer: Cash Price |
$4,457.60
|
| Rate for Payer: Cigna Commercial |
$7,399.61
|
| Rate for Payer: First Health Commercial |
$8,469.43
|
| Rate for Payer: Humana Commercial |
$7,577.91
|
| Rate for Payer: Humana KY Medicaid |
$3,065.93
|
| Rate for Payer: Kentucky WC Medicaid |
$3,097.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,310.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,579.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,127.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,845.37
|
| Rate for Payer: Ohio Health Group HMO |
$6,686.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,132.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,756.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,151.48
|
| Rate for Payer: PHCS Commercial |
$8,558.58
|
| Rate for Payer: United Healthcare All Payer |
$7,845.37
|
|
|
PLATE LD FM LK 4.5M 6H 155M L
|
Facility
|
OP
|
$7,990.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,397.03 |
| Max. Negotiated Rate |
$7,670.50 |
| Rate for Payer: Aetna Commercial |
$6,152.38
|
| Rate for Payer: Anthem Medicaid |
$2,747.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,232.28
|
| Rate for Payer: Cash Price |
$3,995.05
|
| Rate for Payer: Cigna Commercial |
$6,631.78
|
| Rate for Payer: First Health Commercial |
$7,590.60
|
| Rate for Payer: Humana Commercial |
$6,791.59
|
| Rate for Payer: Humana KY Medicaid |
$2,747.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,775.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,551.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,896.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,397.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,802.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,031.29
|
| Rate for Payer: Ohio Health Group HMO |
$5,992.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,392.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,951.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,513.17
|
| Rate for Payer: PHCS Commercial |
$7,670.50
|
| Rate for Payer: United Healthcare All Payer |
$7,031.29
|
|
|
PLATE LD FM LK 4.5M 6H 155M L
|
Facility
|
IP
|
$7,990.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,397.03 |
| Max. Negotiated Rate |
$7,670.50 |
| Rate for Payer: Aetna Commercial |
$6,152.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,232.28
|
| Rate for Payer: Cash Price |
$3,995.05
|
| Rate for Payer: Cigna Commercial |
$6,631.78
|
| Rate for Payer: First Health Commercial |
$7,590.60
|
| Rate for Payer: Humana Commercial |
$6,791.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,551.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,896.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,397.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,031.29
|
| Rate for Payer: Ohio Health Group HMO |
$5,992.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,392.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,951.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,513.17
|
| Rate for Payer: PHCS Commercial |
$7,670.50
|
| Rate for Payer: United Healthcare All Payer |
$7,031.29
|
|
|
PLATE LD FM LK 4.5M 6H 155M R
|
Facility
|
OP
|
$7,990.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,397.03 |
| Max. Negotiated Rate |
$7,670.50 |
| Rate for Payer: Aetna Commercial |
$6,152.38
|
| Rate for Payer: Anthem Medicaid |
$2,747.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,232.28
|
| Rate for Payer: Cash Price |
$3,995.05
|
| Rate for Payer: Cigna Commercial |
$6,631.78
|
| Rate for Payer: First Health Commercial |
$7,590.60
|
| Rate for Payer: Humana Commercial |
$6,791.59
|
| Rate for Payer: Humana KY Medicaid |
$2,747.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,775.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,551.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,896.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,397.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,802.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,031.29
|
| Rate for Payer: Ohio Health Group HMO |
$5,992.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,392.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,951.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,513.17
|
| Rate for Payer: PHCS Commercial |
$7,670.50
|
| Rate for Payer: United Healthcare All Payer |
$7,031.29
|
|
|
PLATE LD FM LK 4.5M 6H 155M R
|
Facility
|
IP
|
$7,990.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,397.03 |
| Max. Negotiated Rate |
$7,670.50 |
| Rate for Payer: Aetna Commercial |
$6,152.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,232.28
|
| Rate for Payer: Cash Price |
$3,995.05
|
| Rate for Payer: Cigna Commercial |
$6,631.78
|
| Rate for Payer: First Health Commercial |
$7,590.60
|
| Rate for Payer: Humana Commercial |
$6,791.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,551.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,896.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,397.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,031.29
|
| Rate for Payer: Ohio Health Group HMO |
$5,992.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,392.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,951.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,513.17
|
| Rate for Payer: PHCS Commercial |
$7,670.50
|
| Rate for Payer: United Healthcare All Payer |
$7,031.29
|
|
|
PLATE LD FM LK 4.5M 8H 193M L
|
Facility
|
IP
|
$8,280.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,484.14 |
| Max. Negotiated Rate |
$7,949.24 |
| Rate for Payer: Aetna Commercial |
$6,375.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,458.76
|
| Rate for Payer: Cash Price |
$4,140.23
|
| Rate for Payer: Cigna Commercial |
$6,872.78
|
| Rate for Payer: First Health Commercial |
$7,866.44
|
| Rate for Payer: Humana Commercial |
$7,038.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,789.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,110.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,484.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,286.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,210.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,624.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,204.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,713.52
|
| Rate for Payer: PHCS Commercial |
$7,949.24
|
| Rate for Payer: United Healthcare All Payer |
$7,286.80
|
|
|
PLATE LD FM LK 4.5M 8H 193M L
|
Facility
|
OP
|
$8,280.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,484.14 |
| Max. Negotiated Rate |
$7,949.24 |
| Rate for Payer: Aetna Commercial |
$6,375.95
|
| Rate for Payer: Anthem Medicaid |
$2,847.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,458.76
|
| Rate for Payer: Cash Price |
$4,140.23
|
| Rate for Payer: Cigna Commercial |
$6,872.78
|
| Rate for Payer: First Health Commercial |
$7,866.44
|
| Rate for Payer: Humana Commercial |
$7,038.39
|
| Rate for Payer: Humana KY Medicaid |
$2,847.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,876.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,789.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,110.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,484.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,904.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,286.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,210.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,624.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,204.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,713.52
|
| Rate for Payer: PHCS Commercial |
$7,949.24
|
| Rate for Payer: United Healthcare All Payer |
$7,286.80
|
|
|
PLATE LD FM LK 4.5M 8H 193M R
|
Facility
|
IP
|
$8,280.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,484.14 |
| Max. Negotiated Rate |
$7,949.24 |
| Rate for Payer: Aetna Commercial |
$6,375.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,458.76
|
| Rate for Payer: Cash Price |
$4,140.23
|
| Rate for Payer: Cigna Commercial |
$6,872.78
|
| Rate for Payer: First Health Commercial |
$7,866.44
|
| Rate for Payer: Humana Commercial |
$7,038.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,789.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,110.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,484.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,286.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,210.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,624.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,204.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,713.52
|
| Rate for Payer: PHCS Commercial |
$7,949.24
|
| Rate for Payer: United Healthcare All Payer |
$7,286.80
|
|
|
PLATE LD FM LK 4.5M 8H 193M R
|
Facility
|
OP
|
$8,280.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,484.14 |
| Max. Negotiated Rate |
$7,949.24 |
| Rate for Payer: Aetna Commercial |
$6,375.95
|
| Rate for Payer: Anthem Medicaid |
$2,847.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,458.76
|
| Rate for Payer: Cash Price |
$4,140.23
|
| Rate for Payer: Cigna Commercial |
$6,872.78
|
| Rate for Payer: First Health Commercial |
$7,866.44
|
| Rate for Payer: Humana Commercial |
$7,038.39
|
| Rate for Payer: Humana KY Medicaid |
$2,847.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,876.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,789.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,110.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,484.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,904.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,286.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,210.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,624.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,204.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,713.52
|
| Rate for Payer: PHCS Commercial |
$7,949.24
|
| Rate for Payer: United Healthcare All Payer |
$7,286.80
|
|
|
PLATELET COUNT AUTOMATED
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 85049
|
| Hospital Charge Code |
30000574
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.33
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.36
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
PLATELET COUNT AUTOMATED
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 85049
|
| Hospital Charge Code |
30000574
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem Medicaid |
$4.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.48
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| 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 |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.36
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
Platelets pheresis path redu
|
Facility
|
OP
|
$1,536.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
30001923
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$528.23 |
| Max. Negotiated Rate |
$1,474.56 |
| Rate for Payer: Aetna Commercial |
$1,182.72
|
| Rate for Payer: Anthem Medicaid |
$528.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$542.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$759.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$732.55
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cigna Commercial |
$1,274.88
|
| Rate for Payer: First Health Commercial |
$1,459.20
|
| Rate for Payer: Humana Commercial |
$1,305.60
|
| Rate for Payer: Humana KY Medicaid |
$528.23
|
| Rate for Payer: Humana Medicare Advantage |
$542.63
|
| Rate for Payer: Kentucky WC Medicaid |
$533.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,259.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,133.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$538.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,351.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,228.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,336.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.84
|
| Rate for Payer: PHCS Commercial |
$1,474.56
|
| Rate for Payer: United Healthcare All Payer |
$1,351.68
|
|
|
Platelets pheresis path redu
|
Facility
|
IP
|
$1,536.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
30001923
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$460.80 |
| Max. Negotiated Rate |
$1,474.56 |
| Rate for Payer: Aetna Commercial |
$1,182.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.08
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cigna Commercial |
$1,274.88
|
| Rate for Payer: First Health Commercial |
$1,459.20
|
| Rate for Payer: Humana Commercial |
$1,305.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,259.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,133.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$460.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,351.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,228.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,336.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.84
|
| Rate for Payer: PHCS Commercial |
$1,474.56
|
| Rate for Payer: United Healthcare All Payer |
$1,351.68
|
|
|
PLATELETSPHESELEUKOREDUCED1UN
|
Facility
|
OP
|
$1,533.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
38000012
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$450.07 |
| Max. Negotiated Rate |
$1,471.68 |
| Rate for Payer: Aetna Commercial |
$1,180.41
|
| Rate for Payer: Anthem Medicaid |
$527.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$450.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,195.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$630.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$607.59
|
| Rate for Payer: Cash Price |
$766.50
|
| Rate for Payer: Cash Price |
$766.50
|
| Rate for Payer: Cigna Commercial |
$1,272.39
|
| Rate for Payer: First Health Commercial |
$1,456.35
|
| Rate for Payer: Humana Commercial |
$1,303.05
|
| Rate for Payer: Humana KY Medicaid |
$527.20
|
| Rate for Payer: Humana Medicare Advantage |
$450.07
|
| Rate for Payer: Kentucky WC Medicaid |
$532.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,257.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,131.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$537.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,349.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,149.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,226.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,333.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,057.77
|
| Rate for Payer: PHCS Commercial |
$1,471.68
|
| Rate for Payer: United Healthcare All Payer |
$1,349.04
|
|
|
PLATELETSPHESELEUKOREDUCED1UN
|
Facility
|
IP
|
$1,533.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
38000012
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$459.90 |
| Max. Negotiated Rate |
$1,471.68 |
| Rate for Payer: Aetna Commercial |
$1,180.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,195.74
|
| Rate for Payer: Cash Price |
$766.50
|
| Rate for Payer: Cigna Commercial |
$1,272.39
|
| Rate for Payer: First Health Commercial |
$1,456.35
|
| Rate for Payer: Humana Commercial |
$1,303.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,257.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,131.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,349.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,149.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,226.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,333.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,057.77
|
| Rate for Payer: PHCS Commercial |
$1,471.68
|
| Rate for Payer: United Healthcare All Payer |
$1,349.04
|
|
|
PLATE L FRAGMENT 2.7*61 L
|
Facility
|
OP
|
$3,147.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.25 |
| Max. Negotiated Rate |
$3,021.60 |
| Rate for Payer: Aetna Commercial |
$2,423.57
|
| Rate for Payer: Anthem Medicaid |
$1,082.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,455.05
|
| Rate for Payer: Cash Price |
$1,573.75
|
| Rate for Payer: Cigna Commercial |
$2,612.43
|
| Rate for Payer: First Health Commercial |
$2,990.12
|
| Rate for Payer: Humana Commercial |
$2,675.38
|
| Rate for Payer: Humana KY Medicaid |
$1,082.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,093.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,580.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,322.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,104.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,769.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,360.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,518.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,738.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.78
|
| Rate for Payer: PHCS Commercial |
$3,021.60
|
| Rate for Payer: United Healthcare All Payer |
$2,769.80
|
|
|
PLATE L FRAGMENT 2.7*61 L
|
Facility
|
IP
|
$3,147.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.25 |
| Max. Negotiated Rate |
$3,021.60 |
| Rate for Payer: Aetna Commercial |
$2,423.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,455.05
|
| Rate for Payer: Cash Price |
$1,573.75
|
| Rate for Payer: Cigna Commercial |
$2,612.43
|
| Rate for Payer: First Health Commercial |
$2,990.12
|
| Rate for Payer: Humana Commercial |
$2,675.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,580.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,322.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,769.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,360.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,518.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,738.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.78
|
| Rate for Payer: PHCS Commercial |
$3,021.60
|
| Rate for Payer: United Healthcare All Payer |
$2,769.80
|
|
|
PLATE L FRAGMENT 2.7*61 R
|
Facility
|
IP
|
$3,147.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.25 |
| Max. Negotiated Rate |
$3,021.60 |
| Rate for Payer: Aetna Commercial |
$2,423.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,455.05
|
| Rate for Payer: Cash Price |
$1,573.75
|
| Rate for Payer: Cigna Commercial |
$2,612.43
|
| Rate for Payer: First Health Commercial |
$2,990.12
|
| Rate for Payer: Humana Commercial |
$2,675.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,580.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,322.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,769.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,360.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,518.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,738.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.78
|
| Rate for Payer: PHCS Commercial |
$3,021.60
|
| Rate for Payer: United Healthcare All Payer |
$2,769.80
|
|
