|
PLUG CPS SHORT ANCHOR 20MM
|
Facility
|
OP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem Medicaid |
$3,178.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Humana KY Medicaid |
$3,178.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
PLUG CPS SHORT ANCHOR 20MM
|
Facility
|
IP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
PLUG CPS SHORT ANCHOR 22MM
|
Facility
|
OP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem Medicaid |
$3,178.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Humana KY Medicaid |
$3,178.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
PLUG CPS SHORT ANCHOR 22MM
|
Facility
|
IP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
PLUG CPS SHORT ANCHOR 24MM
|
Facility
|
OP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem Medicaid |
$3,178.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Humana KY Medicaid |
$3,178.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
PLUG CPS SHORT ANCHOR 24MM
|
Facility
|
IP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
PLUG CPS SHORT ANCHOR 26MM
|
Facility
|
IP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
PLUG CPS SHORT ANCHOR 26MM
|
Facility
|
OP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem Medicaid |
$3,178.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Humana KY Medicaid |
$3,178.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
PLUG CPS SHORT ANCHOR 28MM
|
Facility
|
OP
|
$9,278.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,783.40 |
| Max. Negotiated Rate |
$8,906.88 |
| Rate for Payer: Aetna Commercial |
$7,144.06
|
| Rate for Payer: Anthem Medicaid |
$3,190.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,236.84
|
| Rate for Payer: Cash Price |
$4,639.00
|
| Rate for Payer: Cigna Commercial |
$7,700.74
|
| Rate for Payer: First Health Commercial |
$8,814.10
|
| Rate for Payer: Humana Commercial |
$7,886.30
|
| Rate for Payer: Humana KY Medicaid |
$3,190.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,223.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,607.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,847.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,783.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,254.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,164.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,958.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,071.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,401.82
|
| Rate for Payer: PHCS Commercial |
$8,906.88
|
| Rate for Payer: United Healthcare All Payer |
$8,164.64
|
|
|
PLUG CPS SHORT ANCHOR 28MM
|
Facility
|
IP
|
$9,278.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,783.40 |
| Max. Negotiated Rate |
$8,906.88 |
| Rate for Payer: Aetna Commercial |
$7,144.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,236.84
|
| Rate for Payer: Cash Price |
$4,639.00
|
| Rate for Payer: Cigna Commercial |
$7,700.74
|
| Rate for Payer: First Health Commercial |
$8,814.10
|
| Rate for Payer: Humana Commercial |
$7,886.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,607.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,847.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,783.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,164.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,958.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,071.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,401.82
|
| Rate for Payer: PHCS Commercial |
$8,906.88
|
| Rate for Payer: United Healthcare All Payer |
$8,164.64
|
|
|
PLUG FRESH 10MM
|
Facility
|
IP
|
$12,216.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,664.88 |
| Max. Negotiated Rate |
$11,727.60 |
| Rate for Payer: Aetna Commercial |
$9,406.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,528.67
|
| Rate for Payer: Cash Price |
$6,108.12
|
| Rate for Payer: Cigna Commercial |
$10,139.49
|
| Rate for Payer: First Health Commercial |
$11,605.44
|
| Rate for Payer: Humana Commercial |
$10,383.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,017.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,015.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,664.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,750.30
|
| Rate for Payer: Ohio Health Group HMO |
$9,162.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,773.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,628.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,429.21
|
| Rate for Payer: PHCS Commercial |
$11,727.60
|
| Rate for Payer: United Healthcare All Payer |
$10,750.30
|
|
|
PLUG FRESH 10MM
|
Facility
|
OP
|
$12,216.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,664.88 |
| Max. Negotiated Rate |
$11,727.60 |
| Rate for Payer: Aetna Commercial |
$9,406.51
|
| Rate for Payer: Anthem Medicaid |
$4,201.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,528.67
|
| Rate for Payer: Cash Price |
$6,108.12
|
| Rate for Payer: Cigna Commercial |
$10,139.49
|
| Rate for Payer: First Health Commercial |
$11,605.44
|
| Rate for Payer: Humana Commercial |
$10,383.81
|
| Rate for Payer: Humana KY Medicaid |
$4,201.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,243.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,017.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,015.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,664.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,285.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,750.30
|
| Rate for Payer: Ohio Health Group HMO |
$9,162.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,773.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,628.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,429.21
|
| Rate for Payer: PHCS Commercial |
$11,727.60
|
| Rate for Payer: United Healthcare All Payer |
$10,750.30
|
|
|
PLUG PROLENE LARGE
|
Facility
|
IP
|
$3,782.93
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.88 |
| Max. Negotiated Rate |
$3,631.61 |
| Rate for Payer: Aetna Commercial |
$2,912.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,950.69
|
| Rate for Payer: Cash Price |
$1,891.46
|
| Rate for Payer: Cigna Commercial |
$3,139.83
|
| Rate for Payer: First Health Commercial |
$3,593.78
|
| Rate for Payer: Humana Commercial |
$3,215.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,102.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,791.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,134.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,328.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,837.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,026.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,291.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.22
|
| Rate for Payer: PHCS Commercial |
$3,631.61
|
| Rate for Payer: United Healthcare All Payer |
$3,328.98
|
|
|
PLUG PROLENE LARGE
|
Facility
|
OP
|
$3,782.93
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.88 |
| Max. Negotiated Rate |
$3,631.61 |
| Rate for Payer: Aetna Commercial |
$2,912.86
|
| Rate for Payer: Anthem Medicaid |
$1,300.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,950.69
|
| Rate for Payer: Cash Price |
$1,891.46
|
| Rate for Payer: Cigna Commercial |
$3,139.83
|
| Rate for Payer: First Health Commercial |
$3,593.78
|
| Rate for Payer: Humana Commercial |
$3,215.49
|
| Rate for Payer: Humana KY Medicaid |
$1,300.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,314.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,102.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,791.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,134.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,327.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,328.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,837.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,026.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,291.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.22
|
| Rate for Payer: PHCS Commercial |
$3,631.61
|
| Rate for Payer: United Healthcare All Payer |
$3,328.98
|
|
|
PLU PROMOS HUM STEM 3.5 NONCEM
|
Facility
|
OP
|
$8,112.74
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.82 |
| Max. Negotiated Rate |
$7,788.23 |
| Rate for Payer: Aetna Commercial |
$6,246.81
|
| Rate for Payer: Anthem Medicaid |
$2,789.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,327.94
|
| Rate for Payer: Cash Price |
$4,056.37
|
| Rate for Payer: Cigna Commercial |
$6,733.57
|
| Rate for Payer: First Health Commercial |
$7,707.10
|
| Rate for Payer: Humana Commercial |
$6,895.83
|
| Rate for Payer: Humana KY Medicaid |
$2,789.97
|
| Rate for Payer: Kentucky WC Medicaid |
$2,818.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,652.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,987.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,845.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,139.21
|
| Rate for Payer: Ohio Health Group HMO |
$6,084.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,490.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,058.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,597.79
|
| Rate for Payer: PHCS Commercial |
$7,788.23
|
| Rate for Payer: United Healthcare All Payer |
$7,139.21
|
|
|
PLU PROMOS HUM STEM 3.5 NONCEM
|
Facility
|
IP
|
$8,112.74
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.82 |
| Max. Negotiated Rate |
$7,788.23 |
| Rate for Payer: Aetna Commercial |
$6,246.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,327.94
|
| Rate for Payer: Cash Price |
$4,056.37
|
| Rate for Payer: Cigna Commercial |
$6,733.57
|
| Rate for Payer: First Health Commercial |
$7,707.10
|
| Rate for Payer: Humana Commercial |
$6,895.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,652.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,987.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,139.21
|
| Rate for Payer: Ohio Health Group HMO |
$6,084.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,490.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,058.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,597.79
|
| Rate for Payer: PHCS Commercial |
$7,788.23
|
| Rate for Payer: United Healthcare All Payer |
$7,139.21
|
|
|
PLU PROMOS INCLNTION SET 20MM
|
Facility
|
IP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,594.50 |
| Max. Negotiated Rate |
$5,102.40 |
| Rate for Payer: Aetna Commercial |
$4,092.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,145.70
|
| Rate for Payer: Cash Price |
$2,657.50
|
| Rate for Payer: Cigna Commercial |
$4,411.45
|
| Rate for Payer: First Health Commercial |
$5,049.25
|
| Rate for Payer: Humana Commercial |
$4,517.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,358.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,922.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,594.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,677.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,986.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,624.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,667.35
|
| Rate for Payer: PHCS Commercial |
$5,102.40
|
| Rate for Payer: United Healthcare All Payer |
$4,677.20
|
|
|
PLU PROMOS INCLNTION SET 20MM
|
Facility
|
OP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,594.50 |
| Max. Negotiated Rate |
$5,102.40 |
| Rate for Payer: Aetna Commercial |
$4,092.55
|
| Rate for Payer: Anthem Medicaid |
$1,827.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,145.70
|
| Rate for Payer: Cash Price |
$2,657.50
|
| Rate for Payer: Cigna Commercial |
$4,411.45
|
| Rate for Payer: First Health Commercial |
$5,049.25
|
| Rate for Payer: Humana Commercial |
$4,517.75
|
| Rate for Payer: Humana KY Medicaid |
$1,827.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,846.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,358.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,922.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,594.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,864.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,677.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,986.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,624.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,667.35
|
| Rate for Payer: PHCS Commercial |
$5,102.40
|
| Rate for Payer: United Healthcare All Payer |
$4,677.20
|
|
|
PLU PROMOS INCLNTION SET 22MM
|
Facility
|
OP
|
$5,697.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,709.25 |
| Max. Negotiated Rate |
$5,469.60 |
| Rate for Payer: Aetna Commercial |
$4,387.07
|
| Rate for Payer: Anthem Medicaid |
$1,959.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,444.05
|
| Rate for Payer: Cash Price |
$2,848.75
|
| Rate for Payer: Cigna Commercial |
$4,728.93
|
| Rate for Payer: First Health Commercial |
$5,412.62
|
| Rate for Payer: Humana Commercial |
$4,842.88
|
| Rate for Payer: Humana KY Medicaid |
$1,959.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,979.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,671.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,204.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,709.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,998.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,013.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,273.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,956.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,931.28
|
| Rate for Payer: PHCS Commercial |
$5,469.60
|
| Rate for Payer: United Healthcare All Payer |
$5,013.80
|
|
|
PLU PROMOS INCLNTION SET 22MM
|
Facility
|
IP
|
$5,697.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,709.25 |
| Max. Negotiated Rate |
$5,469.60 |
| Rate for Payer: Aetna Commercial |
$4,387.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,444.05
|
| Rate for Payer: Cash Price |
$2,848.75
|
| Rate for Payer: Cigna Commercial |
$4,728.93
|
| Rate for Payer: First Health Commercial |
$5,412.62
|
| Rate for Payer: Humana Commercial |
$4,842.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,671.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,204.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,709.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,013.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,273.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,956.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,931.28
|
| Rate for Payer: PHCS Commercial |
$5,469.60
|
| Rate for Payer: United Healthcare All Payer |
$5,013.80
|
|
|
PLU PROMOS INCLNTION SET 24MM
|
Facility
|
IP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
PLU PROMOS INCLNTION SET 24MM
|
Facility
|
OP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem Medicaid |
$2,487.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Humana KY Medicaid |
$2,487.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,513.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,537.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
PLU PROMOS INCLNTION SET 26MM
|
Facility
|
OP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem Medicaid |
$2,487.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Humana KY Medicaid |
$2,487.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,513.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,537.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
PLU PROMOS INCLNTION SET 26MM
|
Facility
|
IP
|
$7,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,170.20 |
| Max. Negotiated Rate |
$6,944.64 |
| Rate for Payer: Aetna Commercial |
$5,570.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,642.52
|
| Rate for Payer: Cash Price |
$3,617.00
|
| Rate for Payer: Cigna Commercial |
$6,004.22
|
| Rate for Payer: First Health Commercial |
$6,872.30
|
| Rate for Payer: Humana Commercial |
$6,148.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,931.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,338.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,365.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,787.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,293.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.46
|
| Rate for Payer: PHCS Commercial |
$6,944.64
|
| Rate for Payer: United Healthcare All Payer |
$6,365.92
|
|
|
PLU PROMOS MONBLK STEM 02/30MM
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
