|
BREAST IMP INSPIRA STY MOD 560
|
Facility
|
IP
|
$6,548.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.31 |
| Max. Negotiated Rate |
$6,286.61 |
| Rate for Payer: Aetna Commercial |
$5,042.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,107.87
|
| Rate for Payer: Cash Price |
$3,274.28
|
| Rate for Payer: Cigna Commercial |
$5,435.30
|
| Rate for Payer: First Health Commercial |
$6,221.12
|
| Rate for Payer: Humana Commercial |
$5,566.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,369.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,832.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,762.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,911.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,309.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.05
|
| Rate for Payer: PHCS Commercial |
$6,286.61
|
| Rate for Payer: United Healthcare All Payer |
$5,762.72
|
|
|
BREAST IMP INSPIRA X-FULL 445C
|
Facility
|
OP
|
$6,548.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.31 |
| Max. Negotiated Rate |
$6,286.61 |
| Rate for Payer: Aetna Commercial |
$5,042.38
|
| Rate for Payer: Anthem Medicaid |
$2,252.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,107.87
|
| Rate for Payer: Cash Price |
$3,274.28
|
| Rate for Payer: Cigna Commercial |
$5,435.30
|
| Rate for Payer: First Health Commercial |
$6,221.12
|
| Rate for Payer: Humana Commercial |
$5,566.27
|
| Rate for Payer: Humana KY Medicaid |
$2,252.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,274.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,369.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,832.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,297.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,762.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,911.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,309.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.05
|
| Rate for Payer: PHCS Commercial |
$6,286.61
|
| Rate for Payer: United Healthcare All Payer |
$5,762.72
|
|
|
BREAST IMP INSPIRA X-FULL 445C
|
Facility
|
IP
|
$6,548.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.31 |
| Max. Negotiated Rate |
$6,286.61 |
| Rate for Payer: Aetna Commercial |
$5,042.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,107.87
|
| Rate for Payer: Cash Price |
$3,274.28
|
| Rate for Payer: Cigna Commercial |
$5,435.30
|
| Rate for Payer: First Health Commercial |
$6,221.12
|
| Rate for Payer: Humana Commercial |
$5,566.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,369.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,832.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,762.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,911.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,309.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.05
|
| Rate for Payer: PHCS Commercial |
$6,286.61
|
| Rate for Payer: United Healthcare All Payer |
$5,762.72
|
|
|
BREAST IMP INSPIRA X-FULL 470C
|
Facility
|
IP
|
$6,548.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.31 |
| Max. Negotiated Rate |
$6,286.61 |
| Rate for Payer: Aetna Commercial |
$5,042.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,107.87
|
| Rate for Payer: Cash Price |
$3,274.28
|
| Rate for Payer: Cigna Commercial |
$5,435.30
|
| Rate for Payer: First Health Commercial |
$6,221.12
|
| Rate for Payer: Humana Commercial |
$5,566.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,369.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,832.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,762.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,911.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,309.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.05
|
| Rate for Payer: PHCS Commercial |
$6,286.61
|
| Rate for Payer: United Healthcare All Payer |
$5,762.72
|
|
|
BREAST IMP INSPIRA X-FULL 470C
|
Facility
|
OP
|
$6,548.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.31 |
| Max. Negotiated Rate |
$6,286.61 |
| Rate for Payer: Aetna Commercial |
$5,042.38
|
| Rate for Payer: Anthem Medicaid |
$2,252.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,107.87
|
| Rate for Payer: Cash Price |
$3,274.28
|
| Rate for Payer: Cigna Commercial |
$5,435.30
|
| Rate for Payer: First Health Commercial |
$6,221.12
|
| Rate for Payer: Humana Commercial |
$5,566.27
|
| Rate for Payer: Humana KY Medicaid |
$2,252.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,274.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,369.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,832.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,297.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,762.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,911.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,309.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.05
|
| Rate for Payer: PHCS Commercial |
$6,286.61
|
| Rate for Payer: United Healthcare All Payer |
$5,762.72
|
|
|
BREAST IMP INSPIRA X-FULL 495C
|
Facility
|
OP
|
$6,548.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.31 |
| Max. Negotiated Rate |
$6,286.61 |
| Rate for Payer: Aetna Commercial |
$5,042.38
|
| Rate for Payer: Anthem Medicaid |
$2,252.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,107.87
|
| Rate for Payer: Cash Price |
$3,274.28
|
| Rate for Payer: Cigna Commercial |
$5,435.30
|
| Rate for Payer: First Health Commercial |
$6,221.12
|
| Rate for Payer: Humana Commercial |
$5,566.27
|
| Rate for Payer: Humana KY Medicaid |
$2,252.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,274.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,369.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,832.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,297.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,762.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,911.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,309.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.05
|
| Rate for Payer: PHCS Commercial |
$6,286.61
|
| Rate for Payer: United Healthcare All Payer |
$5,762.72
|
|
|
BREAST IMP INSPIRA X-FULL 495C
|
Facility
|
IP
|
$6,548.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.31 |
| Max. Negotiated Rate |
$6,286.61 |
| Rate for Payer: Aetna Commercial |
$5,042.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,107.87
|
| Rate for Payer: Cash Price |
$3,274.28
|
| Rate for Payer: Cigna Commercial |
$5,435.30
|
| Rate for Payer: First Health Commercial |
$6,221.12
|
| Rate for Payer: Humana Commercial |
$5,566.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,369.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,832.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,762.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,911.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,309.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.05
|
| Rate for Payer: PHCS Commercial |
$6,286.61
|
| Rate for Payer: United Healthcare All Payer |
$5,762.72
|
|
|
BREAST IMP INSPIRA X-FULL 525C
|
Facility
|
OP
|
$6,548.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.31 |
| Max. Negotiated Rate |
$6,286.61 |
| Rate for Payer: Aetna Commercial |
$5,042.38
|
| Rate for Payer: Anthem Medicaid |
$2,252.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,107.87
|
| Rate for Payer: Cash Price |
$3,274.28
|
| Rate for Payer: Cigna Commercial |
$5,435.30
|
| Rate for Payer: First Health Commercial |
$6,221.12
|
| Rate for Payer: Humana Commercial |
$5,566.27
|
| Rate for Payer: Humana KY Medicaid |
$2,252.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,274.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,369.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,832.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,297.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,762.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,911.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,309.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.05
|
| Rate for Payer: PHCS Commercial |
$6,286.61
|
| Rate for Payer: United Healthcare All Payer |
$5,762.72
|
|
|
BREAST IMP INSPIRA X-FULL 525C
|
Facility
|
IP
|
$6,548.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.31 |
| Max. Negotiated Rate |
$6,286.61 |
| Rate for Payer: Aetna Commercial |
$5,042.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,107.87
|
| Rate for Payer: Cash Price |
$3,274.28
|
| Rate for Payer: Cigna Commercial |
$5,435.30
|
| Rate for Payer: First Health Commercial |
$6,221.12
|
| Rate for Payer: Humana Commercial |
$5,566.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,369.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,832.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,762.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,911.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,309.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.05
|
| Rate for Payer: PHCS Commercial |
$6,286.61
|
| Rate for Payer: United Healthcare All Payer |
$5,762.72
|
|
|
BREAST IMP INSPIRA X-FULL 545C
|
Facility
|
OP
|
$6,548.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.31 |
| Max. Negotiated Rate |
$6,286.61 |
| Rate for Payer: Aetna Commercial |
$5,042.38
|
| Rate for Payer: Anthem Medicaid |
$2,252.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,107.87
|
| Rate for Payer: Cash Price |
$3,274.28
|
| Rate for Payer: Cigna Commercial |
$5,435.30
|
| Rate for Payer: First Health Commercial |
$6,221.12
|
| Rate for Payer: Humana Commercial |
$5,566.27
|
| Rate for Payer: Humana KY Medicaid |
$2,252.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,274.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,369.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,832.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,297.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,762.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,911.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,309.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.05
|
| Rate for Payer: PHCS Commercial |
$6,286.61
|
| Rate for Payer: United Healthcare All Payer |
$5,762.72
|
|
|
BREAST IMP INSPIRA X-FULL 545C
|
Facility
|
IP
|
$6,548.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.31 |
| Max. Negotiated Rate |
$6,286.61 |
| Rate for Payer: Aetna Commercial |
$5,042.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,107.87
|
| Rate for Payer: Cash Price |
$3,274.28
|
| Rate for Payer: Cigna Commercial |
$5,435.30
|
| Rate for Payer: First Health Commercial |
$6,221.12
|
| Rate for Payer: Humana Commercial |
$5,566.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,369.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,832.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,762.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,911.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,309.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.05
|
| Rate for Payer: PHCS Commercial |
$6,286.61
|
| Rate for Payer: United Healthcare All Payer |
$5,762.72
|
|
|
BREAST IMP INSPIRA X-FULL 560C
|
Facility
|
IP
|
$6,548.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.31 |
| Max. Negotiated Rate |
$6,286.61 |
| Rate for Payer: Aetna Commercial |
$5,042.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,107.87
|
| Rate for Payer: Cash Price |
$3,274.28
|
| Rate for Payer: Cigna Commercial |
$5,435.30
|
| Rate for Payer: First Health Commercial |
$6,221.12
|
| Rate for Payer: Humana Commercial |
$5,566.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,369.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,832.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,762.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,911.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,309.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.05
|
| Rate for Payer: PHCS Commercial |
$6,286.61
|
| Rate for Payer: United Healthcare All Payer |
$5,762.72
|
|
|
BREAST IMP INSPIRA X-FULL 560C
|
Facility
|
OP
|
$6,548.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.31 |
| Max. Negotiated Rate |
$6,286.61 |
| Rate for Payer: Aetna Commercial |
$5,042.38
|
| Rate for Payer: Anthem Medicaid |
$2,252.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,107.87
|
| Rate for Payer: Cash Price |
$3,274.28
|
| Rate for Payer: Cigna Commercial |
$5,435.30
|
| Rate for Payer: First Health Commercial |
$6,221.12
|
| Rate for Payer: Humana Commercial |
$5,566.27
|
| Rate for Payer: Humana KY Medicaid |
$2,252.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,274.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,369.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,832.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,297.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,762.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,911.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,309.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.05
|
| Rate for Payer: PHCS Commercial |
$6,286.61
|
| Rate for Payer: United Healthcare All Payer |
$5,762.72
|
|
|
BREAST IMP INSPIRA X-FULL 580C
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
BREAST IMP INSPIRA X-FULL 580C
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
BREAST IMP INSPIRA X-FULL 615C
|
Facility
|
IP
|
$6,548.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.31 |
| Max. Negotiated Rate |
$6,286.61 |
| Rate for Payer: Aetna Commercial |
$5,042.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,107.87
|
| Rate for Payer: Cash Price |
$3,274.28
|
| Rate for Payer: Cigna Commercial |
$5,435.30
|
| Rate for Payer: First Health Commercial |
$6,221.12
|
| Rate for Payer: Humana Commercial |
$5,566.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,369.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,832.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,762.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,911.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,309.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.05
|
| Rate for Payer: PHCS Commercial |
$6,286.61
|
| Rate for Payer: United Healthcare All Payer |
$5,762.72
|
|
|
BREAST IMP INSPIRA X-FULL 615C
|
Facility
|
OP
|
$6,548.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.31 |
| Max. Negotiated Rate |
$6,286.61 |
| Rate for Payer: Aetna Commercial |
$5,042.38
|
| Rate for Payer: Anthem Medicaid |
$2,252.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,107.87
|
| Rate for Payer: Cash Price |
$3,274.28
|
| Rate for Payer: Cigna Commercial |
$5,435.30
|
| Rate for Payer: First Health Commercial |
$6,221.12
|
| Rate for Payer: Humana Commercial |
$5,566.27
|
| Rate for Payer: Humana KY Medicaid |
$2,252.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,274.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,369.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,832.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,297.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,762.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,911.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,309.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.05
|
| Rate for Payer: PHCS Commercial |
$6,286.61
|
| Rate for Payer: United Healthcare All Payer |
$5,762.72
|
|
|
BREAST IMP INSPIRA X-FULL 650C
|
Facility
|
OP
|
$6,548.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.31 |
| Max. Negotiated Rate |
$6,286.61 |
| Rate for Payer: Aetna Commercial |
$5,042.38
|
| Rate for Payer: Anthem Medicaid |
$2,252.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,107.87
|
| Rate for Payer: Cash Price |
$3,274.28
|
| Rate for Payer: Cigna Commercial |
$5,435.30
|
| Rate for Payer: First Health Commercial |
$6,221.12
|
| Rate for Payer: Humana Commercial |
$5,566.27
|
| Rate for Payer: Humana KY Medicaid |
$2,252.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,274.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,369.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,832.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,297.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,762.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,911.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,309.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.05
|
| Rate for Payer: PHCS Commercial |
$6,286.61
|
| Rate for Payer: United Healthcare All Payer |
$5,762.72
|
|
|
BREAST IMP INSPIRA X-FULL 650C
|
Facility
|
IP
|
$6,548.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.31 |
| Max. Negotiated Rate |
$6,286.61 |
| Rate for Payer: Aetna Commercial |
$5,042.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,107.87
|
| Rate for Payer: Cash Price |
$3,274.28
|
| Rate for Payer: Cigna Commercial |
$5,435.30
|
| Rate for Payer: First Health Commercial |
$6,221.12
|
| Rate for Payer: Humana Commercial |
$5,566.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,369.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,832.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,762.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,911.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,309.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.05
|
| Rate for Payer: PHCS Commercial |
$6,286.61
|
| Rate for Payer: United Healthcare All Payer |
$5,762.72
|
|
|
BREAST IMP INSPIRA X-FULL 700C
|
Facility
|
OP
|
$6,548.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.31 |
| Max. Negotiated Rate |
$6,286.61 |
| Rate for Payer: Aetna Commercial |
$5,042.38
|
| Rate for Payer: Anthem Medicaid |
$2,252.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,107.87
|
| Rate for Payer: Cash Price |
$3,274.28
|
| Rate for Payer: Cigna Commercial |
$5,435.30
|
| Rate for Payer: First Health Commercial |
$6,221.12
|
| Rate for Payer: Humana Commercial |
$5,566.27
|
| Rate for Payer: Humana KY Medicaid |
$2,252.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,274.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,369.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,832.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,297.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,762.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,911.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,309.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.05
|
| Rate for Payer: PHCS Commercial |
$6,286.61
|
| Rate for Payer: United Healthcare All Payer |
$5,762.72
|
|
|
BREAST IMP INSPIRA X-FULL 700C
|
Facility
|
IP
|
$6,548.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.31 |
| Max. Negotiated Rate |
$6,286.61 |
| Rate for Payer: Aetna Commercial |
$5,042.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,107.87
|
| Rate for Payer: Cash Price |
$3,274.28
|
| Rate for Payer: Cigna Commercial |
$5,435.30
|
| Rate for Payer: First Health Commercial |
$6,221.12
|
| Rate for Payer: Humana Commercial |
$5,566.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,369.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,832.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,762.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,911.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,309.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.05
|
| Rate for Payer: PHCS Commercial |
$6,286.61
|
| Rate for Payer: United Healthcare All Payer |
$5,762.72
|
|
|
BREAST IMP INSPIRA X-FULL 750C
|
Facility
|
OP
|
$6,694.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.29 |
| Max. Negotiated Rate |
$6,426.77 |
| Rate for Payer: Aetna Commercial |
$5,154.80
|
| Rate for Payer: Anthem Medicaid |
$2,302.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,221.75
|
| Rate for Payer: Cash Price |
$3,347.28
|
| Rate for Payer: Cigna Commercial |
$5,556.48
|
| Rate for Payer: First Health Commercial |
$6,359.82
|
| Rate for Payer: Humana Commercial |
$5,690.37
|
| Rate for Payer: Humana KY Medicaid |
$2,302.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,325.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,489.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,940.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,008.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,348.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,891.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,020.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,338.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,075.31
|
| Rate for Payer: PHCS Commercial |
$6,426.77
|
| Rate for Payer: United Healthcare All Payer |
$5,891.20
|
|
|
BREAST IMP INSPIRA X-FULL 750C
|
Facility
|
IP
|
$6,694.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.29 |
| Max. Negotiated Rate |
$6,426.77 |
| Rate for Payer: Aetna Commercial |
$5,154.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,221.75
|
| Rate for Payer: Cash Price |
$3,347.28
|
| Rate for Payer: Cigna Commercial |
$5,556.48
|
| Rate for Payer: First Health Commercial |
$6,359.82
|
| Rate for Payer: Humana Commercial |
$5,690.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,489.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,940.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,008.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,891.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,020.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,338.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,075.31
|
| Rate for Payer: PHCS Commercial |
$6,426.77
|
| Rate for Payer: United Healthcare All Payer |
$5,891.20
|
|
|
BREAST IMP INSPIRA X-FULL 800C
|
Facility
|
IP
|
$6,548.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.31 |
| Max. Negotiated Rate |
$6,286.61 |
| Rate for Payer: Aetna Commercial |
$5,042.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,107.87
|
| Rate for Payer: Cash Price |
$3,274.28
|
| Rate for Payer: Cigna Commercial |
$5,435.30
|
| Rate for Payer: First Health Commercial |
$6,221.12
|
| Rate for Payer: Humana Commercial |
$5,566.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,369.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,832.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,762.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,911.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,309.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.05
|
| Rate for Payer: PHCS Commercial |
$6,286.61
|
| Rate for Payer: United Healthcare All Payer |
$5,762.72
|
|
|
BREAST IMP INSPIRA X-FULL 800C
|
Facility
|
OP
|
$6,548.55
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.31 |
| Max. Negotiated Rate |
$6,286.61 |
| Rate for Payer: Aetna Commercial |
$5,042.38
|
| Rate for Payer: Anthem Medicaid |
$2,252.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,107.87
|
| Rate for Payer: Cash Price |
$3,274.28
|
| Rate for Payer: Cigna Commercial |
$5,435.30
|
| Rate for Payer: First Health Commercial |
$6,221.12
|
| Rate for Payer: Humana Commercial |
$5,566.27
|
| Rate for Payer: Humana KY Medicaid |
$2,252.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,274.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,369.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,832.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,297.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,762.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,911.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,309.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.05
|
| Rate for Payer: PHCS Commercial |
$6,286.61
|
| Rate for Payer: United Healthcare All Payer |
$5,762.72
|
|
