|
LEAD DURATA 7121Q/58
|
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 7121Q/58
|
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 7121Q/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 7121Q/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 7122
|
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
|
|
|
LEAD DURATA 7122
|
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 7122Q-58
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000059
|
|
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 DURATA 7122Q-58
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000059
|
|
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 DURATA 7122Q/65
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
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 DURATA 7122Q/65
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
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 DURATA PKG/STER 7120/60
|
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 PKG/STER 7120/60
|
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 PKG/STER 7120/65
|
Facility
|
IP
|
$17,430.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
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 PKG/STER 7120/65
|
Facility
|
OP
|
$17,430.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
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 SJ4 7120Q
|
Facility
|
IP
|
$16,440.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
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 SJ4 7120Q
|
Facility
|
OP
|
$16,440.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
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 SJ4 7121Q
|
Facility
|
IP
|
$18,330.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,382.90 |
| Max. Negotiated Rate |
$17,596.80 |
| Rate for Payer: Aetna Commercial |
$14,114.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,297.40
|
| Rate for Payer: Cash Price |
$9,165.00
|
| Rate for Payer: Cigna Commercial |
$15,213.90
|
| Rate for Payer: First Health Commercial |
$17,413.50
|
| Rate for Payer: Humana Commercial |
$15,580.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,030.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,527.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,499.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,130.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,747.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,382.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,682.30
|
| Rate for Payer: PHCS Commercial |
$17,596.80
|
| Rate for Payer: United Healthcare All Payer |
$16,130.40
|
|
|
LEAD DURATA SJ4 7121Q
|
Facility
|
OP
|
$18,330.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,382.90 |
| Max. Negotiated Rate |
$17,596.80 |
| Rate for Payer: Aetna Commercial |
$14,114.10
|
| Rate for Payer: Anthem Medicaid |
$6,303.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,297.40
|
| Rate for Payer: Cash Price |
$9,165.00
|
| Rate for Payer: Cigna Commercial |
$15,213.90
|
| Rate for Payer: First Health Commercial |
$17,413.50
|
| Rate for Payer: Humana Commercial |
$15,580.50
|
| Rate for Payer: Humana KY Medicaid |
$6,303.69
|
| Rate for Payer: Kentucky WC Medicaid |
$6,367.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,030.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,527.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,499.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,430.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,130.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,747.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,382.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,682.30
|
| Rate for Payer: PHCS Commercial |
$17,596.80
|
| Rate for Payer: United Healthcare All Payer |
$16,130.40
|
|
|
LEAD DURATA SJ4 7122Q
|
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 SJ4 7122Q
|
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 STS 7120
|
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 STS 7120
|
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 SVC 7120Q/58
|
Facility
|
IP
|
$16,440.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
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 SVC 7120Q/58
|
Facility
|
OP
|
$16,440.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
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 ELOX 45-BP/330 132
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
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
|
|
