|
LEAD 60CM PERC OCTRD PERM 3186
|
Facility
|
OP
|
$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 Medicaid |
$4,021.91
|
| 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: Humana KY Medicaid |
$4,021.91
|
| Rate for Payer: Kentucky WC Medicaid |
$4,062.84
|
| 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: Molina Healthcare Medicaid |
$4,102.61
|
| 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
|
|
|
LEAD 60CM PERC OCTROD TRL 3086
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
LEAD 60CM PERC OCTROD TRL 3086
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem Medicaid |
$1,659.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Humana KY Medicaid |
$1,659.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,676.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,692.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
LEAD 6944-65
|
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 6944-65
|
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 7.5IN DEL SYS EPIDCR 1773
|
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 7.5IN DEL SYS EPIDCR 1773
|
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 ACTIVE 6935M55
|
Facility
|
IP
|
$10,769.10
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.98 |
| Max. Negotiated Rate |
$10,338.34 |
| Rate for Payer: Aetna Commercial |
$8,292.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,399.90
|
| Rate for Payer: Cash Price |
$5,384.55
|
| Rate for Payer: Cigna Commercial |
$8,938.35
|
| Rate for Payer: First Health Commercial |
$10,230.64
|
| Rate for Payer: Humana Commercial |
$9,153.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,830.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,947.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,230.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,476.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,076.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,153.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,399.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,338.42
|
| Rate for Payer: PHCS Commercial |
$10,338.34
|
| Rate for Payer: United Healthcare All Payer |
$9,476.81
|
|
|
LEAD ACTIVE 6935M55
|
Facility
|
OP
|
$10,769.10
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.98 |
| Max. Negotiated Rate |
$10,338.34 |
| Rate for Payer: Aetna Commercial |
$8,292.21
|
| Rate for Payer: Anthem Medicaid |
$3,703.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,399.90
|
| Rate for Payer: Cash Price |
$5,384.55
|
| Rate for Payer: Cigna Commercial |
$8,938.35
|
| Rate for Payer: First Health Commercial |
$10,230.64
|
| Rate for Payer: Humana Commercial |
$9,153.74
|
| Rate for Payer: Humana KY Medicaid |
$3,703.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,741.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,830.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,947.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,230.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,777.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,476.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,076.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,153.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,399.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,338.42
|
| Rate for Payer: PHCS Commercial |
$10,338.34
|
| Rate for Payer: United Healthcare All Payer |
$9,476.81
|
|
|
LEAD ACTIVE 6935M62
|
Facility
|
OP
|
$10,769.10
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.98 |
| Max. Negotiated Rate |
$10,338.34 |
| Rate for Payer: Aetna Commercial |
$8,292.21
|
| Rate for Payer: Anthem Medicaid |
$3,703.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,399.90
|
| Rate for Payer: Cash Price |
$5,384.55
|
| Rate for Payer: Cigna Commercial |
$8,938.35
|
| Rate for Payer: First Health Commercial |
$10,230.64
|
| Rate for Payer: Humana Commercial |
$9,153.74
|
| Rate for Payer: Humana KY Medicaid |
$3,703.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,741.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,830.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,947.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,230.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,777.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,476.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,076.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,153.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,399.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,338.42
|
| Rate for Payer: PHCS Commercial |
$10,338.34
|
| Rate for Payer: United Healthcare All Payer |
$9,476.81
|
|
|
LEAD ACTIVE 6935M62
|
Facility
|
IP
|
$10,769.10
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.98 |
| Max. Negotiated Rate |
$10,338.34 |
| Rate for Payer: Aetna Commercial |
$8,292.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,399.90
|
| Rate for Payer: Cash Price |
$5,384.55
|
| Rate for Payer: Cigna Commercial |
$8,938.35
|
| Rate for Payer: First Health Commercial |
$10,230.64
|
| Rate for Payer: Humana Commercial |
$9,153.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,830.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,947.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,230.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,476.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,076.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,153.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,399.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,338.42
|
| Rate for Payer: PHCS Commercial |
$10,338.34
|
| Rate for Payer: United Healthcare All Payer |
$9,476.81
|
|
|
LEAD ACTIVE DC US 6947M62
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
LEAD ACTIVE DC US 6947M62
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
LEAD ACUITY SPIRAL 4591/92/93
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
LEAD ACUITY SPIRAL 4591/92/93
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
LEAD ADAPTER KIT OSCOR M/IS-10
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
LEAD ADAPTER KIT OSCOR M/IS-10
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
LEAD ADAPTOR BLV/BIS-4403
|
Facility
|
IP
|
$1,593.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.09 |
| Max. Negotiated Rate |
$1,529.28 |
| Rate for Payer: Aetna Commercial |
$1,226.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,242.54
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Cigna Commercial |
$1,322.19
|
| Rate for Payer: First Health Commercial |
$1,513.35
|
| Rate for Payer: Humana Commercial |
$1,354.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,306.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,175.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,401.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,194.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$493.83
|
| Rate for Payer: PHCS Commercial |
$1,529.28
|
| Rate for Payer: United Healthcare All Payer |
$1,401.84
|
|
|
LEAD ADAPTOR BLV/BIS-4403
|
Facility
|
OP
|
$1,593.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.09 |
| Max. Negotiated Rate |
$1,529.28 |
| Rate for Payer: Aetna Commercial |
$1,226.61
|
| Rate for Payer: Anthem Medicaid |
$547.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,242.54
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Cigna Commercial |
$1,322.19
|
| Rate for Payer: First Health Commercial |
$1,513.35
|
| Rate for Payer: Humana Commercial |
$1,354.05
|
| Rate for Payer: Humana KY Medicaid |
$547.83
|
| Rate for Payer: Kentucky WC Medicaid |
$553.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,306.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,175.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$558.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,401.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,194.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$493.83
|
| Rate for Payer: PHCS Commercial |
$1,529.28
|
| Rate for Payer: United Healthcare All Payer |
$1,401.84
|
|
|
LEAD ATRIAL 1944/46CM
|
Facility
|
OP
|
$3,705.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.65 |
| Max. Negotiated Rate |
$3,556.80 |
| Rate for Payer: Aetna Commercial |
$2,852.85
|
| Rate for Payer: Anthem Medicaid |
$1,274.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,889.90
|
| Rate for Payer: Cash Price |
$1,852.50
|
| Rate for Payer: Cigna Commercial |
$3,075.15
|
| Rate for Payer: First Health Commercial |
$3,519.75
|
| Rate for Payer: Humana Commercial |
$3,149.25
|
| Rate for Payer: Humana KY Medicaid |
$1,274.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,287.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,038.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,734.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,111.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,299.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,260.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,778.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$741.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,148.55
|
| Rate for Payer: PHCS Commercial |
$3,556.80
|
| Rate for Payer: United Healthcare All Payer |
$3,260.40
|
|
|
LEAD ATRIAL 1944/46CM
|
Facility
|
IP
|
$3,705.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$481.65 |
| Max. Negotiated Rate |
$3,556.80 |
| Rate for Payer: Aetna Commercial |
$2,852.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,889.90
|
| Rate for Payer: Cash Price |
$1,852.50
|
| Rate for Payer: Cigna Commercial |
$3,075.15
|
| Rate for Payer: First Health Commercial |
$3,519.75
|
| Rate for Payer: Humana Commercial |
$3,149.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,038.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,734.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,111.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,260.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,778.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$741.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,148.55
|
| Rate for Payer: PHCS Commercial |
$3,556.80
|
| Rate for Payer: United Healthcare All Payer |
$3,260.40
|
|
|
LEAD ATRIAL 4592-45
|
Facility
|
OP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
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 ATRIAL 4592-45
|
Facility
|
IP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
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 ATRIAL AROX 338 025
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
LEAD ATRIAL AROX 338 025
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
