|
PLUG CPS ANCHOR 22MM
|
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 22MM
|
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 24MM
|
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 24MM
|
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 SHORT ANCHOR 10MM
|
Facility
|
IP
|
$9,078.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,180.14 |
| Max. Negotiated Rate |
$8,714.88 |
| Rate for Payer: Aetna Commercial |
$6,990.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,080.84
|
| Rate for Payer: Cash Price |
$4,539.00
|
| Rate for Payer: Cigna Commercial |
$7,534.74
|
| Rate for Payer: First Health Commercial |
$8,624.10
|
| Rate for Payer: Humana Commercial |
$7,716.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,443.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,699.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,723.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,988.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,808.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,815.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,180.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,814.18
|
| Rate for Payer: PHCS Commercial |
$8,714.88
|
| Rate for Payer: United Healthcare All Payer |
$7,988.64
|
|
|
PLUG CPS SHORT ANCHOR 10MM
|
Facility
|
OP
|
$9,078.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,180.14 |
| Max. Negotiated Rate |
$8,714.88 |
| Rate for Payer: Aetna Commercial |
$6,990.06
|
| Rate for Payer: Anthem Medicaid |
$3,121.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,080.84
|
| Rate for Payer: Cash Price |
$4,539.00
|
| Rate for Payer: Cigna Commercial |
$7,534.74
|
| Rate for Payer: First Health Commercial |
$8,624.10
|
| Rate for Payer: Humana Commercial |
$7,716.30
|
| Rate for Payer: Humana KY Medicaid |
$3,121.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,153.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,443.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,699.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,723.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,184.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,988.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,808.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,815.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,180.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,814.18
|
| Rate for Payer: PHCS Commercial |
$8,714.88
|
| Rate for Payer: United Healthcare All Payer |
$7,988.64
|
|
|
PLUG CPS SHORT 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 SHORT 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: 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 SHORT 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 SHORT 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 SHORT 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 SHORT 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 SHORT 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: 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 SHORT 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 SHORT 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 SHORT 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
|
|
|
PLUG CPS SHORT ANCHOR 22MM
|
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 SHORT ANCHOR 22MM
|
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 SHORT ANCHOR 24MM
|
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 SHORT ANCHOR 24MM
|
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 SHORT ANCHOR 26MM
|
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 SHORT ANCHOR 26MM
|
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 SHORT ANCHOR 28MM
|
Facility
|
OP
|
$9,078.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,180.14 |
| Max. Negotiated Rate |
$8,714.88 |
| Rate for Payer: Aetna Commercial |
$6,990.06
|
| Rate for Payer: Anthem Medicaid |
$3,121.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,080.84
|
| Rate for Payer: Cash Price |
$4,539.00
|
| Rate for Payer: Cigna Commercial |
$7,534.74
|
| Rate for Payer: First Health Commercial |
$8,624.10
|
| Rate for Payer: Humana Commercial |
$7,716.30
|
| Rate for Payer: Humana KY Medicaid |
$3,121.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,153.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,443.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,699.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,723.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,184.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,988.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,808.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,815.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,180.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,814.18
|
| Rate for Payer: PHCS Commercial |
$8,714.88
|
| Rate for Payer: United Healthcare All Payer |
$7,988.64
|
|
|
PLUG CPS SHORT ANCHOR 28MM
|
Facility
|
IP
|
$9,078.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,180.14 |
| Max. Negotiated Rate |
$8,714.88 |
| Rate for Payer: Aetna Commercial |
$6,990.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,080.84
|
| Rate for Payer: Cash Price |
$4,539.00
|
| Rate for Payer: Cigna Commercial |
$7,534.74
|
| Rate for Payer: First Health Commercial |
$8,624.10
|
| Rate for Payer: Humana Commercial |
$7,716.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,443.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,699.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,723.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,988.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,808.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,815.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,180.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,814.18
|
| Rate for Payer: PHCS Commercial |
$8,714.88
|
| Rate for Payer: United Healthcare All Payer |
$7,988.64
|
|
|
PLUG FRESH 10MM
|
Facility
|
OP
|
$11,968.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.94 |
| Max. Negotiated Rate |
$11,490.00 |
| Rate for Payer: Aetna Commercial |
$9,215.94
|
| Rate for Payer: Anthem Medicaid |
$4,116.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,335.62
|
| Rate for Payer: Cash Price |
$5,984.38
|
| Rate for Payer: Cigna Commercial |
$9,934.06
|
| Rate for Payer: First Health Commercial |
$11,370.31
|
| Rate for Payer: Humana Commercial |
$10,173.44
|
| Rate for Payer: Humana KY Medicaid |
$4,116.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,157.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,814.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,832.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,198.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,532.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,393.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,555.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,710.31
|
| Rate for Payer: PHCS Commercial |
$11,490.00
|
| Rate for Payer: United Healthcare All Payer |
$10,532.50
|
|
