|
LEAD QUICKFLEX 1258T/75
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
LEAD QUICKFLEX 1258T/75
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
LEAD QUICKFLEX 1258T/86
|
Facility
|
IP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
LEAD QUICKFLEX 1258T/86
|
Facility
|
OP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem Medicaid |
$2,789.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Humana KY Medicaid |
$2,789.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,817.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,844.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
LEAD QUIKFLX PKG/STER 1156T/86
|
Facility
|
IP
|
$9,205.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.50 |
| Max. Negotiated Rate |
$8,836.80 |
| Rate for Payer: Aetna Commercial |
$7,087.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,179.90
|
| Rate for Payer: Cash Price |
$4,602.50
|
| Rate for Payer: Cigna Commercial |
$7,640.15
|
| Rate for Payer: First Health Commercial |
$8,744.75
|
| Rate for Payer: Humana Commercial |
$7,824.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,548.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,793.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,761.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,100.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,008.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,351.45
|
| Rate for Payer: PHCS Commercial |
$8,836.80
|
| Rate for Payer: United Healthcare All Payer |
$8,100.40
|
|
|
LEAD QUIKFLX PKG/STER 1156T/86
|
Facility
|
OP
|
$9,205.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.50 |
| Max. Negotiated Rate |
$8,836.80 |
| Rate for Payer: Aetna Commercial |
$7,087.85
|
| Rate for Payer: Anthem Medicaid |
$3,165.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,179.90
|
| Rate for Payer: Cash Price |
$4,602.50
|
| Rate for Payer: Cigna Commercial |
$7,640.15
|
| Rate for Payer: First Health Commercial |
$8,744.75
|
| Rate for Payer: Humana Commercial |
$7,824.25
|
| Rate for Payer: Humana KY Medicaid |
$3,165.60
|
| Rate for Payer: Kentucky WC Medicaid |
$3,197.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,548.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,793.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,761.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,229.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,100.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,008.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,351.45
|
| Rate for Payer: PHCS Commercial |
$8,836.80
|
| Rate for Payer: United Healthcare All Payer |
$8,100.40
|
|
|
LEAD QUIKFLX PKG/STER 1158T/86
|
Facility
|
OP
|
$9,205.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,761.50 |
| Max. Negotiated Rate |
$8,836.80 |
| Rate for Payer: Aetna Commercial |
$7,087.85
|
| Rate for Payer: Anthem Medicaid |
$3,165.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,179.90
|
| Rate for Payer: Cash Price |
$4,602.50
|
| Rate for Payer: Cigna Commercial |
$7,640.15
|
| Rate for Payer: First Health Commercial |
$8,744.75
|
| Rate for Payer: Humana Commercial |
$7,824.25
|
| Rate for Payer: Humana KY Medicaid |
$3,165.60
|
| Rate for Payer: Kentucky WC Medicaid |
$3,197.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,548.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,793.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,761.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,229.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,100.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,008.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,351.45
|
| Rate for Payer: PHCS Commercial |
$8,836.80
|
| Rate for Payer: United Healthcare All Payer |
$8,100.40
|
|
|
LEAD QUIKFLX PKG/STER 1158T/86
|
Facility
|
IP
|
$9,205.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,761.50 |
| Max. Negotiated Rate |
$8,836.80 |
| Rate for Payer: Aetna Commercial |
$7,087.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,179.90
|
| Rate for Payer: Cash Price |
$4,602.50
|
| Rate for Payer: Cigna Commercial |
$7,640.15
|
| Rate for Payer: First Health Commercial |
$8,744.75
|
| Rate for Payer: Humana Commercial |
$7,824.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,548.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,793.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,761.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,100.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,008.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,351.45
|
| Rate for Payer: PHCS Commercial |
$8,836.80
|
| Rate for Payer: United Healthcare All Payer |
$8,100.40
|
|
|
LEAD RELNC DUAL/ACT 59CM 0295
|
Facility
|
OP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem Medicaid |
$5,648.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Humana KY Medicaid |
$5,648.56
|
| Rate for Payer: Kentucky WC Medicaid |
$5,706.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,761.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
LEAD RELNC DUAL/ACT 59CM 0295
|
Facility
|
IP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
LEAD RELNC DUAL/ACT 64CM 0296
|
Facility
|
IP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
LEAD RELNC DUAL/ACT 64CM 0296
|
Facility
|
OP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem Medicaid |
$5,648.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Humana KY Medicaid |
$5,648.56
|
| Rate for Payer: Kentucky WC Medicaid |
$5,706.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,761.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
LEAD RELNC DUAL/PAS 59CM 0285
|
Facility
|
IP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
LEAD RELNC DUAL/PAS 59CM 0285
|
Facility
|
OP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem Medicaid |
$5,648.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Humana KY Medicaid |
$5,648.56
|
| Rate for Payer: Kentucky WC Medicaid |
$5,706.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,761.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
LEAD RELNC DUAL/PAS 64CM 0286
|
Facility
|
IP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
LEAD RELNC DUAL/PAS 64CM 0286
|
Facility
|
OP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem Medicaid |
$5,648.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Humana KY Medicaid |
$5,648.56
|
| Rate for Payer: Kentucky WC Medicaid |
$5,706.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,761.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
LEAD RELNC SING/ACT 59CM 0292
|
Facility
|
IP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
LEAD RELNC SING/ACT 59CM 0292
|
Facility
|
OP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem Medicaid |
$5,648.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Humana KY Medicaid |
$5,648.56
|
| Rate for Payer: Kentucky WC Medicaid |
$5,706.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,761.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
LEAD RELNC SING/ACT 64CM 0293
|
Facility
|
OP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem Medicaid |
$5,648.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Humana KY Medicaid |
$5,648.56
|
| Rate for Payer: Kentucky WC Medicaid |
$5,706.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,761.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
LEAD RELNC SING/ACT 64CM 0293
|
Facility
|
IP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
LEAD RELNC SING/PAS 59CM 0282
|
Facility
|
OP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem Medicaid |
$5,648.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Humana KY Medicaid |
$5,648.56
|
| Rate for Payer: Kentucky WC Medicaid |
$5,706.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,761.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
LEAD RELNC SING/PAS 59CM 0282
|
Facility
|
IP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
LEAD RV SOLIA S 53 377177
|
Facility
|
OP
|
$3,548.75
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,064.62 |
| Max. Negotiated Rate |
$3,406.80 |
| Rate for Payer: Aetna Commercial |
$2,732.54
|
| Rate for Payer: Anthem Medicaid |
$1,220.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,768.03
|
| Rate for Payer: Cash Price |
$1,774.38
|
| Rate for Payer: Cigna Commercial |
$2,945.46
|
| Rate for Payer: First Health Commercial |
$3,371.31
|
| Rate for Payer: Humana Commercial |
$3,016.44
|
| Rate for Payer: Humana KY Medicaid |
$1,220.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,232.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,909.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,618.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,064.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,244.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,122.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,661.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,087.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,448.64
|
| Rate for Payer: PHCS Commercial |
$3,406.80
|
| Rate for Payer: United Healthcare All Payer |
$3,122.90
|
|
|
LEAD RV SOLIA S 53 377177
|
Facility
|
IP
|
$3,548.75
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,064.62 |
| Max. Negotiated Rate |
$3,406.80 |
| Rate for Payer: Aetna Commercial |
$2,732.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,768.03
|
| Rate for Payer: Cash Price |
$1,774.38
|
| Rate for Payer: Cigna Commercial |
$2,945.46
|
| Rate for Payer: First Health Commercial |
$3,371.31
|
| Rate for Payer: Humana Commercial |
$3,016.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,909.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,618.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,064.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,122.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,661.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,087.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,448.64
|
| Rate for Payer: PHCS Commercial |
$3,406.80
|
| Rate for Payer: United Healthcare All Payer |
$3,122.90
|
|
|
LEAD SELOX JT 45 346369
|
Facility
|
IP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$2,550.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,656.25
|
| Rate for Payer: Cigna Commercial |
$2,749.38
|
| Rate for Payer: First Health Commercial |
$3,146.88
|
| Rate for Payer: Humana Commercial |
$2,815.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.62
|
| Rate for Payer: PHCS Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare All Payer |
$2,915.00
|
|
