|
LEAD COMPACT 1*8 MRI 60CM
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
LEAD COMPACT 1*8 MRI 75CM
|
Facility
|
IP
|
$9,899.25
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.90 |
| Max. Negotiated Rate |
$9,503.28 |
| Rate for Payer: Aetna Commercial |
$7,622.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,721.42
|
| Rate for Payer: Cash Price |
$4,949.62
|
| Rate for Payer: Cigna Commercial |
$8,216.38
|
| Rate for Payer: First Health Commercial |
$9,404.29
|
| Rate for Payer: Humana Commercial |
$8,414.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,117.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,305.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,969.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,711.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,424.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,068.77
|
| Rate for Payer: PHCS Commercial |
$9,503.28
|
| Rate for Payer: United Healthcare All Payer |
$8,711.34
|
|
|
LEAD COMPACT 1*8 MRI 75CM
|
Facility
|
OP
|
$9,899.25
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.90 |
| Max. Negotiated Rate |
$9,503.28 |
| Rate for Payer: Aetna Commercial |
$7,622.42
|
| Rate for Payer: Anthem Medicaid |
$3,404.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,721.42
|
| Rate for Payer: Cash Price |
$4,949.62
|
| Rate for Payer: Cigna Commercial |
$8,216.38
|
| Rate for Payer: First Health Commercial |
$9,404.29
|
| Rate for Payer: Humana Commercial |
$8,414.36
|
| Rate for Payer: Humana KY Medicaid |
$3,404.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3,439.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,117.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,305.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,969.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,472.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,711.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,424.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,068.77
|
| Rate for Payer: PHCS Commercial |
$9,503.28
|
| Rate for Payer: United Healthcare All Payer |
$8,711.34
|
|
|
LEAD COMPACT 1*8 MRI 90CM
|
Facility
|
IP
|
$9,899.25
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.90 |
| Max. Negotiated Rate |
$9,503.28 |
| Rate for Payer: Aetna Commercial |
$7,622.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,721.42
|
| Rate for Payer: Cash Price |
$4,949.62
|
| Rate for Payer: Cigna Commercial |
$8,216.38
|
| Rate for Payer: First Health Commercial |
$9,404.29
|
| Rate for Payer: Humana Commercial |
$8,414.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,117.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,305.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,969.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,711.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,424.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,068.77
|
| Rate for Payer: PHCS Commercial |
$9,503.28
|
| Rate for Payer: United Healthcare All Payer |
$8,711.34
|
|
|
LEAD COMPACT 1*8 MRI 90CM
|
Facility
|
OP
|
$9,899.25
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.90 |
| Max. Negotiated Rate |
$9,503.28 |
| Rate for Payer: Aetna Commercial |
$7,622.42
|
| Rate for Payer: Anthem Medicaid |
$3,404.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,721.42
|
| Rate for Payer: Cash Price |
$4,949.62
|
| Rate for Payer: Cigna Commercial |
$8,216.38
|
| Rate for Payer: First Health Commercial |
$9,404.29
|
| Rate for Payer: Humana Commercial |
$8,414.36
|
| Rate for Payer: Humana KY Medicaid |
$3,404.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3,439.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,117.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,305.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,969.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,472.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,711.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,424.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,068.77
|
| Rate for Payer: PHCS Commercial |
$9,503.28
|
| Rate for Payer: United Healthcare All Payer |
$8,711.34
|
|
|
LEAD DEFIB OPTISURE 65CM LDA21
|
Facility
|
IP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
LEAD DEFIB OPTISURE 65CM LDA21
|
Facility
|
OP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem Medicaid |
$3,770.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Humana KY Medicaid |
$3,770.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,809.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,846.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
LEAD DEFIB RELIANCE AF 0158
|
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 DEFIB RELIANCE AF 0158
|
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 DEPLOYABLE 78CM 419578
|
Facility
|
OP
|
$9,005.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,170.65 |
| Max. Negotiated Rate |
$8,644.80 |
| Rate for Payer: Aetna Commercial |
$6,933.85
|
| Rate for Payer: Anthem Medicaid |
$3,096.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,023.90
|
| Rate for Payer: Cash Price |
$4,502.50
|
| Rate for Payer: Cigna Commercial |
$7,474.15
|
| Rate for Payer: First Health Commercial |
$8,554.75
|
| Rate for Payer: Humana Commercial |
$7,654.25
|
| Rate for Payer: Humana KY Medicaid |
$3,096.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3,128.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,384.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,645.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,158.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,924.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,801.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,170.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,791.55
|
| Rate for Payer: PHCS Commercial |
$8,644.80
|
| Rate for Payer: United Healthcare All Payer |
$7,924.40
|
|
|
LEAD DEPLOYABLE 78CM 419578
|
Facility
|
IP
|
$9,005.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,170.65 |
| Max. Negotiated Rate |
$8,644.80 |
| Rate for Payer: Aetna Commercial |
$6,933.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,023.90
|
| Rate for Payer: Cash Price |
$4,502.50
|
| Rate for Payer: Cigna Commercial |
$7,474.15
|
| Rate for Payer: First Health Commercial |
$8,554.75
|
| Rate for Payer: Humana Commercial |
$7,654.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,384.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,645.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,924.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,801.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,170.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,791.55
|
| Rate for Payer: PHCS Commercial |
$8,644.80
|
| Rate for Payer: United Healthcare All Payer |
$7,924.40
|
|
|
LEAD DEPLOYABLE 88CM 419588
|
Facility
|
IP
|
$9,005.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,170.65 |
| Max. Negotiated Rate |
$8,644.80 |
| Rate for Payer: Aetna Commercial |
$6,933.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,023.90
|
| Rate for Payer: Cash Price |
$4,502.50
|
| Rate for Payer: Cigna Commercial |
$7,474.15
|
| Rate for Payer: First Health Commercial |
$8,554.75
|
| Rate for Payer: Humana Commercial |
$7,654.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,384.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,645.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,924.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,801.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,170.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,791.55
|
| Rate for Payer: PHCS Commercial |
$8,644.80
|
| Rate for Payer: United Healthcare All Payer |
$7,924.40
|
|
|
LEAD DEPLOYABLE 88CM 419588
|
Facility
|
OP
|
$9,005.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,170.65 |
| Max. Negotiated Rate |
$8,644.80 |
| Rate for Payer: Aetna Commercial |
$6,933.85
|
| Rate for Payer: Anthem Medicaid |
$3,096.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,023.90
|
| Rate for Payer: Cash Price |
$4,502.50
|
| Rate for Payer: Cigna Commercial |
$7,474.15
|
| Rate for Payer: First Health Commercial |
$8,554.75
|
| Rate for Payer: Humana Commercial |
$7,654.25
|
| Rate for Payer: Humana KY Medicaid |
$3,096.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3,128.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,384.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,645.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,158.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,924.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,801.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,170.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,791.55
|
| Rate for Payer: PHCS Commercial |
$8,644.80
|
| Rate for Payer: United Healthcare All Payer |
$7,924.40
|
|
|
LEAD DEXTRUS 4135
|
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 DEXTRUS 4135
|
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 DEXTRUS 4136
|
Facility
|
IP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
LEAD DEXTRUS 4136
|
Facility
|
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem Medicaid |
$1,599.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Humana KY Medicaid |
$1,599.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,615.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,631.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
LEAD DEXTRUS 4137
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
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
|
|
|
LEAD DEXTRUS 4137
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
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 DURATA 7120Q/65
|
Facility
|
IP
|
$16,440.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,137.20 |
| Max. Negotiated Rate |
$15,782.40 |
| Rate for Payer: Aetna Commercial |
$12,658.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,823.20
|
| Rate for Payer: Cash Price |
$8,220.00
|
| Rate for Payer: Cigna Commercial |
$13,645.20
|
| Rate for Payer: First Health Commercial |
$15,618.00
|
| Rate for Payer: Humana Commercial |
$13,974.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,480.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,132.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,932.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,467.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,137.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,096.40
|
| Rate for Payer: PHCS Commercial |
$15,782.40
|
| Rate for Payer: United Healthcare All Payer |
$14,467.20
|
|
|
LEAD DURATA 7120Q/65
|
Facility
|
OP
|
$16,440.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,137.20 |
| Max. Negotiated Rate |
$15,782.40 |
| Rate for Payer: Aetna Commercial |
$12,658.80
|
| Rate for Payer: Anthem Medicaid |
$5,653.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,823.20
|
| Rate for Payer: Cash Price |
$8,220.00
|
| Rate for Payer: Cigna Commercial |
$13,645.20
|
| Rate for Payer: First Health Commercial |
$15,618.00
|
| Rate for Payer: Humana Commercial |
$13,974.00
|
| Rate for Payer: Humana KY Medicaid |
$5,653.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,711.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,480.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,132.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,932.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,767.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,467.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,137.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,096.40
|
| Rate for Payer: PHCS Commercial |
$15,782.40
|
| Rate for Payer: United Healthcare All Payer |
$14,467.20
|
|
|
LEAD DURATA 7121/60
|
Facility
|
IP
|
$17,430.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,265.90 |
| Max. Negotiated Rate |
$16,732.80 |
| Rate for Payer: Aetna Commercial |
$13,421.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,595.40
|
| Rate for Payer: Cash Price |
$8,715.00
|
| Rate for Payer: Cigna Commercial |
$14,466.90
|
| Rate for Payer: First Health Commercial |
$16,558.50
|
| Rate for Payer: Humana Commercial |
$14,815.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,292.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,863.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,229.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,072.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,265.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,403.30
|
| Rate for Payer: PHCS Commercial |
$16,732.80
|
| Rate for Payer: United Healthcare All Payer |
$15,338.40
|
|
|
LEAD DURATA 7121/60
|
Facility
|
OP
|
$17,430.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,265.90 |
| Max. Negotiated Rate |
$16,732.80 |
| Rate for Payer: Aetna Commercial |
$13,421.10
|
| Rate for Payer: Anthem Medicaid |
$5,994.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,595.40
|
| Rate for Payer: Cash Price |
$8,715.00
|
| Rate for Payer: Cigna Commercial |
$14,466.90
|
| Rate for Payer: First Health Commercial |
$16,558.50
|
| Rate for Payer: Humana Commercial |
$14,815.50
|
| Rate for Payer: Humana KY Medicaid |
$5,994.18
|
| Rate for Payer: Kentucky WC Medicaid |
$6,055.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,292.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,863.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,229.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,114.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,072.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,265.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,403.30
|
| Rate for Payer: PHCS Commercial |
$16,732.80
|
| Rate for Payer: United Healthcare All Payer |
$15,338.40
|
|
|
LEAD DURATA 7121/65
|
Facility
|
OP
|
$15,720.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.60 |
| Max. Negotiated Rate |
$15,091.20 |
| Rate for Payer: Aetna Commercial |
$12,104.40
|
| Rate for Payer: Anthem Medicaid |
$5,406.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,261.60
|
| Rate for Payer: Cash Price |
$7,860.00
|
| Rate for Payer: Cigna Commercial |
$13,047.60
|
| Rate for Payer: First Health Commercial |
$14,934.00
|
| Rate for Payer: Humana Commercial |
$13,362.00
|
| Rate for Payer: Humana KY Medicaid |
$5,406.11
|
| Rate for Payer: Kentucky WC Medicaid |
$5,461.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,890.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,601.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,716.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,514.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,833.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,790.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,043.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,873.20
|
| Rate for Payer: PHCS Commercial |
$15,091.20
|
| Rate for Payer: United Healthcare All Payer |
$13,833.60
|
|
|
LEAD DURATA 7121/65
|
Facility
|
IP
|
$15,720.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.60 |
| Max. Negotiated Rate |
$15,091.20 |
| Rate for Payer: Aetna Commercial |
$12,104.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,261.60
|
| Rate for Payer: Cash Price |
$7,860.00
|
| Rate for Payer: Cigna Commercial |
$13,047.60
|
| Rate for Payer: First Health Commercial |
$14,934.00
|
| Rate for Payer: Humana Commercial |
$13,362.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,890.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,601.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,716.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,833.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,790.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,043.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,873.20
|
| Rate for Payer: PHCS Commercial |
$15,091.20
|
| Rate for Payer: United Healthcare All Payer |
$13,833.60
|
|
