|
LEAD INTELLIS TRIAL KIT 977D26
|
Facility
|
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
278
|
| 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 INTELLIS TRIAL KIT 977D26
|
Facility
|
IP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
278
|
| 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 INTELLIS TRL KIT 977D160
|
Facility
|
IP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
278
|
| 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 INTELLIS TRL KIT 977D160
|
Facility
|
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
278
|
| 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 ISOFLEX-S 1642T/46
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem Medicaid |
$1,238.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Humana KY Medicaid |
$1,238.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,250.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,262.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
LEAD ISOFLEX-S 1642T/46
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
LEAD ISOFLEX-S 1646T/52
|
Facility
|
OP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem Medicaid |
$1,298.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Humana KY Medicaid |
$1,298.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
LEAD ISOFLEX-S 1646T/52
|
Facility
|
IP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
LEAD ISOFLEX-S 1646T/58
|
Facility
|
OP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem Medicaid |
$1,298.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Humana KY Medicaid |
$1,298.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
LEAD ISOFLEX-S 1646T/58
|
Facility
|
IP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
LEAD KENTROX RV 332 232
|
Facility
|
IP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
LEAD KENTROX RV 332 232
|
Facility
|
OP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem Medicaid |
$5,777.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Humana KY Medicaid |
$5,777.52
|
| Rate for Payer: Kentucky WC Medicaid |
$5,836.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,893.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
LEAD LEFT VENT COROX OTW 85-BP
|
Facility
|
IP
|
$8,238.50
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.00 |
| Max. Negotiated Rate |
$7,908.96 |
| Rate for Payer: Aetna Commercial |
$6,343.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,426.03
|
| Rate for Payer: Cash Price |
$4,119.25
|
| Rate for Payer: Cigna Commercial |
$6,837.96
|
| Rate for Payer: First Health Commercial |
$7,826.58
|
| Rate for Payer: Humana Commercial |
$7,002.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,755.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,080.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,471.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,249.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,178.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,647.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,071.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,553.94
|
| Rate for Payer: PHCS Commercial |
$7,908.96
|
| Rate for Payer: United Healthcare All Payer |
$7,249.88
|
|
|
LEAD LEFT VENT COROX OTW 85-BP
|
Facility
|
OP
|
$8,238.50
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.00 |
| Max. Negotiated Rate |
$7,908.96 |
| Rate for Payer: Aetna Commercial |
$6,343.64
|
| Rate for Payer: Anthem Medicaid |
$2,833.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,426.03
|
| Rate for Payer: Cash Price |
$4,119.25
|
| Rate for Payer: Cigna Commercial |
$6,837.96
|
| Rate for Payer: First Health Commercial |
$7,826.58
|
| Rate for Payer: Humana Commercial |
$7,002.72
|
| Rate for Payer: Humana KY Medicaid |
$2,833.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,862.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,755.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,080.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,471.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,890.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,249.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,178.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,647.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,071.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,553.94
|
| Rate for Payer: PHCS Commercial |
$7,908.96
|
| Rate for Payer: United Healthcare All Payer |
$7,249.88
|
|
|
LEAD LINOX SD 60/16 363 303
|
Facility
|
IP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
LEAD LINOX SD 60/16 363 303
|
Facility
|
OP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem Medicaid |
$5,777.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Humana KY Medicaid |
$5,777.52
|
| Rate for Payer: Kentucky WC Medicaid |
$5,836.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,893.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
LEAD LINOX SD 65/16 350 053
|
Facility
|
OP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem Medicaid |
$5,777.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Humana KY Medicaid |
$5,777.52
|
| Rate for Payer: Kentucky WC Medicaid |
$5,836.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,893.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
LEAD LINOX SD 65/16 350 053
|
Facility
|
IP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
LEAD LINOX SD 65/18 350 054
|
Facility
|
OP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem Medicaid |
$5,777.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Humana KY Medicaid |
$5,777.52
|
| Rate for Payer: Kentucky WC Medicaid |
$5,836.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,893.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
LEAD LINOX SD 65/18 350 054
|
Facility
|
IP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
LEAD LINOX SD 65/18 359 067
|
Facility
|
OP
|
$1,129.50
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.84 |
| Max. Negotiated Rate |
$1,084.32 |
| Rate for Payer: Aetna Commercial |
$869.72
|
| Rate for Payer: Anthem Medicaid |
$388.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.01
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: Cigna Commercial |
$937.48
|
| Rate for Payer: First Health Commercial |
$1,073.02
|
| Rate for Payer: Humana Commercial |
$960.08
|
| Rate for Payer: Humana KY Medicaid |
$388.44
|
| Rate for Payer: Kentucky WC Medicaid |
$392.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$396.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.96
|
| Rate for Payer: Ohio Health Group HMO |
$847.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.14
|
| Rate for Payer: PHCS Commercial |
$1,084.32
|
| Rate for Payer: United Healthcare All Payer |
$993.96
|
|
|
LEAD LINOX SD 65/18 359 067
|
Facility
|
IP
|
$1,129.50
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.84 |
| Max. Negotiated Rate |
$1,084.32 |
| Rate for Payer: First Health Commercial |
$1,073.02
|
| Rate for Payer: Aetna Commercial |
$869.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.01
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: Cigna Commercial |
$937.48
|
| Rate for Payer: Humana Commercial |
$960.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.96
|
| Rate for Payer: Ohio Health Group HMO |
$847.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.14
|
| Rate for Payer: PHCS Commercial |
$1,084.32
|
| Rate for Payer: United Healthcare All Payer |
$993.96
|
|
|
LEAD LINOX SD 75/18 350 056
|
Facility
|
IP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
LEAD LINOX SD 75/18 350 056
|
Facility
|
OP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem Medicaid |
$5,777.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Humana KY Medicaid |
$5,777.52
|
| Rate for Payer: Kentucky WC Medicaid |
$5,836.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,893.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
LEAD L VENT COROX OTW-S 85-BP
|
Facility
|
OP
|
$8,238.50
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,071.00 |
| Max. Negotiated Rate |
$7,908.96 |
| Rate for Payer: Aetna Commercial |
$6,343.64
|
| Rate for Payer: Anthem Medicaid |
$2,833.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,426.03
|
| Rate for Payer: Cash Price |
$4,119.25
|
| Rate for Payer: Cigna Commercial |
$6,837.96
|
| Rate for Payer: First Health Commercial |
$7,826.58
|
| Rate for Payer: Humana Commercial |
$7,002.72
|
| Rate for Payer: Humana KY Medicaid |
$2,833.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,862.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,755.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,080.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,471.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,890.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,249.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,178.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,647.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,071.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,553.94
|
| Rate for Payer: PHCS Commercial |
$7,908.96
|
| Rate for Payer: United Healthcare All Payer |
$7,249.88
|
|
