|
LEAD 60CM PERC OCTROD TRL 3086
|
Facility
|
IP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
LEAD 60CM PERC OCTROD TRL 3086
|
Facility
|
OP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem Medicaid |
$1,655.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Humana KY Medicaid |
$1,655.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,688.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
LEAD 6944-65
|
Facility
|
IP
|
$23,750.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,125.00 |
| Max. Negotiated Rate |
$22,800.00 |
| Rate for Payer: Aetna Commercial |
$18,287.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,525.00
|
| Rate for Payer: Cash Price |
$11,875.00
|
| Rate for Payer: Cigna Commercial |
$19,712.50
|
| Rate for Payer: First Health Commercial |
$22,562.50
|
| Rate for Payer: Humana Commercial |
$20,187.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,475.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,527.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,125.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,900.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,812.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,662.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,387.50
|
| Rate for Payer: PHCS Commercial |
$22,800.00
|
| Rate for Payer: United Healthcare All Payer |
$20,900.00
|
|
|
LEAD 6944-65
|
Facility
|
OP
|
$23,750.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,125.00 |
| Max. Negotiated Rate |
$22,800.00 |
| Rate for Payer: Aetna Commercial |
$18,287.50
|
| Rate for Payer: Anthem Medicaid |
$8,167.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,525.00
|
| Rate for Payer: Cash Price |
$11,875.00
|
| Rate for Payer: Cigna Commercial |
$19,712.50
|
| Rate for Payer: First Health Commercial |
$22,562.50
|
| Rate for Payer: Humana Commercial |
$20,187.50
|
| Rate for Payer: Humana KY Medicaid |
$8,167.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8,250.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,475.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,527.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,125.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,331.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,900.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,812.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,662.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,387.50
|
| Rate for Payer: PHCS Commercial |
$22,800.00
|
| Rate for Payer: United Healthcare All Payer |
$20,900.00
|
|
|
LEAD 7.5IN DEL SYS EPIDCR 1773
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
LEAD 7.5IN DEL SYS EPIDCR 1773
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem Medicaid |
$1,203.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Humana KY Medicaid |
$1,203.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,215.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,227.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
LEAD ACTIVE 6935M55
|
Facility
|
OP
|
$11,010.03
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,303.01 |
| Max. Negotiated Rate |
$10,569.63 |
| Rate for Payer: Aetna Commercial |
$8,477.72
|
| Rate for Payer: Anthem Medicaid |
$3,786.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,587.82
|
| Rate for Payer: Cash Price |
$5,505.02
|
| Rate for Payer: Cigna Commercial |
$9,138.32
|
| Rate for Payer: First Health Commercial |
$10,459.53
|
| Rate for Payer: Humana Commercial |
$9,358.53
|
| Rate for Payer: Humana KY Medicaid |
$3,786.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3,824.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,028.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,125.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,862.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,688.83
|
| Rate for Payer: Ohio Health Group HMO |
$8,257.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,808.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,578.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,596.92
|
| Rate for Payer: PHCS Commercial |
$10,569.63
|
| Rate for Payer: United Healthcare All Payer |
$9,688.83
|
|
|
LEAD ACTIVE 6935M55
|
Facility
|
IP
|
$11,010.03
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,303.01 |
| Max. Negotiated Rate |
$10,569.63 |
| Rate for Payer: Aetna Commercial |
$8,477.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,587.82
|
| Rate for Payer: Cash Price |
$5,505.02
|
| Rate for Payer: Cigna Commercial |
$9,138.32
|
| Rate for Payer: First Health Commercial |
$10,459.53
|
| Rate for Payer: Humana Commercial |
$9,358.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,028.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,125.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,688.83
|
| Rate for Payer: Ohio Health Group HMO |
$8,257.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,808.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,578.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,596.92
|
| Rate for Payer: PHCS Commercial |
$10,569.63
|
| Rate for Payer: United Healthcare All Payer |
$9,688.83
|
|
|
LEAD ACTIVE 6935M62
|
Facility
|
OP
|
$11,010.03
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,303.01 |
| Max. Negotiated Rate |
$10,569.63 |
| Rate for Payer: Aetna Commercial |
$8,477.72
|
| Rate for Payer: Anthem Medicaid |
$3,786.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,587.82
|
| Rate for Payer: Cash Price |
$5,505.02
|
| Rate for Payer: Cigna Commercial |
$9,138.32
|
| Rate for Payer: First Health Commercial |
$10,459.53
|
| Rate for Payer: Humana Commercial |
$9,358.53
|
| Rate for Payer: Humana KY Medicaid |
$3,786.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3,824.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,028.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,125.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,862.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,688.83
|
| Rate for Payer: Ohio Health Group HMO |
$8,257.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,808.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,578.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,596.92
|
| Rate for Payer: PHCS Commercial |
$10,569.63
|
| Rate for Payer: United Healthcare All Payer |
$9,688.83
|
|
|
LEAD ACTIVE 6935M62
|
Facility
|
IP
|
$11,010.03
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,303.01 |
| Max. Negotiated Rate |
$10,569.63 |
| Rate for Payer: Aetna Commercial |
$8,477.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,587.82
|
| Rate for Payer: Cash Price |
$5,505.02
|
| Rate for Payer: Cigna Commercial |
$9,138.32
|
| Rate for Payer: First Health Commercial |
$10,459.53
|
| Rate for Payer: Humana Commercial |
$9,358.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,028.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,125.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,303.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,688.83
|
| Rate for Payer: Ohio Health Group HMO |
$8,257.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,808.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,578.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,596.92
|
| Rate for Payer: PHCS Commercial |
$10,569.63
|
| Rate for Payer: United Healthcare All Payer |
$9,688.83
|
|
|
LEAD ACTIVE DC US 6947M62
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
LEAD ACTIVE DC US 6947M62
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
LEAD ACUITY SPIRAL 4591/92/93
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
LEAD ACUITY SPIRAL 4591/92/93
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
LEAD ADAPTER KIT OSCOR M/IS-10
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
LEAD ADAPTER KIT OSCOR M/IS-10
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem Medicaid |
$1,332.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Humana KY Medicaid |
$1,332.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
LEAD ADAPTOR BLV/BIS-4403
|
Facility
|
OP
|
$1,572.40
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.72 |
| Max. Negotiated Rate |
$1,509.50 |
| Rate for Payer: Aetna Commercial |
$1,210.75
|
| Rate for Payer: Anthem Medicaid |
$540.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,226.47
|
| Rate for Payer: Cash Price |
$786.20
|
| Rate for Payer: Cigna Commercial |
$1,305.09
|
| Rate for Payer: First Health Commercial |
$1,493.78
|
| Rate for Payer: Humana Commercial |
$1,336.54
|
| Rate for Payer: Humana KY Medicaid |
$540.75
|
| Rate for Payer: Kentucky WC Medicaid |
$546.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,289.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,160.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$551.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,383.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,179.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,257.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,367.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,084.96
|
| Rate for Payer: PHCS Commercial |
$1,509.50
|
| Rate for Payer: United Healthcare All Payer |
$1,383.71
|
|
|
LEAD ADAPTOR BLV/BIS-4403
|
Facility
|
IP
|
$1,572.40
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.72 |
| Max. Negotiated Rate |
$1,509.50 |
| Rate for Payer: Aetna Commercial |
$1,210.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,226.47
|
| Rate for Payer: Cash Price |
$786.20
|
| Rate for Payer: Cigna Commercial |
$1,305.09
|
| Rate for Payer: First Health Commercial |
$1,493.78
|
| Rate for Payer: Humana Commercial |
$1,336.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,289.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,160.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,383.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,179.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,257.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,367.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,084.96
|
| Rate for Payer: PHCS Commercial |
$1,509.50
|
| Rate for Payer: United Healthcare All Payer |
$1,383.71
|
|
|
LEAD ATRIAL 1944/46CM
|
Facility
|
OP
|
$3,612.50
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,083.75 |
| Max. Negotiated Rate |
$3,468.00 |
| Rate for Payer: Aetna Commercial |
$2,781.62
|
| Rate for Payer: Anthem Medicaid |
$1,242.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,817.75
|
| Rate for Payer: Cash Price |
$1,806.25
|
| Rate for Payer: Cigna Commercial |
$2,998.38
|
| Rate for Payer: First Health Commercial |
$3,431.88
|
| Rate for Payer: Humana Commercial |
$3,070.62
|
| Rate for Payer: Humana KY Medicaid |
$1,242.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,254.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,962.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,666.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,083.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,267.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,179.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,709.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,890.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,142.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,492.62
|
| Rate for Payer: PHCS Commercial |
$3,468.00
|
| Rate for Payer: United Healthcare All Payer |
$3,179.00
|
|
|
LEAD ATRIAL 1944/46CM
|
Facility
|
IP
|
$3,612.50
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,083.75 |
| Max. Negotiated Rate |
$3,468.00 |
| Rate for Payer: Aetna Commercial |
$2,781.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,817.75
|
| Rate for Payer: Cash Price |
$1,806.25
|
| Rate for Payer: Cigna Commercial |
$2,998.38
|
| Rate for Payer: First Health Commercial |
$3,431.88
|
| Rate for Payer: Humana Commercial |
$3,070.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,962.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,666.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,083.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,179.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,709.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,890.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,142.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,492.62
|
| Rate for Payer: PHCS Commercial |
$3,468.00
|
| Rate for Payer: United Healthcare All Payer |
$3,179.00
|
|
|
LEAD ATRIAL 4592-45
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,027.50 |
| 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 |
$2,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,363.25
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
LEAD ATRIAL 4592-45
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,027.50 |
| 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 |
$1,189.85
|
| 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 |
$2,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,363.25
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
LEAD ATRIAL AROX 338 025
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
LEAD ATRIAL AROX 338 025
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem Medicaid |
$1,332.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Humana KY Medicaid |
$1,332.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
LEAD ATRIAL SELOX 343 081
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
