|
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
|
|
|
LEAD MARKET EN 5086MRI52
|
Facility
|
OP
|
$4,387.50
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$570.38 |
| Max. Negotiated Rate |
$4,212.00 |
| Rate for Payer: Aetna Commercial |
$3,378.38
|
| Rate for Payer: Anthem Medicaid |
$1,508.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,422.25
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna Commercial |
$3,641.62
|
| Rate for Payer: First Health Commercial |
$4,168.12
|
| Rate for Payer: Humana Commercial |
$3,729.38
|
| Rate for Payer: Humana KY Medicaid |
$1,508.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,524.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,597.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,237.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,316.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,539.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,861.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,290.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$570.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,360.12
|
| Rate for Payer: PHCS Commercial |
$4,212.00
|
| Rate for Payer: United Healthcare All Payer |
$3,861.00
|
|
|
LEAD MARKET EN 5086MRI52
|
Facility
|
IP
|
$4,387.50
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$570.38 |
| Max. Negotiated Rate |
$4,212.00 |
| Rate for Payer: Aetna Commercial |
$3,378.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,422.25
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna Commercial |
$3,641.62
|
| Rate for Payer: First Health Commercial |
$4,168.12
|
| Rate for Payer: Humana Commercial |
$3,729.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,597.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,237.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,316.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,861.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,290.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$570.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,360.12
|
| Rate for Payer: PHCS Commercial |
$4,212.00
|
| Rate for Payer: United Healthcare All Payer |
$3,861.00
|
|
|
LEAD MARKET EN 5086MRI58
|
Facility
|
IP
|
$4,387.50
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$570.38 |
| Max. Negotiated Rate |
$4,212.00 |
| Rate for Payer: Aetna Commercial |
$3,378.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,422.25
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna Commercial |
$3,641.62
|
| Rate for Payer: First Health Commercial |
$4,168.12
|
| Rate for Payer: Humana Commercial |
$3,729.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,597.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,237.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,316.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,861.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,290.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$570.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,360.12
|
| Rate for Payer: PHCS Commercial |
$4,212.00
|
| Rate for Payer: United Healthcare All Payer |
$3,861.00
|
|
|
LEAD MARKET EN 5086MRI58
|
Facility
|
OP
|
$4,387.50
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$570.38 |
| Max. Negotiated Rate |
$4,212.00 |
| Rate for Payer: Aetna Commercial |
$3,378.38
|
| Rate for Payer: Anthem Medicaid |
$1,508.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,422.25
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna Commercial |
$3,641.62
|
| Rate for Payer: First Health Commercial |
$4,168.12
|
| Rate for Payer: Humana Commercial |
$3,729.38
|
| Rate for Payer: Humana KY Medicaid |
$1,508.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,524.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,597.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,237.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,316.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,539.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,861.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,290.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$570.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,360.12
|
| Rate for Payer: PHCS Commercial |
$4,212.00
|
| Rate for Payer: United Healthcare All Payer |
$3,861.00
|
|
|
LEAD MRI CONDTENDRIL LPA1200M/
|
Facility
|
IP
|
$3,327.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$432.51 |
| Max. Negotiated Rate |
$3,193.92 |
| Rate for Payer: Aetna Commercial |
$2,561.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,595.06
|
| Rate for Payer: Cash Price |
$1,663.50
|
| Rate for Payer: Cigna Commercial |
$2,761.41
|
| Rate for Payer: First Health Commercial |
$3,160.65
|
| Rate for Payer: Humana Commercial |
$2,827.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,728.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,455.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,927.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,495.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$665.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$432.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.37
|
| Rate for Payer: PHCS Commercial |
$3,193.92
|
| Rate for Payer: United Healthcare All Payer |
$2,927.76
|
|
|
LEAD MRI CONDTENDRIL LPA1200M/
|
Facility
|
OP
|
$3,327.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$432.51 |
| Max. Negotiated Rate |
$3,193.92 |
| Rate for Payer: Aetna Commercial |
$2,561.79
|
| Rate for Payer: Anthem Medicaid |
$1,144.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,595.06
|
| Rate for Payer: Cash Price |
$1,663.50
|
| Rate for Payer: Cigna Commercial |
$2,761.41
|
| Rate for Payer: First Health Commercial |
$3,160.65
|
| Rate for Payer: Humana Commercial |
$2,827.95
|
| Rate for Payer: Humana KY Medicaid |
$1,144.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,155.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,728.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,455.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,167.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,927.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,495.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$665.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$432.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.37
|
| Rate for Payer: PHCS Commercial |
$3,193.92
|
| Rate for Payer: United Healthcare All Payer |
$2,927.76
|
|
|
LEAD MRI CONDTNDRL LPA1200M/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 MRI CONDTNDRL LPA1200M/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 OPTISENSE 1999/46
|
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 OPTISENSE 1999/46
|
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 OPTISENSE 1999/52
|
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 OPTISENSE 1999/52
|
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 POC
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
30001937
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
LEAD POC
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
30001937
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem Medicaid |
$12.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.11
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Humana KY Medicaid |
$12.11
|
| Rate for Payer: Humana Medicare Advantage |
$12.11
|
| Rate for Payer: Kentucky WC Medicaid |
$12.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
LEAD POC
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
30001937
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna Commercial |
$11.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$92.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$10.79
|
| Rate for Payer: Healthspan PPO |
$12.68
|
| Rate for Payer: Multiplan PHCS |
$55.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$64.40
|
| Rate for Payer: UHCCP Medicaid |
$32.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.27
|
|
|
LEAD QUARTET 1458Q/86
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
LEAD QUARTET 1458Q/86
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
LEAD QUATTRO DEFIB SNG 693565
|
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 QUATTRO DEFIB SNG 693565
|
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 QUICK FLEX 1156T/ 75CM
|
Facility
|
OP
|
$9,005.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,170.65 |
| Max. Negotiated Rate |
$8,644.80 |
| Rate for Payer: Aetna Commercial |
$6,933.85
|
| Rate for Payer: Anthem Medicaid |
$3,096.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,023.90
|
| Rate for Payer: Cash Price |
$4,502.50
|
| Rate for Payer: Cigna Commercial |
$7,474.15
|
| Rate for Payer: First Health Commercial |
$8,554.75
|
| Rate for Payer: Humana Commercial |
$7,654.25
|
| Rate for Payer: Humana KY Medicaid |
$3,096.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3,128.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,384.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,645.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,158.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,924.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,801.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,170.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,791.55
|
| Rate for Payer: PHCS Commercial |
$8,644.80
|
| Rate for Payer: United Healthcare All Payer |
$7,924.40
|
|
|
LEAD QUICK FLEX 1156T/ 75CM
|
Facility
|
IP
|
$9,005.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,170.65 |
| Max. Negotiated Rate |
$8,644.80 |
| Rate for Payer: Aetna Commercial |
$6,933.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,023.90
|
| Rate for Payer: Cash Price |
$4,502.50
|
| Rate for Payer: Cigna Commercial |
$7,474.15
|
| Rate for Payer: First Health Commercial |
$8,554.75
|
| Rate for Payer: Humana Commercial |
$7,654.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,384.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,645.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,924.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,801.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,170.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,791.55
|
| Rate for Payer: PHCS Commercial |
$8,644.80
|
| Rate for Payer: United Healthcare All Payer |
$7,924.40
|
|
|
LEAD QUICKFLEX 1258T/75
|
Facility
|
OP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem Medicaid |
$3,645.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Humana KY Medicaid |
$3,645.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,682.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,718.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
LEAD QUICKFLEX 1258T/75
|
Facility
|
IP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
LEAD QUICKFLEX 1258T/86
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
