|
LEAD 5076-65 BIPOLAR SIL SCREW
|
Facility
|
IP
|
$3,589.50
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$466.64 |
| Max. Negotiated Rate |
$3,445.92 |
| Rate for Payer: Aetna Commercial |
$2,763.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,799.81
|
| Rate for Payer: Cash Price |
$1,794.75
|
| Rate for Payer: Cigna Commercial |
$2,979.28
|
| Rate for Payer: First Health Commercial |
$3,410.02
|
| Rate for Payer: Humana Commercial |
$3,051.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,943.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,649.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,076.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,158.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,692.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$717.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,112.74
|
| Rate for Payer: PHCS Commercial |
$3,445.92
|
| Rate for Payer: United Healthcare All Payer |
$3,158.76
|
|
|
LEAD 5076-65 BIPOLAR SIL SCREW
|
Facility
|
OP
|
$3,589.50
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$466.64 |
| Max. Negotiated Rate |
$3,445.92 |
| Rate for Payer: Aetna Commercial |
$2,763.92
|
| Rate for Payer: Anthem Medicaid |
$1,234.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,799.81
|
| Rate for Payer: Cash Price |
$1,794.75
|
| Rate for Payer: Cigna Commercial |
$2,979.28
|
| Rate for Payer: First Health Commercial |
$3,410.02
|
| Rate for Payer: Humana Commercial |
$3,051.08
|
| Rate for Payer: Humana KY Medicaid |
$1,234.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,246.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,943.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,649.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,076.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,259.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,158.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,692.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$717.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,112.74
|
| Rate for Payer: PHCS Commercial |
$3,445.92
|
| Rate for Payer: United Healthcare All Payer |
$3,158.76
|
|
|
LEAD 5092-52
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
LEAD 5092-52
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
LEAD 5092-58
|
Facility
|
IP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 5092-58
|
Facility
|
OP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem Medicaid |
$1,213.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Humana KY Medicaid |
$1,213.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,226.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,238.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 5568-45
|
Facility
|
OP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem Medicaid |
$1,213.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Humana KY Medicaid |
$1,213.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,226.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,238.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 5568-45
|
Facility
|
IP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 5568-53
|
Facility
|
OP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem Medicaid |
$1,213.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Humana KY Medicaid |
$1,213.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,226.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,238.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 5568-53
|
Facility
|
IP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 5592-45
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem Medicaid |
$1,238.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Humana KY Medicaid |
$1,238.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,250.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,262.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
LEAD 5592-45
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
LEAD 5592-53
|
Facility
|
IP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 5592-53
|
Facility
|
OP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem Medicaid |
$1,213.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Humana KY Medicaid |
$1,213.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,226.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,238.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 5IN DEL SYS EPIDUCER 1772
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem Medicaid |
$1,238.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Humana KY Medicaid |
$1,238.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,250.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,262.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
LEAD 5IN DEL SYS EPIDUCER 1772
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
LEAD 60CM 16ELECT DUALARY 3288
|
Facility
|
OP
|
$23,050.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,996.50 |
| Max. Negotiated Rate |
$22,128.00 |
| Rate for Payer: Aetna Commercial |
$17,748.50
|
| Rate for Payer: Anthem Medicaid |
$7,926.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,979.00
|
| Rate for Payer: Cash Price |
$11,525.00
|
| Rate for Payer: Cigna Commercial |
$19,131.50
|
| Rate for Payer: First Health Commercial |
$21,897.50
|
| Rate for Payer: Humana Commercial |
$19,592.50
|
| Rate for Payer: Humana KY Medicaid |
$7,926.90
|
| Rate for Payer: Kentucky WC Medicaid |
$8,007.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,901.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,010.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,915.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,085.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,284.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,610.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,996.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,145.50
|
| Rate for Payer: PHCS Commercial |
$22,128.00
|
| Rate for Payer: United Healthcare All Payer |
$20,284.00
|
|
|
LEAD 60CM 16ELECT DUALARY 3288
|
Facility
|
IP
|
$23,050.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,996.50 |
| Max. Negotiated Rate |
$22,128.00 |
| Rate for Payer: Aetna Commercial |
$17,748.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,979.00
|
| Rate for Payer: Cash Price |
$11,525.00
|
| Rate for Payer: Cigna Commercial |
$19,131.50
|
| Rate for Payer: First Health Commercial |
$21,897.50
|
| Rate for Payer: Humana Commercial |
$19,592.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,901.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,010.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,915.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,284.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,610.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,996.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,145.50
|
| Rate for Payer: PHCS Commercial |
$22,128.00
|
| Rate for Payer: United Healthcare All Payer |
$20,284.00
|
|
|
LEAD 60CM 8ELECT DUAL ARY 3244
|
Facility
|
OP
|
$15,360.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,996.80 |
| Max. Negotiated Rate |
$14,745.60 |
| Rate for Payer: Aetna Commercial |
$11,827.20
|
| Rate for Payer: Anthem Medicaid |
$5,282.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,980.80
|
| Rate for Payer: Cash Price |
$7,680.00
|
| Rate for Payer: Cigna Commercial |
$12,748.80
|
| Rate for Payer: First Health Commercial |
$14,592.00
|
| Rate for Payer: Humana Commercial |
$13,056.00
|
| Rate for Payer: Humana KY Medicaid |
$5,282.30
|
| Rate for Payer: Kentucky WC Medicaid |
$5,336.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,595.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,335.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,608.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,388.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,516.80
|
| Rate for Payer: Ohio Health Group HMO |
$11,520.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,996.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,761.60
|
| Rate for Payer: PHCS Commercial |
$14,745.60
|
| Rate for Payer: United Healthcare All Payer |
$13,516.80
|
|
|
LEAD 60CM 8ELECT DUAL ARY 3244
|
Facility
|
IP
|
$15,360.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,996.80 |
| Max. Negotiated Rate |
$14,745.60 |
| Rate for Payer: Aetna Commercial |
$11,827.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,980.80
|
| Rate for Payer: Cash Price |
$7,680.00
|
| Rate for Payer: Cigna Commercial |
$12,748.80
|
| Rate for Payer: First Health Commercial |
$14,592.00
|
| Rate for Payer: Humana Commercial |
$13,056.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,595.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,335.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,608.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,516.80
|
| Rate for Payer: Ohio Health Group HMO |
$11,520.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,996.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,761.60
|
| Rate for Payer: PHCS Commercial |
$14,745.60
|
| Rate for Payer: United Healthcare All Payer |
$13,516.80
|
|
|
LEAD 60CM 8ELECT LAMITRDE 3286
|
Facility
|
OP
|
$12,917.75
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,679.31 |
| Max. Negotiated Rate |
$12,401.04 |
| Rate for Payer: Aetna Commercial |
$9,946.67
|
| Rate for Payer: Anthem Medicaid |
$4,442.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,075.84
|
| Rate for Payer: Cash Price |
$6,458.88
|
| Rate for Payer: Cigna Commercial |
$10,721.73
|
| Rate for Payer: First Health Commercial |
$12,271.86
|
| Rate for Payer: Humana Commercial |
$10,980.09
|
| Rate for Payer: Humana KY Medicaid |
$4,442.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,487.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,592.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,533.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,875.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,531.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,367.62
|
| Rate for Payer: Ohio Health Group HMO |
$9,688.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,583.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,004.50
|
| Rate for Payer: PHCS Commercial |
$12,401.04
|
| Rate for Payer: United Healthcare All Payer |
$11,367.62
|
|
|
LEAD 60CM 8ELECT LAMITRDE 3286
|
Facility
|
IP
|
$12,917.75
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,679.31 |
| Max. Negotiated Rate |
$12,401.04 |
| Rate for Payer: Aetna Commercial |
$9,946.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,075.84
|
| Rate for Payer: Cash Price |
$6,458.88
|
| Rate for Payer: Cigna Commercial |
$10,721.73
|
| Rate for Payer: First Health Commercial |
$12,271.86
|
| Rate for Payer: Humana Commercial |
$10,980.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,592.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,533.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,875.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,367.62
|
| Rate for Payer: Ohio Health Group HMO |
$9,688.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,583.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,004.50
|
| Rate for Payer: PHCS Commercial |
$12,401.04
|
| Rate for Payer: United Healthcare All Payer |
$11,367.62
|
|
|
LEAD 60CM PENTA 3228
|
Facility
|
OP
|
$25,605.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,328.65 |
| Max. Negotiated Rate |
$24,580.80 |
| Rate for Payer: Aetna Commercial |
$19,715.85
|
| Rate for Payer: Anthem Medicaid |
$8,805.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,971.90
|
| Rate for Payer: Cash Price |
$12,802.50
|
| Rate for Payer: Cigna Commercial |
$21,252.15
|
| Rate for Payer: First Health Commercial |
$24,324.75
|
| Rate for Payer: Humana Commercial |
$21,764.25
|
| Rate for Payer: Humana KY Medicaid |
$8,805.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,895.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,996.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,896.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,681.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,982.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,532.40
|
| Rate for Payer: Ohio Health Group HMO |
$19,203.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,121.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,328.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,937.55
|
| Rate for Payer: PHCS Commercial |
$24,580.80
|
| Rate for Payer: United Healthcare All Payer |
$22,532.40
|
|
|
LEAD 60CM PENTA 3228
|
Facility
|
IP
|
$25,605.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,328.65 |
| Max. Negotiated Rate |
$24,580.80 |
| Rate for Payer: Aetna Commercial |
$19,715.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,971.90
|
| Rate for Payer: Cash Price |
$12,802.50
|
| Rate for Payer: Cigna Commercial |
$21,252.15
|
| Rate for Payer: First Health Commercial |
$24,324.75
|
| Rate for Payer: Humana Commercial |
$21,764.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,996.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,896.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,681.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,532.40
|
| Rate for Payer: Ohio Health Group HMO |
$19,203.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,121.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,328.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,937.55
|
| Rate for Payer: PHCS Commercial |
$24,580.80
|
| Rate for Payer: United Healthcare All Payer |
$22,532.40
|
|
|
LEAD 60CM PERC OCTRD PERM 3186
|
Facility
|
IP
|
$11,695.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,520.35 |
| Max. Negotiated Rate |
$11,227.20 |
| Rate for Payer: Aetna Commercial |
$9,005.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.10
|
| Rate for Payer: Cash Price |
$5,847.50
|
| Rate for Payer: Cigna Commercial |
$9,706.85
|
| Rate for Payer: First Health Commercial |
$11,110.25
|
| Rate for Payer: Humana Commercial |
$9,940.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.45
|
| Rate for Payer: PHCS Commercial |
$11,227.20
|
| Rate for Payer: United Healthcare All Payer |
$10,291.60
|
|
