|
LEAD ELOX 45-BP/330 132
|
Facility
|
OP
|
$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 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 ENDO ISOFLEX 1948/52
|
Facility
|
IP
|
$3,512.50
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$456.62 |
| Max. Negotiated Rate |
$3,372.00 |
| Rate for Payer: Aetna Commercial |
$2,704.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,739.75
|
| Rate for Payer: Cash Price |
$1,756.25
|
| Rate for Payer: Cigna Commercial |
$2,915.38
|
| Rate for Payer: First Health Commercial |
$3,336.88
|
| Rate for Payer: Humana Commercial |
$2,985.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,880.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,592.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,053.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,091.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$702.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.88
|
| Rate for Payer: PHCS Commercial |
$3,372.00
|
| Rate for Payer: United Healthcare All Payer |
$3,091.00
|
|
|
LEAD ENDO ISOFLEX 1948/52
|
Facility
|
OP
|
$3,512.50
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$456.62 |
| Max. Negotiated Rate |
$3,372.00 |
| Rate for Payer: Aetna Commercial |
$2,704.62
|
| Rate for Payer: Anthem Medicaid |
$1,207.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,739.75
|
| Rate for Payer: Cash Price |
$1,756.25
|
| Rate for Payer: Cigna Commercial |
$2,915.38
|
| Rate for Payer: First Health Commercial |
$3,336.88
|
| Rate for Payer: Humana Commercial |
$2,985.62
|
| Rate for Payer: Humana KY Medicaid |
$1,207.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,220.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,880.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,592.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,053.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,232.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,091.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$702.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.88
|
| Rate for Payer: PHCS Commercial |
$3,372.00
|
| Rate for Payer: United Healthcare All Payer |
$3,091.00
|
|
|
LEAD ENDO ISOFLEX 1948/58
|
Facility
|
IP
|
$3,512.50
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$456.62 |
| Max. Negotiated Rate |
$3,372.00 |
| Rate for Payer: Aetna Commercial |
$2,704.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,739.75
|
| Rate for Payer: Cash Price |
$1,756.25
|
| Rate for Payer: Cigna Commercial |
$2,915.38
|
| Rate for Payer: First Health Commercial |
$3,336.88
|
| Rate for Payer: Humana Commercial |
$2,985.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,880.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,592.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,053.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,091.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$702.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.88
|
| Rate for Payer: PHCS Commercial |
$3,372.00
|
| Rate for Payer: United Healthcare All Payer |
$3,091.00
|
|
|
LEAD ENDO ISOFLEX 1948/58
|
Facility
|
OP
|
$3,512.50
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$456.62 |
| Max. Negotiated Rate |
$3,372.00 |
| Rate for Payer: Aetna Commercial |
$2,704.62
|
| Rate for Payer: Anthem Medicaid |
$1,207.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,739.75
|
| Rate for Payer: Cash Price |
$1,756.25
|
| Rate for Payer: Cigna Commercial |
$2,915.38
|
| Rate for Payer: First Health Commercial |
$3,336.88
|
| Rate for Payer: Humana Commercial |
$2,985.62
|
| Rate for Payer: Humana KY Medicaid |
$1,207.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,220.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,880.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,592.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,053.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,232.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,091.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$702.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.88
|
| Rate for Payer: PHCS Commercial |
$3,372.00
|
| Rate for Payer: United Healthcare All Payer |
$3,091.00
|
|
|
LEAD ENDO TENDRIL STS 2088TC/4
|
Facility
|
OP
|
$3,152.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$409.76 |
| Max. Negotiated Rate |
$3,025.92 |
| Rate for Payer: Aetna Commercial |
$2,427.04
|
| Rate for Payer: Anthem Medicaid |
$1,083.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,458.56
|
| Rate for Payer: Cash Price |
$1,576.00
|
| Rate for Payer: Cigna Commercial |
$2,616.16
|
| Rate for Payer: First Health Commercial |
$2,994.40
|
| Rate for Payer: Humana Commercial |
$2,679.20
|
| Rate for Payer: Humana KY Medicaid |
$1,083.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,095.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,584.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,326.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$945.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,105.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,773.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,364.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$409.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$977.12
|
| Rate for Payer: PHCS Commercial |
$3,025.92
|
| Rate for Payer: United Healthcare All Payer |
$2,773.76
|
|
|
LEAD ENDO TENDRIL STS 2088TC/4
|
Facility
|
IP
|
$3,152.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$409.76 |
| Max. Negotiated Rate |
$3,025.92 |
| Rate for Payer: Aetna Commercial |
$2,427.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,458.56
|
| Rate for Payer: Cash Price |
$1,576.00
|
| Rate for Payer: Cigna Commercial |
$2,616.16
|
| Rate for Payer: First Health Commercial |
$2,994.40
|
| Rate for Payer: Humana Commercial |
$2,679.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,584.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,326.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$945.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,773.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,364.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$409.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$977.12
|
| Rate for Payer: PHCS Commercial |
$3,025.92
|
| Rate for Payer: United Healthcare All Payer |
$2,773.76
|
|
|
LEAD ENDO TENDRIL STS 2088TC/5
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem Medicaid |
$1,057.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Humana KY Medicaid |
$1,057.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
LEAD ENDO TENDRIL STS 2088TC/5
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
LEAD ENDO TENDRL STS 2088TC/52
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
LEAD ENDO TENDRL STS 2088TC/52
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem Medicaid |
$1,057.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Humana KY Medicaid |
$1,057.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
LEAD EPICARDIAL 35CM 511211
|
Facility
|
OP
|
$5,682.50
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.72 |
| Max. Negotiated Rate |
$5,455.20 |
| Rate for Payer: Aetna Commercial |
$4,375.52
|
| Rate for Payer: Anthem Medicaid |
$1,954.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,432.35
|
| Rate for Payer: Cash Price |
$2,841.25
|
| Rate for Payer: Cigna Commercial |
$4,716.48
|
| Rate for Payer: First Health Commercial |
$5,398.38
|
| Rate for Payer: Humana Commercial |
$4,830.12
|
| Rate for Payer: Humana KY Medicaid |
$1,954.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,974.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,659.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,193.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,993.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,000.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,136.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,761.58
|
| Rate for Payer: PHCS Commercial |
$5,455.20
|
| Rate for Payer: United Healthcare All Payer |
$5,000.60
|
|
|
LEAD EPICARDIAL 35CM 511211
|
Facility
|
IP
|
$5,682.50
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.72 |
| Max. Negotiated Rate |
$5,455.20 |
| Rate for Payer: Aetna Commercial |
$4,375.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,432.35
|
| Rate for Payer: Cash Price |
$2,841.25
|
| Rate for Payer: Cigna Commercial |
$4,716.48
|
| Rate for Payer: First Health Commercial |
$5,398.38
|
| Rate for Payer: Humana Commercial |
$4,830.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,659.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,193.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,000.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,136.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,761.58
|
| Rate for Payer: PHCS Commercial |
$5,455.20
|
| Rate for Payer: United Healthcare All Payer |
$5,000.60
|
|
|
LEAD EPICARDIAL BIOMEC 54CM
|
Facility
|
IP
|
$3,512.50
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$456.62 |
| Max. Negotiated Rate |
$3,372.00 |
| Rate for Payer: Aetna Commercial |
$2,704.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,739.75
|
| Rate for Payer: Cash Price |
$1,756.25
|
| Rate for Payer: Cigna Commercial |
$2,915.38
|
| Rate for Payer: First Health Commercial |
$3,336.88
|
| Rate for Payer: Humana Commercial |
$2,985.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,880.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,592.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,053.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,091.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$702.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.88
|
| Rate for Payer: PHCS Commercial |
$3,372.00
|
| Rate for Payer: United Healthcare All Payer |
$3,091.00
|
|
|
LEAD EPICARDIAL BIOMEC 54CM
|
Facility
|
OP
|
$3,512.50
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$456.62 |
| Max. Negotiated Rate |
$3,372.00 |
| Rate for Payer: Aetna Commercial |
$2,704.62
|
| Rate for Payer: Anthem Medicaid |
$1,207.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,739.75
|
| Rate for Payer: Cash Price |
$1,756.25
|
| Rate for Payer: Cigna Commercial |
$2,915.38
|
| Rate for Payer: First Health Commercial |
$3,336.88
|
| Rate for Payer: Humana Commercial |
$2,985.62
|
| Rate for Payer: Humana KY Medicaid |
$1,207.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,220.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,880.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,592.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,053.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,232.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,091.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$702.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.88
|
| Rate for Payer: PHCS Commercial |
$3,372.00
|
| Rate for Payer: United Healthcare All Payer |
$3,091.00
|
|
|
LEAD EXTENSION KIT 35CM
|
Facility
|
IP
|
$4,528.86
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.75 |
| Max. Negotiated Rate |
$4,347.71 |
| Rate for Payer: Aetna Commercial |
$3,487.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,532.51
|
| Rate for Payer: Cash Price |
$2,264.43
|
| Rate for Payer: Cigna Commercial |
$3,758.95
|
| Rate for Payer: First Health Commercial |
$4,302.42
|
| Rate for Payer: Humana Commercial |
$3,849.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,713.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,342.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,358.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,985.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,396.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$905.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$588.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,403.95
|
| Rate for Payer: PHCS Commercial |
$4,347.71
|
| Rate for Payer: United Healthcare All Payer |
$3,985.40
|
|
|
LEAD EXTENSION KIT 35CM
|
Facility
|
OP
|
$4,528.86
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.75 |
| Max. Negotiated Rate |
$4,347.71 |
| Rate for Payer: Aetna Commercial |
$3,487.22
|
| Rate for Payer: Anthem Medicaid |
$1,557.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,532.51
|
| Rate for Payer: Cash Price |
$2,264.43
|
| Rate for Payer: Cigna Commercial |
$3,758.95
|
| Rate for Payer: First Health Commercial |
$4,302.42
|
| Rate for Payer: Humana Commercial |
$3,849.53
|
| Rate for Payer: Humana KY Medicaid |
$1,557.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,573.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,713.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,342.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,358.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,588.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,985.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,396.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$905.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$588.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,403.95
|
| Rate for Payer: PHCS Commercial |
$4,347.71
|
| Rate for Payer: United Healthcare All Payer |
$3,985.40
|
|
|
LEAD FINELINE II STEROX 4456
|
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 FINELINE II STEROX 4456
|
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 FINELINE II STEROX 4457
|
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
|
|
|
LEAD FINELINE II STEROX 4457
|
Facility
|
OP
|
$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 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 FLEXTEND 4086
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
LEAD FLEXTEND 4086
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
LEAD FLEXTEND 4087
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LEAD FLEXTEND 4087
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
