|
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
|
|
|
PLUG PROLENE LARGE
|
Facility
|
IP
|
$3,864.06
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$502.33 |
| Max. Negotiated Rate |
$3,709.50 |
| Rate for Payer: Aetna Commercial |
$2,975.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,013.97
|
| Rate for Payer: Cash Price |
$1,932.03
|
| Rate for Payer: Cigna Commercial |
$3,207.17
|
| Rate for Payer: First Health Commercial |
$3,670.86
|
| Rate for Payer: Humana Commercial |
$3,284.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,168.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,851.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,159.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,400.37
|
| Rate for Payer: Ohio Health Group HMO |
$2,898.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.86
|
| Rate for Payer: PHCS Commercial |
$3,709.50
|
| Rate for Payer: United Healthcare All Payer |
$3,400.37
|
|
|
PLUG PROLENE LARGE
|
Facility
|
OP
|
$3,864.06
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$502.33 |
| Max. Negotiated Rate |
$3,709.50 |
| Rate for Payer: Aetna Commercial |
$2,975.33
|
| Rate for Payer: Anthem Medicaid |
$1,328.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,013.97
|
| Rate for Payer: Cash Price |
$1,932.03
|
| Rate for Payer: Cigna Commercial |
$3,207.17
|
| Rate for Payer: First Health Commercial |
$3,670.86
|
| Rate for Payer: Humana Commercial |
$3,284.45
|
| Rate for Payer: Humana KY Medicaid |
$1,328.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,342.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,168.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,851.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,159.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,355.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,400.37
|
| Rate for Payer: Ohio Health Group HMO |
$2,898.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.86
|
| Rate for Payer: PHCS Commercial |
$3,709.50
|
| Rate for Payer: United Healthcare All Payer |
$3,400.37
|
|
|
PLU PROMOS HUM STEM 3.5 NONCEM
|
Facility
|
OP
|
$7,912.74
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.66 |
| Max. Negotiated Rate |
$7,596.23 |
| Rate for Payer: Aetna Commercial |
$6,092.81
|
| Rate for Payer: Anthem Medicaid |
$2,721.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,171.94
|
| Rate for Payer: Cash Price |
$3,956.37
|
| Rate for Payer: Cigna Commercial |
$6,567.57
|
| Rate for Payer: First Health Commercial |
$7,517.10
|
| Rate for Payer: Humana Commercial |
$6,725.83
|
| Rate for Payer: Humana KY Medicaid |
$2,721.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,748.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,488.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,839.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,775.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,963.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,934.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.95
|
| Rate for Payer: PHCS Commercial |
$7,596.23
|
| Rate for Payer: United Healthcare All Payer |
$6,963.21
|
|
|
PLU PROMOS HUM STEM 3.5 NONCEM
|
Facility
|
IP
|
$7,912.74
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.66 |
| Max. Negotiated Rate |
$7,596.23 |
| Rate for Payer: Aetna Commercial |
$6,092.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,171.94
|
| Rate for Payer: Cash Price |
$3,956.37
|
| Rate for Payer: Cigna Commercial |
$6,567.57
|
| Rate for Payer: First Health Commercial |
$7,517.10
|
| Rate for Payer: Humana Commercial |
$6,725.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,488.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,839.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,963.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,934.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.95
|
| Rate for Payer: PHCS Commercial |
$7,596.23
|
| Rate for Payer: United Healthcare All Payer |
$6,963.21
|
|
|
PLU PROMOS INCLNTION SET 20MM
|
Facility
|
IP
|
$5,294.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$688.22 |
| Max. Negotiated Rate |
$5,082.24 |
| Rate for Payer: Aetna Commercial |
$4,076.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,129.32
|
| Rate for Payer: Cash Price |
$2,647.00
|
| Rate for Payer: Cigna Commercial |
$4,394.02
|
| Rate for Payer: First Health Commercial |
$5,029.30
|
| Rate for Payer: Humana Commercial |
$4,499.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,341.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,906.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,588.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,658.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,970.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,058.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$688.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,641.14
|
| Rate for Payer: PHCS Commercial |
$5,082.24
|
| Rate for Payer: United Healthcare All Payer |
$4,658.72
|
|
|
PLU PROMOS INCLNTION SET 20MM
|
Facility
|
OP
|
$5,294.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$688.22 |
| Max. Negotiated Rate |
$5,082.24 |
| Rate for Payer: Aetna Commercial |
$4,076.38
|
| Rate for Payer: Anthem Medicaid |
$1,820.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,129.32
|
| Rate for Payer: Cash Price |
$2,647.00
|
| Rate for Payer: Cigna Commercial |
$4,394.02
|
| Rate for Payer: First Health Commercial |
$5,029.30
|
| Rate for Payer: Humana Commercial |
$4,499.90
|
| Rate for Payer: Humana KY Medicaid |
$1,820.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,839.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,341.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,906.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,588.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,857.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,658.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,970.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,058.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$688.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,641.14
|
| Rate for Payer: PHCS Commercial |
$5,082.24
|
| Rate for Payer: United Healthcare All Payer |
$4,658.72
|
|
|
PLU PROMOS INCLNTION SET 22MM
|
Facility
|
IP
|
$5,651.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$734.63 |
| Max. Negotiated Rate |
$5,424.96 |
| Rate for Payer: Aetna Commercial |
$4,351.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,407.78
|
| Rate for Payer: Cash Price |
$2,825.50
|
| Rate for Payer: Cigna Commercial |
$4,690.33
|
| Rate for Payer: First Health Commercial |
$5,368.45
|
| Rate for Payer: Humana Commercial |
$4,803.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,633.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,170.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,695.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,972.88
|
| Rate for Payer: Ohio Health Group HMO |
$4,238.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,130.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$734.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,751.81
|
| Rate for Payer: PHCS Commercial |
$5,424.96
|
| Rate for Payer: United Healthcare All Payer |
$4,972.88
|
|
|
PLU PROMOS INCLNTION SET 22MM
|
Facility
|
OP
|
$5,651.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$734.63 |
| Max. Negotiated Rate |
$5,424.96 |
| Rate for Payer: Aetna Commercial |
$4,351.27
|
| Rate for Payer: Anthem Medicaid |
$1,943.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,407.78
|
| Rate for Payer: Cash Price |
$2,825.50
|
| Rate for Payer: Cigna Commercial |
$4,690.33
|
| Rate for Payer: First Health Commercial |
$5,368.45
|
| Rate for Payer: Humana Commercial |
$4,803.35
|
| Rate for Payer: Humana KY Medicaid |
$1,943.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,963.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,633.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,170.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,695.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,982.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,972.88
|
| Rate for Payer: Ohio Health Group HMO |
$4,238.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,130.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$734.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,751.81
|
| Rate for Payer: PHCS Commercial |
$5,424.96
|
| Rate for Payer: United Healthcare All Payer |
$4,972.88
|
|
|
PLU PROMOS INCLNTION SET 24MM
|
Facility
|
OP
|
$7,034.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.42 |
| Max. Negotiated Rate |
$6,752.64 |
| Rate for Payer: Aetna Commercial |
$5,416.18
|
| Rate for Payer: Anthem Medicaid |
$2,418.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,486.52
|
| Rate for Payer: Cash Price |
$3,517.00
|
| Rate for Payer: Cigna Commercial |
$5,838.22
|
| Rate for Payer: First Health Commercial |
$6,682.30
|
| Rate for Payer: Humana Commercial |
$5,978.90
|
| Rate for Payer: Humana KY Medicaid |
$2,418.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,443.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,767.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,191.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,110.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,467.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,189.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,275.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.54
|
| Rate for Payer: PHCS Commercial |
$6,752.64
|
| Rate for Payer: United Healthcare All Payer |
$6,189.92
|
|
|
PLU PROMOS INCLNTION SET 24MM
|
Facility
|
IP
|
$7,034.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.42 |
| Max. Negotiated Rate |
$6,752.64 |
| Rate for Payer: Aetna Commercial |
$5,416.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,486.52
|
| Rate for Payer: Cash Price |
$3,517.00
|
| Rate for Payer: Cigna Commercial |
$5,838.22
|
| Rate for Payer: First Health Commercial |
$6,682.30
|
| Rate for Payer: Humana Commercial |
$5,978.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,767.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,191.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,110.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,189.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,275.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.54
|
| Rate for Payer: PHCS Commercial |
$6,752.64
|
| Rate for Payer: United Healthcare All Payer |
$6,189.92
|
|
|
PLU PROMOS INCLNTION SET 26MM
|
Facility
|
OP
|
$7,034.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.42 |
| Max. Negotiated Rate |
$6,752.64 |
| Rate for Payer: Aetna Commercial |
$5,416.18
|
| Rate for Payer: Anthem Medicaid |
$2,418.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,486.52
|
| Rate for Payer: Cash Price |
$3,517.00
|
| Rate for Payer: Cigna Commercial |
$5,838.22
|
| Rate for Payer: First Health Commercial |
$6,682.30
|
| Rate for Payer: Humana Commercial |
$5,978.90
|
| Rate for Payer: Humana KY Medicaid |
$2,418.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,443.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,767.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,191.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,110.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,467.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,189.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,275.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.54
|
| Rate for Payer: PHCS Commercial |
$6,752.64
|
| Rate for Payer: United Healthcare All Payer |
$6,189.92
|
|
|
PLU PROMOS INCLNTION SET 26MM
|
Facility
|
IP
|
$7,034.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.42 |
| Max. Negotiated Rate |
$6,752.64 |
| Rate for Payer: Aetna Commercial |
$5,416.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,486.52
|
| Rate for Payer: Cash Price |
$3,517.00
|
| Rate for Payer: Cigna Commercial |
$5,838.22
|
| Rate for Payer: First Health Commercial |
$6,682.30
|
| Rate for Payer: Humana Commercial |
$5,978.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,767.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,191.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,110.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,189.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,275.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.54
|
| Rate for Payer: PHCS Commercial |
$6,752.64
|
| Rate for Payer: United Healthcare All Payer |
$6,189.92
|
|
|
PLU PROMOS MONBLK STEM 02/30MM
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
PLU PROMOS MONBLK STEM 02/30MM
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
PLU PROMOS MONBLK STEM 02/35MM
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
PLU PROMOS MONBLK STEM 02/35MM
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
PLU PROMOS MONBLK STEM 02/40MM
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
PLU PROMOS MONBLK STEM 02/40MM
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
PLU PROMOS REV PE-INSRT 36/12M
|
Facility
|
OP
|
$7,675.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$997.81 |
| Max. Negotiated Rate |
$7,368.47 |
| Rate for Payer: Aetna Commercial |
$5,910.13
|
| Rate for Payer: Anthem Medicaid |
$2,639.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,986.88
|
| Rate for Payer: Cash Price |
$3,837.74
|
| Rate for Payer: Cigna Commercial |
$6,370.66
|
| Rate for Payer: First Health Commercial |
$7,291.72
|
| Rate for Payer: Humana Commercial |
$6,524.17
|
| Rate for Payer: Humana KY Medicaid |
$2,639.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,666.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,293.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,664.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,302.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,692.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,754.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,756.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,535.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$997.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,379.40
|
| Rate for Payer: PHCS Commercial |
$7,368.47
|
| Rate for Payer: United Healthcare All Payer |
$6,754.43
|
|
|
PLU PROMOS REV PE-INSRT 36/12M
|
Facility
|
IP
|
$7,675.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$997.81 |
| Max. Negotiated Rate |
$7,368.47 |
| Rate for Payer: Aetna Commercial |
$5,910.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,986.88
|
| Rate for Payer: Cash Price |
$3,837.74
|
| Rate for Payer: Cigna Commercial |
$6,370.66
|
| Rate for Payer: First Health Commercial |
$7,291.72
|
| Rate for Payer: Humana Commercial |
$6,524.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,293.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,664.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,302.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,754.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,756.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,535.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$997.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,379.40
|
| Rate for Payer: PHCS Commercial |
$7,368.47
|
| Rate for Payer: United Healthcare All Payer |
$6,754.43
|
|
|
PLU PROMOS REV PE-INSRT 36/6MM
|
Facility
|
IP
|
$7,675.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$997.81 |
| Max. Negotiated Rate |
$7,368.47 |
| Rate for Payer: Aetna Commercial |
$5,910.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,986.88
|
| Rate for Payer: Cash Price |
$3,837.74
|
| Rate for Payer: Cigna Commercial |
$6,370.66
|
| Rate for Payer: First Health Commercial |
$7,291.72
|
| Rate for Payer: Humana Commercial |
$6,524.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,293.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,664.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,302.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,754.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,756.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,535.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$997.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,379.40
|
| Rate for Payer: PHCS Commercial |
$7,368.47
|
| Rate for Payer: United Healthcare All Payer |
$6,754.43
|
|
|
PLU PROMOS REV PE-INSRT 36/6MM
|
Facility
|
OP
|
$7,675.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$997.81 |
| Max. Negotiated Rate |
$7,368.47 |
| Rate for Payer: Aetna Commercial |
$5,910.13
|
| Rate for Payer: Anthem Medicaid |
$2,639.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,986.88
|
| Rate for Payer: Cash Price |
$3,837.74
|
| Rate for Payer: Cigna Commercial |
$6,370.66
|
| Rate for Payer: First Health Commercial |
$7,291.72
|
| Rate for Payer: Humana Commercial |
$6,524.17
|
| Rate for Payer: Humana KY Medicaid |
$2,639.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,666.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,293.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,664.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,302.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,692.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,754.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,756.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,535.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$997.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,379.40
|
| Rate for Payer: PHCS Commercial |
$7,368.47
|
| Rate for Payer: United Healthcare All Payer |
$6,754.43
|
|
|
PLU PROMOS REV PE-INSRT 36/9MM
|
Facility
|
IP
|
$7,675.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$997.81 |
| Max. Negotiated Rate |
$7,368.47 |
| Rate for Payer: Aetna Commercial |
$5,910.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,986.88
|
| Rate for Payer: Cash Price |
$3,837.74
|
| Rate for Payer: Cigna Commercial |
$6,370.66
|
| Rate for Payer: First Health Commercial |
$7,291.72
|
| Rate for Payer: Humana Commercial |
$6,524.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,293.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,664.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,302.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,754.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,756.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,535.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$997.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,379.40
|
| Rate for Payer: PHCS Commercial |
$7,368.47
|
| Rate for Payer: United Healthcare All Payer |
$6,754.43
|
|
|
PLU PROMOS REV PE-INSRT 36/9MM
|
Facility
|
OP
|
$7,675.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$997.81 |
| Max. Negotiated Rate |
$7,368.47 |
| Rate for Payer: Aetna Commercial |
$5,910.13
|
| Rate for Payer: Anthem Medicaid |
$2,639.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,986.88
|
| Rate for Payer: Cash Price |
$3,837.74
|
| Rate for Payer: Cigna Commercial |
$6,370.66
|
| Rate for Payer: First Health Commercial |
$7,291.72
|
| Rate for Payer: Humana Commercial |
$6,524.17
|
| Rate for Payer: Humana KY Medicaid |
$2,639.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,666.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,293.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,664.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,302.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,692.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,754.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,756.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,535.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$997.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,379.40
|
| Rate for Payer: PHCS Commercial |
$7,368.47
|
| Rate for Payer: United Healthcare All Payer |
$6,754.43
|
|
