|
PET RP LOCLZJ TUM SPECT W/CT 1
|
Facility
|
IP
|
$2,713.00
|
|
|
Service Code
|
HCPCS 78830
|
| Hospital Charge Code |
40400011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$813.90 |
| Max. Negotiated Rate |
$2,604.48 |
| Rate for Payer: Aetna Commercial |
$2,089.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,116.14
|
| Rate for Payer: Cash Price |
$1,356.50
|
| Rate for Payer: Cigna Commercial |
$2,251.79
|
| Rate for Payer: First Health Commercial |
$2,577.35
|
| Rate for Payer: Humana Commercial |
$2,306.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,224.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,002.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$813.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,387.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,034.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,170.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,360.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,871.97
|
| Rate for Payer: PHCS Commercial |
$2,604.48
|
| Rate for Payer: United Healthcare All Payer |
$2,387.44
|
|
|
PET RP LOCLZJ TUM SPECT W/CT 1
|
Professional
|
Both
|
$2,713.00
|
|
|
Service Code
|
HCPCS 78830
|
| Hospital Charge Code |
40400011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$1,627.80 |
| Rate for Payer: Ambetter Exchange |
$380.40
|
| Rate for Payer: Anthem Medicaid |
$369.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$380.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$380.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$456.48
|
| Rate for Payer: Cash Price |
$1,356.50
|
| Rate for Payer: Cash Price |
$1,356.50
|
| Rate for Payer: Humana Medicaid |
$369.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$81.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$380.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$380.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$377.11
|
| Rate for Payer: Molina Healthcare Passport |
$369.72
|
| Rate for Payer: Multiplan PHCS |
$1,627.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$494.52
|
| Rate for Payer: UHCCP Medicaid |
$949.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$373.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$380.40
|
|
|
PET RP LOCLZJ TUM SPECT W/CT 2
|
Facility
|
OP
|
$2,492.00
|
|
|
Service Code
|
HCPCS 78832
|
| Hospital Charge Code |
40400013
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$857.00 |
| Max. Negotiated Rate |
$2,392.32 |
| Rate for Payer: Aetna Commercial |
$1,918.84
|
| Rate for Payer: Anthem Medicaid |
$857.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,347.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,943.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,886.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,819.41
|
| Rate for Payer: Cash Price |
$1,246.00
|
| Rate for Payer: Cash Price |
$1,246.00
|
| Rate for Payer: Cigna Commercial |
$2,068.36
|
| Rate for Payer: First Health Commercial |
$2,367.40
|
| Rate for Payer: Humana Commercial |
$2,118.20
|
| Rate for Payer: Humana KY Medicaid |
$857.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,347.71
|
| Rate for Payer: Kentucky WC Medicaid |
$865.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,043.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,839.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,617.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$874.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,192.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,869.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,993.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,168.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,719.48
|
| Rate for Payer: PHCS Commercial |
$2,392.32
|
| Rate for Payer: United Healthcare All Payer |
$2,192.96
|
|
|
PET RP LOCLZJ TUM SPECT W/CT 2
|
Facility
|
IP
|
$2,492.00
|
|
|
Service Code
|
HCPCS 78832
|
| Hospital Charge Code |
40400013
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$747.60 |
| Max. Negotiated Rate |
$2,392.32 |
| Rate for Payer: Aetna Commercial |
$1,918.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,943.76
|
| Rate for Payer: Cash Price |
$1,246.00
|
| Rate for Payer: Cigna Commercial |
$2,068.36
|
| Rate for Payer: First Health Commercial |
$2,367.40
|
| Rate for Payer: Humana Commercial |
$2,118.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,043.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,839.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$747.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,192.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,869.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,993.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,168.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,719.48
|
| Rate for Payer: PHCS Commercial |
$2,392.32
|
| Rate for Payer: United Healthcare All Payer |
$2,192.96
|
|
|
PET RP QUAN MEAS SINGLE AREA
|
Facility
|
OP
|
$2,492.00
|
|
|
Service Code
|
HCPCS 78835
|
| Hospital Charge Code |
40400014
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$747.60 |
| Max. Negotiated Rate |
$2,392.32 |
| Rate for Payer: Aetna Commercial |
$1,918.84
|
| Rate for Payer: Anthem Medicaid |
$857.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,943.76
|
| Rate for Payer: Cash Price |
$1,246.00
|
| Rate for Payer: Cigna Commercial |
$2,068.36
|
| Rate for Payer: First Health Commercial |
$2,367.40
|
| Rate for Payer: Humana Commercial |
$2,118.20
|
| Rate for Payer: Humana KY Medicaid |
$857.00
|
| Rate for Payer: Kentucky WC Medicaid |
$865.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,043.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,839.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$747.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$874.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,192.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,869.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,993.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,168.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,719.48
|
| Rate for Payer: PHCS Commercial |
$2,392.32
|
| Rate for Payer: United Healthcare All Payer |
$2,192.96
|
|
|
PET RP QUAN MEAS SINGLE AREA
|
Facility
|
IP
|
$2,492.00
|
|
|
Service Code
|
HCPCS 78835
|
| Hospital Charge Code |
40400014
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$747.60 |
| Max. Negotiated Rate |
$2,392.32 |
| Rate for Payer: Aetna Commercial |
$1,918.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,943.76
|
| Rate for Payer: Cash Price |
$1,246.00
|
| Rate for Payer: Cigna Commercial |
$2,068.36
|
| Rate for Payer: First Health Commercial |
$2,367.40
|
| Rate for Payer: Humana Commercial |
$2,118.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,043.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,839.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$747.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,192.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,869.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,993.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,168.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,719.48
|
| Rate for Payer: PHCS Commercial |
$2,392.32
|
| Rate for Payer: United Healthcare All Payer |
$2,192.96
|
|
|
PFC DIST. AUG. 4*4MM RT
|
Facility
|
IP
|
$8,767.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.26 |
| Max. Negotiated Rate |
$8,416.85 |
| Rate for Payer: Aetna Commercial |
$6,751.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.69
|
| Rate for Payer: Cash Price |
$4,383.77
|
| Rate for Payer: Cigna Commercial |
$7,277.07
|
| Rate for Payer: First Health Commercial |
$8,329.17
|
| Rate for Payer: Humana Commercial |
$7,452.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,189.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,715.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,014.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.61
|
| Rate for Payer: PHCS Commercial |
$8,416.85
|
| Rate for Payer: United Healthcare All Payer |
$7,715.44
|
|
|
PFC DIST. AUG. 4*4MM RT
|
Facility
|
OP
|
$8,767.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.26 |
| Max. Negotiated Rate |
$8,416.85 |
| Rate for Payer: Aetna Commercial |
$6,751.01
|
| Rate for Payer: Anthem Medicaid |
$3,015.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.69
|
| Rate for Payer: Cash Price |
$4,383.77
|
| Rate for Payer: Cigna Commercial |
$7,277.07
|
| Rate for Payer: First Health Commercial |
$8,329.17
|
| Rate for Payer: Humana Commercial |
$7,452.42
|
| Rate for Payer: Humana KY Medicaid |
$3,015.16
|
| Rate for Payer: Kentucky WC Medicaid |
$3,045.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,189.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,075.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,715.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,014.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.61
|
| Rate for Payer: PHCS Commercial |
$8,416.85
|
| Rate for Payer: United Healthcare All Payer |
$7,715.44
|
|
|
PFC FEM HEAD 22.225MM +10MM
|
Facility
|
IP
|
$5,160.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.04 |
| Max. Negotiated Rate |
$4,953.72 |
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,489.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,560.48
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
|
|
PFC FEM HEAD 22.225MM +10MM
|
Facility
|
OP
|
$5,160.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.04 |
| Max. Negotiated Rate |
$4,953.72 |
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem Medicaid |
$1,774.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Humana KY Medicaid |
$1,774.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,489.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,560.48
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
|
|
PFC FEMORAL HEAD 22.225MM +0MM
|
Facility
|
OP
|
$5,160.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.04 |
| Max. Negotiated Rate |
$4,953.72 |
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem Medicaid |
$1,774.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Humana KY Medicaid |
$1,774.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,489.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,560.48
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
|
|
PFC FEMORAL HEAD 22.225MM +0MM
|
Facility
|
IP
|
$5,160.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.04 |
| Max. Negotiated Rate |
$4,953.72 |
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,489.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,560.48
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
|
|
PFC FEMORAL HEAD 22.225MM +5MM
|
Facility
|
OP
|
$5,160.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.04 |
| Max. Negotiated Rate |
$4,953.72 |
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem Medicaid |
$1,774.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Humana KY Medicaid |
$1,774.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,489.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,560.48
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
|
|
PFC FEMORAL HEAD 22.225MM +5MM
|
Facility
|
IP
|
$5,160.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.04 |
| Max. Negotiated Rate |
$4,953.72 |
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,489.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,560.48
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
|
|
PF CHEST
|
Professional
|
Both
|
$1,500.00
|
|
| Hospital Charge Code |
22200311
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
|
|
PF Chest - PP Visit 1 50%
|
Professional
|
Both
|
$1,913.00
|
|
| Hospital Charge Code |
22200312
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$669.55 |
| Max. Negotiated Rate |
$1,339.10 |
| Rate for Payer: Cash Price |
$956.50
|
| Rate for Payer: Multiplan PHCS |
$1,147.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,339.10
|
| Rate for Payer: UHCCP Medicaid |
$669.55
|
|
|
PF Chest - PP Visit 2/3 25%
|
Professional
|
Both
|
$956.00
|
|
| Hospital Charge Code |
22200521
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$334.60 |
| Max. Negotiated Rate |
$669.20 |
| Rate for Payer: Cash Price |
$478.00
|
| Rate for Payer: Multiplan PHCS |
$573.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$669.20
|
| Rate for Payer: UHCCP Medicaid |
$334.60
|
|
|
PFC MOD KNEE SYS CEM STEM 13*3
|
Facility
|
OP
|
$8,724.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.23 |
| Max. Negotiated Rate |
$8,375.15 |
| Rate for Payer: Aetna Commercial |
$6,717.56
|
| Rate for Payer: Anthem Medicaid |
$3,000.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,804.81
|
| Rate for Payer: Cash Price |
$4,362.06
|
| Rate for Payer: Cigna Commercial |
$7,241.01
|
| Rate for Payer: First Health Commercial |
$8,287.90
|
| Rate for Payer: Humana Commercial |
$7,415.49
|
| Rate for Payer: Humana KY Medicaid |
$3,000.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,030.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,153.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,438.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,060.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,677.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,543.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,979.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,589.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,019.64
|
| Rate for Payer: PHCS Commercial |
$8,375.15
|
| Rate for Payer: United Healthcare All Payer |
$7,677.22
|
|
|
PFC MOD KNEE SYS CEM STEM 13*3
|
Facility
|
IP
|
$8,724.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.23 |
| Max. Negotiated Rate |
$8,375.15 |
| Rate for Payer: Aetna Commercial |
$6,717.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,804.81
|
| Rate for Payer: Cash Price |
$4,362.06
|
| Rate for Payer: Cigna Commercial |
$7,241.01
|
| Rate for Payer: First Health Commercial |
$8,287.90
|
| Rate for Payer: Humana Commercial |
$7,415.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,153.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,438.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,677.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,543.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,979.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,589.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,019.64
|
| Rate for Payer: PHCS Commercial |
$8,375.15
|
| Rate for Payer: United Healthcare All Payer |
$7,677.22
|
|
|
PFC MOD KNEE SYS CEM STEM 13*6
|
Facility
|
OP
|
$8,724.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.23 |
| Max. Negotiated Rate |
$8,375.15 |
| Rate for Payer: Aetna Commercial |
$6,717.56
|
| Rate for Payer: Anthem Medicaid |
$3,000.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,804.81
|
| Rate for Payer: Cash Price |
$4,362.06
|
| Rate for Payer: Cigna Commercial |
$7,241.01
|
| Rate for Payer: First Health Commercial |
$8,287.90
|
| Rate for Payer: Humana Commercial |
$7,415.49
|
| Rate for Payer: Humana KY Medicaid |
$3,000.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,030.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,153.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,438.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,060.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,677.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,543.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,979.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,589.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,019.64
|
| Rate for Payer: PHCS Commercial |
$8,375.15
|
| Rate for Payer: United Healthcare All Payer |
$7,677.22
|
|
|
PFC MOD KNEE SYS CEM STEM 13*6
|
Facility
|
IP
|
$8,724.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.23 |
| Max. Negotiated Rate |
$8,375.15 |
| Rate for Payer: Aetna Commercial |
$6,717.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,804.81
|
| Rate for Payer: Cash Price |
$4,362.06
|
| Rate for Payer: Cigna Commercial |
$7,241.01
|
| Rate for Payer: First Health Commercial |
$8,287.90
|
| Rate for Payer: Humana Commercial |
$7,415.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,153.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,438.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,677.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,543.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,979.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,589.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,019.64
|
| Rate for Payer: PHCS Commercial |
$8,375.15
|
| Rate for Payer: United Healthcare All Payer |
$7,677.22
|
|
|
PFC MOD KNEE SYS CEM STEM 15*3
|
Facility
|
OP
|
$8,724.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.23 |
| Max. Negotiated Rate |
$8,375.15 |
| Rate for Payer: Aetna Commercial |
$6,717.56
|
| Rate for Payer: Anthem Medicaid |
$3,000.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,804.81
|
| Rate for Payer: Cash Price |
$4,362.06
|
| Rate for Payer: Cigna Commercial |
$7,241.01
|
| Rate for Payer: First Health Commercial |
$8,287.90
|
| Rate for Payer: Humana Commercial |
$7,415.49
|
| Rate for Payer: Humana KY Medicaid |
$3,000.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,030.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,153.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,438.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,060.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,677.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,543.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,979.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,589.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,019.64
|
| Rate for Payer: PHCS Commercial |
$8,375.15
|
| Rate for Payer: United Healthcare All Payer |
$7,677.22
|
|
|
PFC MOD KNEE SYS CEM STEM 15*3
|
Facility
|
IP
|
$8,724.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.23 |
| Max. Negotiated Rate |
$8,375.15 |
| Rate for Payer: Aetna Commercial |
$6,717.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,804.81
|
| Rate for Payer: Cash Price |
$4,362.06
|
| Rate for Payer: Cigna Commercial |
$7,241.01
|
| Rate for Payer: First Health Commercial |
$8,287.90
|
| Rate for Payer: Humana Commercial |
$7,415.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,153.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,438.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,677.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,543.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,979.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,589.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,019.64
|
| Rate for Payer: PHCS Commercial |
$8,375.15
|
| Rate for Payer: United Healthcare All Payer |
$7,677.22
|
|
|
PFC MOD KNEE SYS CEM STEM 15*6
|
Facility
|
IP
|
$8,724.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.23 |
| Max. Negotiated Rate |
$8,375.15 |
| Rate for Payer: Aetna Commercial |
$6,717.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,804.81
|
| Rate for Payer: Cash Price |
$4,362.06
|
| Rate for Payer: Cigna Commercial |
$7,241.01
|
| Rate for Payer: First Health Commercial |
$8,287.90
|
| Rate for Payer: Humana Commercial |
$7,415.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,153.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,438.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,677.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,543.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,979.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,589.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,019.64
|
| Rate for Payer: PHCS Commercial |
$8,375.15
|
| Rate for Payer: United Healthcare All Payer |
$7,677.22
|
|
|
PFC MOD KNEE SYS CEM STEM 15*6
|
Facility
|
OP
|
$8,724.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.23 |
| Max. Negotiated Rate |
$8,375.15 |
| Rate for Payer: Aetna Commercial |
$6,717.56
|
| Rate for Payer: Anthem Medicaid |
$3,000.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,804.81
|
| Rate for Payer: Cash Price |
$4,362.06
|
| Rate for Payer: Cigna Commercial |
$7,241.01
|
| Rate for Payer: First Health Commercial |
$8,287.90
|
| Rate for Payer: Humana Commercial |
$7,415.49
|
| Rate for Payer: Humana KY Medicaid |
$3,000.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,030.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,153.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,438.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,060.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,677.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,543.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,979.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,589.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,019.64
|
| Rate for Payer: PHCS Commercial |
$8,375.15
|
| Rate for Payer: United Healthcare All Payer |
$7,677.22
|
|
