|
PLMT URETERAL STENT PRQ (T
|
Facility
|
OP
|
$5,862.00
|
|
|
Service Code
|
HCPCS 50695
|
| Hospital Charge Code |
761T2778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$762.06 |
| Max. Negotiated Rate |
$5,627.52 |
| Rate for Payer: Aetna Commercial |
$4,513.74
|
| Rate for Payer: Anthem Medicaid |
$2,015.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,572.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$2,931.00
|
| Rate for Payer: Cash Price |
$2,931.00
|
| Rate for Payer: Cigna Commercial |
$4,865.46
|
| Rate for Payer: First Health Commercial |
$5,568.90
|
| Rate for Payer: Humana Commercial |
$4,982.70
|
| Rate for Payer: Humana KY Medicaid |
$2,015.94
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,036.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,806.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,326.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,056.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,158.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,396.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,172.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$762.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,817.22
|
| Rate for Payer: PHCS Commercial |
$5,627.52
|
| Rate for Payer: United Healthcare All Payer |
$5,158.56
|
|
|
PLMT XTN PROSTH EVASC RPR
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
HCPCS 34709
|
| Hospital Charge Code |
76101350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.55 |
| Max. Negotiated Rate |
$513.60 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.30
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: First Health Commercial |
$508.25
|
| Rate for Payer: Humana Commercial |
$454.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.80
|
| Rate for Payer: Ohio Health Group HMO |
$401.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.85
|
| Rate for Payer: PHCS Commercial |
$513.60
|
| Rate for Payer: United Healthcare All Payer |
$470.80
|
|
|
PLMT XTN PROSTH EVASC RPR
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 34709
|
| Hospital Charge Code |
76101350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.25 |
| Max. Negotiated Rate |
$595.80 |
| Rate for Payer: Anthem Medicaid |
$260.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$535.00
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$595.80
|
| Rate for Payer: Humana Medicaid |
$260.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$435.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$265.73
|
| Rate for Payer: Molina Healthcare Passport |
$260.52
|
| Rate for Payer: Multiplan PHCS |
$321.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$374.50
|
| Rate for Payer: UHCCP Medicaid |
$187.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$263.13
|
|
|
PLMT XTN PROSTH EVASC RPR
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
HCPCS 34709
|
| Hospital Charge Code |
76101350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.55 |
| Max. Negotiated Rate |
$513.60 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Anthem Medicaid |
$183.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.30
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: First Health Commercial |
$508.25
|
| Rate for Payer: Humana Commercial |
$454.75
|
| Rate for Payer: Humana KY Medicaid |
$183.99
|
| Rate for Payer: Kentucky WC Medicaid |
$185.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.80
|
| Rate for Payer: Ohio Health Group HMO |
$401.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.85
|
| Rate for Payer: PHCS Commercial |
$513.60
|
| Rate for Payer: United Healthcare All Payer |
$470.80
|
|
|
PLMT XTN PROSTH EVASC RPR(P
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 34709
|
| Hospital Charge Code |
761P1350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.25 |
| Max. Negotiated Rate |
$595.80 |
| Rate for Payer: Anthem Medicaid |
$260.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$535.00
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$595.80
|
| Rate for Payer: Humana Medicaid |
$260.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$435.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$265.73
|
| Rate for Payer: Molina Healthcare Passport |
$260.52
|
| Rate for Payer: Multiplan PHCS |
$321.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$374.50
|
| Rate for Payer: UHCCP Medicaid |
$187.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$263.13
|
|
|
PLT APHERESIS LEUKOREDUCED IRR
|
Facility
|
OP
|
$1,330.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
38000013
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$1,276.80 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Anthem Medicaid |
$457.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$610.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,037.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$854.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$823.96
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,103.90
|
| Rate for Payer: First Health Commercial |
$1,263.50
|
| Rate for Payer: Humana Commercial |
$1,130.50
|
| Rate for Payer: Humana KY Medicaid |
$457.39
|
| Rate for Payer: Humana Medicare Advantage |
$610.34
|
| Rate for Payer: Kentucky WC Medicaid |
$462.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,090.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$981.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$732.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$466.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,170.40
|
| Rate for Payer: Ohio Health Group HMO |
$997.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$412.30
|
| Rate for Payer: PHCS Commercial |
$1,276.80
|
| Rate for Payer: United Healthcare All Payer |
$1,170.40
|
|
|
PLT APHERESIS LEUKOREDUCED IRR
|
Facility
|
IP
|
$1,330.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
38000013
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$1,276.80 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,037.40
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,103.90
|
| Rate for Payer: First Health Commercial |
$1,263.50
|
| Rate for Payer: Humana Commercial |
$1,130.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,090.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$981.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,170.40
|
| Rate for Payer: Ohio Health Group HMO |
$997.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$412.30
|
| Rate for Payer: PHCS Commercial |
$1,276.80
|
| Rate for Payer: United Healthcare All Payer |
$1,170.40
|
|
|
PLT OR CRYO POOLING EA UNIT
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
HCPCS 86965
|
| Hospital Charge Code |
30001241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.51 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem Medicaid |
$78.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$147.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$206.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$199.40
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Humana KY Medicaid |
$78.07
|
| Rate for Payer: Humana Medicare Advantage |
$147.70
|
| Rate for Payer: Kentucky WC Medicaid |
$78.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$79.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.37
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
PLT OR CRYO POOLING EA UNIT
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
HCPCS 86965
|
| Hospital Charge Code |
30001241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.51 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.37
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
PLUG CANC W/CARTILAGE 10MM
|
Facility
|
OP
|
$3,806.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.84 |
| Max. Negotiated Rate |
$3,654.24 |
| Rate for Payer: Aetna Commercial |
$2,931.00
|
| Rate for Payer: Anthem Medicaid |
$1,309.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.07
|
| Rate for Payer: Cash Price |
$1,903.25
|
| Rate for Payer: Cigna Commercial |
$3,159.40
|
| Rate for Payer: First Health Commercial |
$3,616.18
|
| Rate for Payer: Humana Commercial |
$3,235.52
|
| Rate for Payer: Humana KY Medicaid |
$1,309.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,322.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,335.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,349.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,854.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.02
|
| Rate for Payer: PHCS Commercial |
$3,654.24
|
| Rate for Payer: United Healthcare All Payer |
$3,349.72
|
|
|
PLUG CANC W/CARTILAGE 10MM
|
Facility
|
IP
|
$3,806.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.84 |
| Max. Negotiated Rate |
$3,654.24 |
| Rate for Payer: Aetna Commercial |
$2,931.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.07
|
| Rate for Payer: Cash Price |
$1,903.25
|
| Rate for Payer: Cigna Commercial |
$3,159.40
|
| Rate for Payer: First Health Commercial |
$3,616.18
|
| Rate for Payer: Humana Commercial |
$3,235.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,349.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,854.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.02
|
| Rate for Payer: PHCS Commercial |
$3,654.24
|
| Rate for Payer: United Healthcare All Payer |
$3,349.72
|
|
|
PLUG CANC W/CARTILAGE 11MM
|
Facility
|
OP
|
$3,806.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.84 |
| Max. Negotiated Rate |
$3,654.24 |
| Rate for Payer: Anthem Medicaid |
$1,309.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.07
|
| Rate for Payer: Cash Price |
$1,903.25
|
| Rate for Payer: Cigna Commercial |
$3,159.40
|
| Rate for Payer: First Health Commercial |
$3,616.18
|
| Rate for Payer: Humana Commercial |
$3,235.52
|
| Rate for Payer: Humana KY Medicaid |
$1,309.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,322.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.33
|
| Rate for Payer: Aetna Commercial |
$2,931.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,335.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,349.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,854.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.02
|
| Rate for Payer: PHCS Commercial |
$3,654.24
|
| Rate for Payer: United Healthcare All Payer |
$3,349.72
|
|
|
PLUG CANC W/CARTILAGE 11MM
|
Facility
|
IP
|
$3,806.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.84 |
| Max. Negotiated Rate |
$3,654.24 |
| Rate for Payer: Aetna Commercial |
$2,931.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.07
|
| Rate for Payer: Cash Price |
$1,903.25
|
| Rate for Payer: Cigna Commercial |
$3,159.40
|
| Rate for Payer: First Health Commercial |
$3,616.18
|
| Rate for Payer: Humana Commercial |
$3,235.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,349.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,854.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.02
|
| Rate for Payer: PHCS Commercial |
$3,654.24
|
| Rate for Payer: United Healthcare All Payer |
$3,349.72
|
|
|
PLUG CPS ANCHOR 10MM
|
Facility
|
IP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
PLUG CPS ANCHOR 10MM
|
Facility
|
OP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem Medicaid |
$3,109.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Humana KY Medicaid |
$3,109.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
PLUG CPS ANCHOR 12MM
|
Facility
|
IP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
PLUG CPS ANCHOR 12MM
|
Facility
|
OP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem Medicaid |
$3,109.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Humana KY Medicaid |
$3,109.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
PLUG CPS ANCHOR 14MM
|
Facility
|
IP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
PLUG CPS ANCHOR 14MM
|
Facility
|
OP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem Medicaid |
$3,109.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Humana KY Medicaid |
$3,109.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
PLUG CPS ANCHOR 16MM
|
Facility
|
IP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
PLUG CPS ANCHOR 16MM
|
Facility
|
OP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem Medicaid |
$3,109.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Humana KY Medicaid |
$3,109.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
PLUG CPS ANCHOR 18MM
|
Facility
|
OP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Anthem Medicaid |
$3,109.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Humana KY Medicaid |
$3,109.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
PLUG CPS ANCHOR 18MM
|
Facility
|
IP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
PLUG CPS ANCHOR 20MM
|
Facility
|
OP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem Medicaid |
$3,109.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Humana KY Medicaid |
$3,109.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
PLUG CPS ANCHOR 20MM
|
Facility
|
IP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
