|
LEAD SETROX S 45 350 973
|
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
|
|
|
LEAD SETROX S 45 350 973
|
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 SETROX S 53 350974
|
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
|
|
|
LEAD SETROX S 53 350974
|
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 SETROX S 60 350 975
|
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 SETROX S 60 350 975
|
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 SPRINT FIDELIS 6949
|
Facility
|
OP
|
$26,700.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,471.00 |
| Max. Negotiated Rate |
$25,632.00 |
| Rate for Payer: Aetna Commercial |
$20,559.00
|
| Rate for Payer: Anthem Medicaid |
$9,182.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,826.00
|
| Rate for Payer: Cash Price |
$13,350.00
|
| Rate for Payer: Cigna Commercial |
$22,161.00
|
| Rate for Payer: First Health Commercial |
$25,365.00
|
| Rate for Payer: Humana Commercial |
$22,695.00
|
| Rate for Payer: Humana KY Medicaid |
$9,182.13
|
| Rate for Payer: Kentucky WC Medicaid |
$9,275.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,894.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,704.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,010.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,366.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,471.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,277.00
|
| Rate for Payer: PHCS Commercial |
$25,632.00
|
| Rate for Payer: United Healthcare All Payer |
$23,496.00
|
|
|
LEAD SPRINT FIDELIS 6949
|
Facility
|
IP
|
$26,700.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,471.00 |
| Max. Negotiated Rate |
$25,632.00 |
| Rate for Payer: Aetna Commercial |
$20,559.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,826.00
|
| Rate for Payer: Cash Price |
$13,350.00
|
| Rate for Payer: Cigna Commercial |
$22,161.00
|
| Rate for Payer: First Health Commercial |
$25,365.00
|
| Rate for Payer: Humana Commercial |
$22,695.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,894.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,704.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,010.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,471.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,277.00
|
| Rate for Payer: PHCS Commercial |
$25,632.00
|
| Rate for Payer: United Healthcare All Payer |
$23,496.00
|
|
|
LEAD SPRINT QUATTRO 6947
|
Facility
|
IP
|
$17,160.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,230.80 |
| Max. Negotiated Rate |
$16,473.60 |
| Rate for Payer: Aetna Commercial |
$13,213.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,384.80
|
| Rate for Payer: Cash Price |
$8,580.00
|
| Rate for Payer: Cigna Commercial |
$14,242.80
|
| Rate for Payer: First Health Commercial |
$16,302.00
|
| Rate for Payer: Humana Commercial |
$14,586.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,100.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,230.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,319.60
|
| Rate for Payer: PHCS Commercial |
$16,473.60
|
| Rate for Payer: United Healthcare All Payer |
$15,100.80
|
|
|
LEAD SPRINT QUATTRO 6947
|
Facility
|
OP
|
$17,160.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,230.80 |
| Max. Negotiated Rate |
$16,473.60 |
| Rate for Payer: Aetna Commercial |
$13,213.20
|
| Rate for Payer: Anthem Medicaid |
$5,901.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,384.80
|
| Rate for Payer: Cash Price |
$8,580.00
|
| Rate for Payer: Cigna Commercial |
$14,242.80
|
| Rate for Payer: First Health Commercial |
$16,302.00
|
| Rate for Payer: Humana Commercial |
$14,586.00
|
| Rate for Payer: Humana KY Medicaid |
$5,901.32
|
| Rate for Payer: Kentucky WC Medicaid |
$5,961.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,019.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,100.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,230.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,319.60
|
| Rate for Payer: PHCS Commercial |
$16,473.60
|
| Rate for Payer: United Healthcare All Payer |
$15,100.80
|
|
|
LEAD SPRINT QUATTRO 6947-65
|
Facility
|
IP
|
$15,468.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,010.84 |
| Max. Negotiated Rate |
$14,849.28 |
| Rate for Payer: Aetna Commercial |
$11,910.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,065.04
|
| Rate for Payer: Cash Price |
$7,734.00
|
| Rate for Payer: Cigna Commercial |
$12,838.44
|
| Rate for Payer: First Health Commercial |
$14,694.60
|
| Rate for Payer: Humana Commercial |
$13,147.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,683.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,415.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,640.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,611.84
|
| Rate for Payer: Ohio Health Group HMO |
$11,601.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,093.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,010.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,795.08
|
| Rate for Payer: PHCS Commercial |
$14,849.28
|
| Rate for Payer: United Healthcare All Payer |
$13,611.84
|
|
|
LEAD SPRINT QUATTRO 6947-65
|
Facility
|
OP
|
$15,468.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,010.84 |
| Max. Negotiated Rate |
$14,849.28 |
| Rate for Payer: Aetna Commercial |
$11,910.36
|
| Rate for Payer: Anthem Medicaid |
$5,319.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,065.04
|
| Rate for Payer: Cash Price |
$7,734.00
|
| Rate for Payer: Cigna Commercial |
$12,838.44
|
| Rate for Payer: First Health Commercial |
$14,694.60
|
| Rate for Payer: Humana Commercial |
$13,147.80
|
| Rate for Payer: Humana KY Medicaid |
$5,319.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,373.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,683.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,415.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,640.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,426.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,611.84
|
| Rate for Payer: Ohio Health Group HMO |
$11,601.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,093.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,010.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,795.08
|
| Rate for Payer: PHCS Commercial |
$14,849.28
|
| Rate for Payer: United Healthcare All Payer |
$13,611.84
|
|
|
LEAD SPRINT QUATTRO 6947M-55
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
LEAD SPRINT QUATTRO 6947M-55
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
LEAD STREAMLINE BIPOLAR 6495
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
LEAD STREAMLINE BIPOLAR 6495
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem Medicaid |
$366.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Humana KY Medicaid |
$366.25
|
| Rate for Payer: Kentucky WC Medicaid |
$369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$373.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
LEAD STREAMLINE UNIPOLAR 6494
|
Facility
|
IP
|
$554.58
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$532.40 |
| Rate for Payer: Aetna Commercial |
$427.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.57
|
| Rate for Payer: Cash Price |
$277.29
|
| Rate for Payer: Cigna Commercial |
$460.30
|
| Rate for Payer: First Health Commercial |
$526.85
|
| Rate for Payer: Humana Commercial |
$471.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$454.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$409.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$488.03
|
| Rate for Payer: Ohio Health Group HMO |
$415.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.92
|
| Rate for Payer: PHCS Commercial |
$532.40
|
| Rate for Payer: United Healthcare All Payer |
$488.03
|
|
|
LEAD STREAMLINE UNIPOLAR 6494
|
Facility
|
OP
|
$554.58
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$532.40 |
| Rate for Payer: Aetna Commercial |
$427.03
|
| Rate for Payer: Anthem Medicaid |
$190.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.57
|
| Rate for Payer: Cash Price |
$277.29
|
| Rate for Payer: Cigna Commercial |
$460.30
|
| Rate for Payer: First Health Commercial |
$526.85
|
| Rate for Payer: Humana Commercial |
$471.39
|
| Rate for Payer: Humana KY Medicaid |
$190.72
|
| Rate for Payer: Kentucky WC Medicaid |
$192.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$454.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$409.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$194.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$488.03
|
| Rate for Payer: Ohio Health Group HMO |
$415.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.92
|
| Rate for Payer: PHCS Commercial |
$532.40
|
| Rate for Payer: United Healthcare All Payer |
$488.03
|
|
|
LEAD SUBCOMPACT 1*8 MRI 60CM
|
Facility
|
IP
|
$9,899.25
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.90 |
| Max. Negotiated Rate |
$9,503.28 |
| Rate for Payer: Aetna Commercial |
$7,622.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,721.42
|
| Rate for Payer: Cash Price |
$4,949.62
|
| Rate for Payer: Cigna Commercial |
$8,216.38
|
| Rate for Payer: First Health Commercial |
$9,404.29
|
| Rate for Payer: Humana Commercial |
$8,414.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,117.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,305.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,969.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,711.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,424.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,068.77
|
| Rate for Payer: PHCS Commercial |
$9,503.28
|
| Rate for Payer: United Healthcare All Payer |
$8,711.34
|
|
|
LEAD SUBCOMPACT 1*8 MRI 60CM
|
Facility
|
OP
|
$9,899.25
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.90 |
| Max. Negotiated Rate |
$9,503.28 |
| Rate for Payer: Aetna Commercial |
$7,622.42
|
| Rate for Payer: Anthem Medicaid |
$3,404.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,721.42
|
| Rate for Payer: Cash Price |
$4,949.62
|
| Rate for Payer: Cigna Commercial |
$8,216.38
|
| Rate for Payer: First Health Commercial |
$9,404.29
|
| Rate for Payer: Humana Commercial |
$8,414.36
|
| Rate for Payer: Humana KY Medicaid |
$3,404.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3,439.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,117.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,305.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,969.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,472.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,711.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,424.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,068.77
|
| Rate for Payer: PHCS Commercial |
$9,503.28
|
| Rate for Payer: United Healthcare All Payer |
$8,711.34
|
|
|
LEAD SUBCOMPACT 1*8 MRI 75CM
|
Facility
|
OP
|
$9,899.25
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.90 |
| Max. Negotiated Rate |
$9,503.28 |
| Rate for Payer: Aetna Commercial |
$7,622.42
|
| Rate for Payer: Anthem Medicaid |
$3,404.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,721.42
|
| Rate for Payer: Cash Price |
$4,949.62
|
| Rate for Payer: Cigna Commercial |
$8,216.38
|
| Rate for Payer: First Health Commercial |
$9,404.29
|
| Rate for Payer: Humana Commercial |
$8,414.36
|
| Rate for Payer: Humana KY Medicaid |
$3,404.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3,439.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,117.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,305.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,969.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,472.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,711.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,424.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,068.77
|
| Rate for Payer: PHCS Commercial |
$9,503.28
|
| Rate for Payer: United Healthcare All Payer |
$8,711.34
|
|
|
LEAD SUBCOMPACT 1*8 MRI 75CM
|
Facility
|
IP
|
$9,899.25
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.90 |
| Max. Negotiated Rate |
$9,503.28 |
| Rate for Payer: Aetna Commercial |
$7,622.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,721.42
|
| Rate for Payer: Cash Price |
$4,949.62
|
| Rate for Payer: Cigna Commercial |
$8,216.38
|
| Rate for Payer: First Health Commercial |
$9,404.29
|
| Rate for Payer: Humana Commercial |
$8,414.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,117.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,305.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,969.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,711.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,424.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,068.77
|
| Rate for Payer: PHCS Commercial |
$9,503.28
|
| Rate for Payer: United Healthcare All Payer |
$8,711.34
|
|
|
LEAD SUBCOMPACT 1*8 MRI 90CM
|
Facility
|
OP
|
$9,899.25
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.90 |
| Max. Negotiated Rate |
$9,503.28 |
| Rate for Payer: Aetna Commercial |
$7,622.42
|
| Rate for Payer: Anthem Medicaid |
$3,404.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,721.42
|
| Rate for Payer: Cash Price |
$4,949.62
|
| Rate for Payer: Cigna Commercial |
$8,216.38
|
| Rate for Payer: First Health Commercial |
$9,404.29
|
| Rate for Payer: Humana Commercial |
$8,414.36
|
| Rate for Payer: Humana KY Medicaid |
$3,404.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3,439.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,117.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,305.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,969.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,472.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,711.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,424.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,068.77
|
| Rate for Payer: PHCS Commercial |
$9,503.28
|
| Rate for Payer: United Healthcare All Payer |
$8,711.34
|
|
|
LEAD SUBCOMPACT 1*8 MRI 90CM
|
Facility
|
IP
|
$9,899.25
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.90 |
| Max. Negotiated Rate |
$9,503.28 |
| Rate for Payer: Aetna Commercial |
$7,622.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,721.42
|
| Rate for Payer: Cash Price |
$4,949.62
|
| Rate for Payer: Cigna Commercial |
$8,216.38
|
| Rate for Payer: First Health Commercial |
$9,404.29
|
| Rate for Payer: Humana Commercial |
$8,414.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,117.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,305.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,969.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,711.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,424.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,068.77
|
| Rate for Payer: PHCS Commercial |
$9,503.28
|
| Rate for Payer: United Healthcare All Payer |
$8,711.34
|
|
|
LEAD SWEET TIP RX 4243
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
