|
LEAD ATRIAL SELOX 343 081
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem Medicaid |
$1,332.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Humana KY Medicaid |
$1,332.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
LEAD ATRL KENTRX SL-S 345 988
|
Facility
|
IP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,205.00 |
| Max. Negotiated Rate |
$16,656.00 |
| Rate for Payer: Aetna Commercial |
$13,359.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,533.00
|
| Rate for Payer: Cash Price |
$8,675.00
|
| Rate for Payer: Cigna Commercial |
$14,400.50
|
| Rate for Payer: First Health Commercial |
$16,482.50
|
| Rate for Payer: Humana Commercial |
$14,747.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,227.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,804.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,205.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,094.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,971.50
|
| Rate for Payer: PHCS Commercial |
$16,656.00
|
| Rate for Payer: United Healthcare All Payer |
$15,268.00
|
|
|
LEAD ATRL KENTRX SL-S 345 988
|
Facility
|
OP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,205.00 |
| Max. Negotiated Rate |
$16,656.00 |
| Rate for Payer: Aetna Commercial |
$13,359.50
|
| Rate for Payer: Anthem Medicaid |
$5,966.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,533.00
|
| Rate for Payer: Cash Price |
$8,675.00
|
| Rate for Payer: Cigna Commercial |
$14,400.50
|
| Rate for Payer: First Health Commercial |
$16,482.50
|
| Rate for Payer: Humana Commercial |
$14,747.50
|
| Rate for Payer: Humana KY Medicaid |
$5,966.66
|
| Rate for Payer: Kentucky WC Medicaid |
$6,027.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,227.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,804.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,205.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,086.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,094.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,971.50
|
| Rate for Payer: PHCS Commercial |
$16,656.00
|
| Rate for Payer: United Healthcare All Payer |
$15,268.00
|
|
|
LEAD ATTAIN OTW 78CM 419478
|
Facility
|
OP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem Medicaid |
$3,040.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Humana KY Medicaid |
$3,040.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
LEAD ATTAIN OTW 78CM 419478
|
Facility
|
IP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
LEAD ATTAIN OTW 88CM 419488
|
Facility
|
IP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
LEAD ATTAIN OTW 88CM 419488
|
Facility
|
OP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem Medicaid |
$3,040.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Humana KY Medicaid |
$3,040.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
LEAD ATTAIN PRFMA ST4298-78CM
|
Facility
|
IP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
|
LEAD ATTAIN PRFMA ST4298-78CM
|
Facility
|
OP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem Medicaid |
$4,232.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Humana KY Medicaid |
$4,232.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,275.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,317.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
|
LEAD ATTAIN PRFMA ST4298-88CM
|
Facility
|
IP
|
$7,668.64
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,300.59 |
| Max. Negotiated Rate |
$7,361.89 |
| Rate for Payer: Aetna Commercial |
$5,904.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,981.54
|
| Rate for Payer: Cash Price |
$3,834.32
|
| Rate for Payer: Cigna Commercial |
$6,364.97
|
| Rate for Payer: First Health Commercial |
$7,285.21
|
| Rate for Payer: Humana Commercial |
$6,518.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,288.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,659.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,300.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,748.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,751.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,134.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,671.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,291.36
|
| Rate for Payer: PHCS Commercial |
$7,361.89
|
| Rate for Payer: United Healthcare All Payer |
$6,748.40
|
|
|
LEAD ATTAIN PRFMA ST4298-88CM
|
Facility
|
OP
|
$7,668.64
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,300.59 |
| Max. Negotiated Rate |
$7,361.89 |
| Rate for Payer: Aetna Commercial |
$5,904.85
|
| Rate for Payer: Anthem Medicaid |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,981.54
|
| Rate for Payer: Cash Price |
$3,834.32
|
| Rate for Payer: Cigna Commercial |
$6,364.97
|
| Rate for Payer: First Health Commercial |
$7,285.21
|
| Rate for Payer: Humana Commercial |
$6,518.34
|
| Rate for Payer: Humana KY Medicaid |
$2,637.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,664.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,288.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,659.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,300.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,690.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,748.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,751.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,134.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,671.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,291.36
|
| Rate for Payer: PHCS Commercial |
$7,361.89
|
| Rate for Payer: United Healthcare All Payer |
$6,748.40
|
|
|
LEAD ATTAIN PRFMA ST4398-78CM
|
Facility
|
IP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
|
LEAD ATTAIN PRFMA ST4398-78CM
|
Facility
|
OP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem Medicaid |
$4,232.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Humana KY Medicaid |
$4,232.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,275.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,317.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
|
LEAD ATTAIN PRFMA ST4398-88CM
|
Facility
|
IP
|
$7,668.64
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,300.59 |
| Max. Negotiated Rate |
$7,361.89 |
| Rate for Payer: Aetna Commercial |
$5,904.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,981.54
|
| Rate for Payer: Cash Price |
$3,834.32
|
| Rate for Payer: Cigna Commercial |
$6,364.97
|
| Rate for Payer: First Health Commercial |
$7,285.21
|
| Rate for Payer: Humana Commercial |
$6,518.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,288.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,659.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,300.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,748.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,751.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,134.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,671.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,291.36
|
| Rate for Payer: PHCS Commercial |
$7,361.89
|
| Rate for Payer: United Healthcare All Payer |
$6,748.40
|
|
|
LEAD ATTAIN PRFMA ST4398-88CM
|
Facility
|
OP
|
$7,668.64
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,300.59 |
| Max. Negotiated Rate |
$7,361.89 |
| Rate for Payer: Aetna Commercial |
$5,904.85
|
| Rate for Payer: Anthem Medicaid |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,981.54
|
| Rate for Payer: Cash Price |
$3,834.32
|
| Rate for Payer: Cigna Commercial |
$6,364.97
|
| Rate for Payer: First Health Commercial |
$7,285.21
|
| Rate for Payer: Humana Commercial |
$6,518.34
|
| Rate for Payer: Humana KY Medicaid |
$2,637.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,664.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,288.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,659.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,300.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,690.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,748.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,751.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,134.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,671.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,291.36
|
| Rate for Payer: PHCS Commercial |
$7,361.89
|
| Rate for Payer: United Healthcare All Payer |
$6,748.40
|
|
|
LEAD ATTAIN PRFMA ST4598-78CM
|
Facility
|
OP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem Medicaid |
$4,232.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Humana KY Medicaid |
$4,232.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,275.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,317.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
|
LEAD ATTAIN PRFMA ST4598-78CM
|
Facility
|
IP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
|
LEAD ATTAIN PRFMA ST4598-88CM
|
Facility
|
IP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
|
LEAD ATTAIN PRFMA ST4598-88CM
|
Facility
|
OP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem Medicaid |
$4,232.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Humana KY Medicaid |
$4,232.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,275.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,317.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
|
LEAD CAPSUREFIX NOVUS 407658
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,027.50 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,363.25
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
LEAD CAPSUREFIX NOVUS 407658
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,027.50 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,363.25
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
LEAD CAPSURE NOVUS 407652
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,027.50 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,363.25
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
LEAD CAPSURE NOVUS 407652
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,027.50 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,363.25
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
LEAD COMPACT 1*8 MRI 60CM
|
Facility
|
IP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
LEAD COMPACT 1*8 MRI 60CM
|
Facility
|
OP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem Medicaid |
$3,904.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Humana KY Medicaid |
$3,904.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,944.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,982.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
