|
LEAD SELOX JT 45 346369
|
Facility
|
OP
|
$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 Medicaid |
$1,139.17
|
| 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: Humana KY Medicaid |
$1,139.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,150.76
|
| 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: Molina Healthcare Medicaid |
$1,162.03
|
| 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
|
|
|
LEAD SELOX ST 53 346 366
|
Facility
|
OP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
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 Medicaid |
$1,139.17
|
| 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: Humana KY Medicaid |
$1,139.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,150.76
|
| 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: Molina Healthcare Medicaid |
$1,162.03
|
| 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
|
|
|
LEAD SELOX ST 53 346 366
|
Facility
|
IP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
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
|
|
|
LEAD SETROX S 45 350 973
|
Facility
|
IP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
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
|
|
|
LEAD SETROX S 45 350 973
|
Facility
|
OP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
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 Medicaid |
$1,139.17
|
| 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: Humana KY Medicaid |
$1,139.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,150.76
|
| 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: Molina Healthcare Medicaid |
$1,162.03
|
| 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
|
|
|
LEAD SETROX S 53 350974
|
Facility
|
IP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
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
|
|
|
LEAD SETROX S 53 350974
|
Facility
|
OP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
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 Medicaid |
$1,139.17
|
| 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: Humana KY Medicaid |
$1,139.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,150.76
|
| 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: Molina Healthcare Medicaid |
$1,162.03
|
| 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
|
|
|
LEAD SETROX S 60 350 975
|
Facility
|
IP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.38
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
LEAD SETROX S 60 350 975
|
Facility
|
OP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem Medicaid |
$1,268.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Humana KY Medicaid |
$1,268.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,293.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.38
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
LEAD SPRINT FIDELIS 6949
|
Facility
|
IP
|
$27,500.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,250.00 |
| Max. Negotiated Rate |
$26,400.00 |
| Rate for Payer: Aetna Commercial |
$21,175.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,450.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna Commercial |
$22,825.00
|
| Rate for Payer: First Health Commercial |
$26,125.00
|
| Rate for Payer: Humana Commercial |
$23,375.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,550.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,295.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,250.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,925.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,975.00
|
| Rate for Payer: PHCS Commercial |
$26,400.00
|
| Rate for Payer: United Healthcare All Payer |
$24,200.00
|
|
|
LEAD SPRINT FIDELIS 6949
|
Facility
|
OP
|
$27,500.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,250.00 |
| Max. Negotiated Rate |
$26,400.00 |
| Rate for Payer: Aetna Commercial |
$21,175.00
|
| Rate for Payer: Anthem Medicaid |
$9,457.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,450.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna Commercial |
$22,825.00
|
| Rate for Payer: First Health Commercial |
$26,125.00
|
| Rate for Payer: Humana Commercial |
$23,375.00
|
| Rate for Payer: Humana KY Medicaid |
$9,457.25
|
| Rate for Payer: Kentucky WC Medicaid |
$9,553.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,550.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,295.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,250.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,647.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,925.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,975.00
|
| Rate for Payer: PHCS Commercial |
$26,400.00
|
| Rate for Payer: United Healthcare All Payer |
$24,200.00
|
|
|
LEAD SPRINT QUATTRO 6947
|
Facility
|
IP
|
$17,720.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,316.00 |
| Max. Negotiated Rate |
$17,011.20 |
| Rate for Payer: Aetna Commercial |
$13,644.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,821.60
|
| Rate for Payer: Cash Price |
$8,860.00
|
| Rate for Payer: Cigna Commercial |
$14,707.60
|
| Rate for Payer: First Health Commercial |
$16,834.00
|
| Rate for Payer: Humana Commercial |
$15,062.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,530.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,077.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,316.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,593.60
|
| Rate for Payer: Ohio Health Group HMO |
$13,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,416.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,226.80
|
| Rate for Payer: PHCS Commercial |
$17,011.20
|
| Rate for Payer: United Healthcare All Payer |
$15,593.60
|
|
|
LEAD SPRINT QUATTRO 6947
|
Facility
|
OP
|
$17,720.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,316.00 |
| Max. Negotiated Rate |
$17,011.20 |
| Rate for Payer: Aetna Commercial |
$13,644.40
|
| Rate for Payer: Anthem Medicaid |
$6,093.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,821.60
|
| Rate for Payer: Cash Price |
$8,860.00
|
| Rate for Payer: Cigna Commercial |
$14,707.60
|
| Rate for Payer: First Health Commercial |
$16,834.00
|
| Rate for Payer: Humana Commercial |
$15,062.00
|
| Rate for Payer: Humana KY Medicaid |
$6,093.91
|
| Rate for Payer: Kentucky WC Medicaid |
$6,155.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,530.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,077.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,316.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,216.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,593.60
|
| Rate for Payer: Ohio Health Group HMO |
$13,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,416.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,226.80
|
| Rate for Payer: PHCS Commercial |
$17,011.20
|
| Rate for Payer: United Healthcare All Payer |
$15,593.60
|
|
|
LEAD SPRINT QUATTRO 6947-65
|
Facility
|
IP
|
$15,981.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,794.30 |
| Max. Negotiated Rate |
$15,341.76 |
| Rate for Payer: Aetna Commercial |
$12,305.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,465.18
|
| Rate for Payer: Cash Price |
$7,990.50
|
| Rate for Payer: Cigna Commercial |
$13,264.23
|
| Rate for Payer: First Health Commercial |
$15,181.95
|
| Rate for Payer: Humana Commercial |
$13,583.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,104.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,793.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,794.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,063.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,985.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,903.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,026.89
|
| Rate for Payer: PHCS Commercial |
$15,341.76
|
| Rate for Payer: United Healthcare All Payer |
$14,063.28
|
|
|
LEAD SPRINT QUATTRO 6947-65
|
Facility
|
OP
|
$15,981.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,794.30 |
| Max. Negotiated Rate |
$15,341.76 |
| Rate for Payer: Aetna Commercial |
$12,305.37
|
| Rate for Payer: Anthem Medicaid |
$5,495.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,465.18
|
| Rate for Payer: Cash Price |
$7,990.50
|
| Rate for Payer: Cigna Commercial |
$13,264.23
|
| Rate for Payer: First Health Commercial |
$15,181.95
|
| Rate for Payer: Humana Commercial |
$13,583.85
|
| Rate for Payer: Humana KY Medicaid |
$5,495.87
|
| Rate for Payer: Kentucky WC Medicaid |
$5,551.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,104.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,793.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,794.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,606.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,063.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,985.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,903.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,026.89
|
| Rate for Payer: PHCS Commercial |
$15,341.76
|
| Rate for Payer: United Healthcare All Payer |
$14,063.28
|
|
|
LEAD SPRINT QUATTRO 6947M-55
|
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 SPRINT QUATTRO 6947M-55
|
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 STREAMLINE BIPOLAR 6495
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
LEAD STREAMLINE BIPOLAR 6495
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
LEAD STREAMLINE UNIPOLAR 6494
|
Facility
|
IP
|
$561.88
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.56 |
| Max. Negotiated Rate |
$539.40 |
| Rate for Payer: Aetna Commercial |
$432.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$438.27
|
| Rate for Payer: Cash Price |
$280.94
|
| Rate for Payer: Cigna Commercial |
$466.36
|
| Rate for Payer: First Health Commercial |
$533.79
|
| Rate for Payer: Humana Commercial |
$477.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$460.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$414.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$494.45
|
| Rate for Payer: Ohio Health Group HMO |
$421.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$449.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.70
|
| Rate for Payer: PHCS Commercial |
$539.40
|
| Rate for Payer: United Healthcare All Payer |
$494.45
|
|
|
LEAD STREAMLINE UNIPOLAR 6494
|
Facility
|
OP
|
$561.88
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.56 |
| Max. Negotiated Rate |
$539.40 |
| Rate for Payer: Aetna Commercial |
$432.65
|
| Rate for Payer: Anthem Medicaid |
$193.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$438.27
|
| Rate for Payer: Cash Price |
$280.94
|
| Rate for Payer: Cigna Commercial |
$466.36
|
| Rate for Payer: First Health Commercial |
$533.79
|
| Rate for Payer: Humana Commercial |
$477.60
|
| Rate for Payer: Humana KY Medicaid |
$193.23
|
| Rate for Payer: Kentucky WC Medicaid |
$195.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$460.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$414.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$197.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$494.45
|
| Rate for Payer: Ohio Health Group HMO |
$421.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$449.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.70
|
| Rate for Payer: PHCS Commercial |
$539.40
|
| Rate for Payer: United Healthcare All Payer |
$494.45
|
|
|
LEAD SUBCOMPACT 1*8 MRI 60CM
|
Facility
|
OP
|
$10,099.25
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,029.78 |
| Max. Negotiated Rate |
$9,695.28 |
| Rate for Payer: Aetna Commercial |
$7,776.42
|
| Rate for Payer: Anthem Medicaid |
$3,473.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,877.41
|
| Rate for Payer: Cash Price |
$5,049.62
|
| Rate for Payer: Cigna Commercial |
$8,382.38
|
| Rate for Payer: First Health Commercial |
$9,594.29
|
| Rate for Payer: Humana Commercial |
$8,584.36
|
| Rate for Payer: Humana KY Medicaid |
$3,473.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3,508.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,281.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,453.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,029.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,542.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,887.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,574.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,079.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,786.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,968.48
|
| Rate for Payer: PHCS Commercial |
$9,695.28
|
| Rate for Payer: United Healthcare All Payer |
$8,887.34
|
|
|
LEAD SUBCOMPACT 1*8 MRI 60CM
|
Facility
|
IP
|
$10,099.25
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,029.78 |
| Max. Negotiated Rate |
$9,695.28 |
| Rate for Payer: Aetna Commercial |
$7,776.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,877.41
|
| Rate for Payer: Cash Price |
$5,049.62
|
| Rate for Payer: Cigna Commercial |
$8,382.38
|
| Rate for Payer: First Health Commercial |
$9,594.29
|
| Rate for Payer: Humana Commercial |
$8,584.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,281.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,453.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,029.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,887.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,574.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,079.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,786.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,968.48
|
| Rate for Payer: PHCS Commercial |
$9,695.28
|
| Rate for Payer: United Healthcare All Payer |
$8,887.34
|
|
|
LEAD SUBCOMPACT 1*8 MRI 75CM
|
Facility
|
IP
|
$10,099.25
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,029.78 |
| Max. Negotiated Rate |
$9,695.28 |
| Rate for Payer: Aetna Commercial |
$7,776.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,877.41
|
| Rate for Payer: Cash Price |
$5,049.62
|
| Rate for Payer: Cigna Commercial |
$8,382.38
|
| Rate for Payer: First Health Commercial |
$9,594.29
|
| Rate for Payer: Humana Commercial |
$8,584.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,281.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,453.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,029.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,887.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,574.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,079.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,786.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,968.48
|
| Rate for Payer: PHCS Commercial |
$9,695.28
|
| Rate for Payer: United Healthcare All Payer |
$8,887.34
|
|
|
LEAD SUBCOMPACT 1*8 MRI 75CM
|
Facility
|
OP
|
$10,099.25
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,029.78 |
| Max. Negotiated Rate |
$9,695.28 |
| Rate for Payer: Aetna Commercial |
$7,776.42
|
| Rate for Payer: Anthem Medicaid |
$3,473.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,877.41
|
| Rate for Payer: Cash Price |
$5,049.62
|
| Rate for Payer: Cigna Commercial |
$8,382.38
|
| Rate for Payer: First Health Commercial |
$9,594.29
|
| Rate for Payer: Humana Commercial |
$8,584.36
|
| Rate for Payer: Humana KY Medicaid |
$3,473.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3,508.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,281.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,453.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,029.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,542.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,887.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,574.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,079.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,786.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,968.48
|
| Rate for Payer: PHCS Commercial |
$9,695.28
|
| Rate for Payer: United Healthcare All Payer |
$8,887.34
|
|
