|
LEAD QUICKFLEX 1258T/86
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
LEAD QUIKFLX PKG/STER 1156T/86
|
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 QUIKFLX PKG/STER 1156T/86
|
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 QUIKFLX PKG/STER 1158T/86
|
Facility
|
IP
|
$9,005.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,170.65 |
| Max. Negotiated Rate |
$8,644.80 |
| Rate for Payer: Aetna Commercial |
$6,933.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,023.90
|
| Rate for Payer: Cash Price |
$4,502.50
|
| Rate for Payer: Cigna Commercial |
$7,474.15
|
| Rate for Payer: First Health Commercial |
$8,554.75
|
| Rate for Payer: Humana Commercial |
$7,654.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,384.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,645.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,924.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,801.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,170.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,791.55
|
| Rate for Payer: PHCS Commercial |
$8,644.80
|
| Rate for Payer: United Healthcare All Payer |
$7,924.40
|
|
|
LEAD QUIKFLX PKG/STER 1158T/86
|
Facility
|
OP
|
$9,005.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,170.65 |
| Max. Negotiated Rate |
$8,644.80 |
| Rate for Payer: Aetna Commercial |
$6,933.85
|
| Rate for Payer: Anthem Medicaid |
$3,096.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,023.90
|
| Rate for Payer: Cash Price |
$4,502.50
|
| Rate for Payer: Cigna Commercial |
$7,474.15
|
| Rate for Payer: First Health Commercial |
$8,554.75
|
| Rate for Payer: Humana Commercial |
$7,654.25
|
| Rate for Payer: Humana KY Medicaid |
$3,096.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3,128.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,384.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,645.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,158.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,924.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,801.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,170.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,791.55
|
| Rate for Payer: PHCS Commercial |
$8,644.80
|
| Rate for Payer: United Healthcare All Payer |
$7,924.40
|
|
|
LEAD RELNC DUAL/ACT 59CM 0295
|
Facility
|
IP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
LEAD RELNC DUAL/ACT 59CM 0295
|
Facility
|
OP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem Medicaid |
$5,468.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Humana KY Medicaid |
$5,468.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,523.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,577.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
LEAD RELNC DUAL/ACT 64CM 0296
|
Facility
|
OP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem Medicaid |
$5,468.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Humana KY Medicaid |
$5,468.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,523.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,577.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
LEAD RELNC DUAL/ACT 64CM 0296
|
Facility
|
IP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
LEAD RELNC DUAL/PAS 59CM 0285
|
Facility
|
IP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
LEAD RELNC DUAL/PAS 59CM 0285
|
Facility
|
OP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem Medicaid |
$5,468.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Humana KY Medicaid |
$5,468.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,523.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,577.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
LEAD RELNC DUAL/PAS 64CM 0286
|
Facility
|
IP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
LEAD RELNC DUAL/PAS 64CM 0286
|
Facility
|
OP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem Medicaid |
$5,468.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Humana KY Medicaid |
$5,468.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,523.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,577.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
LEAD RELNC SING/ACT 59CM 0292
|
Facility
|
OP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem Medicaid |
$5,468.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Humana KY Medicaid |
$5,468.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,523.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,577.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
LEAD RELNC SING/ACT 59CM 0292
|
Facility
|
IP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
LEAD RELNC SING/ACT 64CM 0293
|
Facility
|
IP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
LEAD RELNC SING/ACT 64CM 0293
|
Facility
|
OP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem Medicaid |
$5,468.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Humana KY Medicaid |
$5,468.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,523.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,577.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
LEAD RELNC SING/PAS 59CM 0282
|
Facility
|
OP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem Medicaid |
$5,468.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Humana KY Medicaid |
$5,468.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,523.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,577.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
LEAD RELNC SING/PAS 59CM 0282
|
Facility
|
IP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
LEAD RV SOLIA S 53 377177
|
Facility
|
OP
|
$3,645.50
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$473.92 |
| Max. Negotiated Rate |
$3,499.68 |
| Rate for Payer: Aetna Commercial |
$2,807.04
|
| Rate for Payer: Anthem Medicaid |
$1,253.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,843.49
|
| Rate for Payer: Cash Price |
$1,822.75
|
| Rate for Payer: Cigna Commercial |
$3,025.76
|
| Rate for Payer: First Health Commercial |
$3,463.22
|
| Rate for Payer: Humana Commercial |
$3,098.68
|
| Rate for Payer: Humana KY Medicaid |
$1,253.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,266.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,989.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,690.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,093.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,278.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,208.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,734.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$729.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$473.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,130.10
|
| Rate for Payer: PHCS Commercial |
$3,499.68
|
| Rate for Payer: United Healthcare All Payer |
$3,208.04
|
|
|
LEAD RV SOLIA S 53 377177
|
Facility
|
IP
|
$3,645.50
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$473.92 |
| Max. Negotiated Rate |
$3,499.68 |
| Rate for Payer: Aetna Commercial |
$2,807.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,843.49
|
| Rate for Payer: Cash Price |
$1,822.75
|
| Rate for Payer: Cigna Commercial |
$3,025.76
|
| Rate for Payer: First Health Commercial |
$3,463.22
|
| Rate for Payer: Humana Commercial |
$3,098.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,989.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,690.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,093.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,208.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,734.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$729.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$473.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,130.10
|
| Rate for Payer: PHCS Commercial |
$3,499.68
|
| Rate for Payer: United Healthcare All Payer |
$3,208.04
|
|
|
LEAD SELOX JT 45 346369
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
LEAD SELOX JT 45 346369
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
LEAD SELOX ST 53 346 366
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
LEAD SELOX ST 53 346 366
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
