|
DECORTICATION PULMONARY
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32225
|
| Hospital Charge Code |
76101184
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
DECORTICATION PULMONARY
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32225
|
| Hospital Charge Code |
76101184
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
DECORTICATION PULMONARY(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32225
|
| Hospital Charge Code |
761P1184
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,646.42
|
| Rate for Payer: Anthem Medicaid |
$728.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,544.28
|
| Rate for Payer: Healthspan PPO |
$1,285.48
|
| Rate for Payer: Humana Medicaid |
$728.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,376.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$742.59
|
| Rate for Payer: Molina Healthcare Passport |
$728.03
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$735.31
|
|
|
DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC
|
Facility
|
IP
|
$12,794.33
|
|
|
Service Code
|
MSDRG 294
|
| Min. Negotiated Rate |
$8,681.87 |
| Max. Negotiated Rate |
$12,794.33 |
| Rate for Payer: Anthem Medicaid |
$8,681.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,138.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,794.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,337.39
|
| Rate for Payer: Humana KY Medicaid |
$8,681.87
|
| Rate for Payer: Humana Medicare Advantage |
$9,138.81
|
| Rate for Payer: Kentucky WC Medicaid |
$8,768.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,966.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,855.51
|
|
|
DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$9,324.64
|
|
|
Service Code
|
MSDRG 295
|
| Min. Negotiated Rate |
$6,327.44 |
| Max. Negotiated Rate |
$9,324.64 |
| Rate for Payer: Anthem Medicaid |
$6,327.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,660.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,324.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,991.62
|
| Rate for Payer: Humana KY Medicaid |
$6,327.44
|
| Rate for Payer: Humana Medicare Advantage |
$6,660.46
|
| Rate for Payer: Kentucky WC Medicaid |
$6,390.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,992.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,453.99
|
|
|
DEFEROXAMINE 500mg(2gm) IM SDV
|
Facility
|
IP
|
$224.54
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
25004297
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.19 |
| Max. Negotiated Rate |
$215.56 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.14
|
| Rate for Payer: Cash Price |
$112.27
|
| Rate for Payer: Cigna Commercial |
$186.37
|
| Rate for Payer: First Health Commercial |
$213.31
|
| Rate for Payer: Humana Commercial |
$190.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$165.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$197.60
|
| Rate for Payer: Ohio Health Group HMO |
$168.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.61
|
| Rate for Payer: PHCS Commercial |
$215.56
|
| Rate for Payer: United Healthcare All Payer |
$197.60
|
|
|
DEFEROXAMINE 500mg(2gm) IM SDV
|
Facility
|
OP
|
$224.54
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
25004297
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.19 |
| Max. Negotiated Rate |
$215.56 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Anthem Medicaid |
$77.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.14
|
| Rate for Payer: Cash Price |
$112.27
|
| Rate for Payer: Cigna Commercial |
$186.37
|
| Rate for Payer: First Health Commercial |
$213.31
|
| Rate for Payer: Humana Commercial |
$190.86
|
| Rate for Payer: Humana KY Medicaid |
$77.22
|
| Rate for Payer: Kentucky WC Medicaid |
$78.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$165.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$78.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$197.60
|
| Rate for Payer: Ohio Health Group HMO |
$168.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.61
|
| Rate for Payer: PHCS Commercial |
$215.56
|
| Rate for Payer: United Healthcare All Payer |
$197.60
|
|
|
DEFEROXAMINE 500mg(2gm) IV SDV
|
Facility
|
OP
|
$224.54
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
25004296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.19 |
| Max. Negotiated Rate |
$215.56 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Anthem Medicaid |
$77.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.14
|
| Rate for Payer: Cash Price |
$112.27
|
| Rate for Payer: Cigna Commercial |
$186.37
|
| Rate for Payer: First Health Commercial |
$213.31
|
| Rate for Payer: Humana Commercial |
$190.86
|
| Rate for Payer: Humana KY Medicaid |
$77.22
|
| Rate for Payer: Kentucky WC Medicaid |
$78.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$165.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$78.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$197.60
|
| Rate for Payer: Ohio Health Group HMO |
$168.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.61
|
| Rate for Payer: PHCS Commercial |
$215.56
|
| Rate for Payer: United Healthcare All Payer |
$197.60
|
|
|
DEFEROXAMINE 500mg(2gm) IV SDV
|
Facility
|
IP
|
$224.54
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
25004296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.19 |
| Max. Negotiated Rate |
$215.56 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.14
|
| Rate for Payer: Cash Price |
$112.27
|
| Rate for Payer: Cigna Commercial |
$186.37
|
| Rate for Payer: First Health Commercial |
$213.31
|
| Rate for Payer: Humana Commercial |
$190.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$165.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$197.60
|
| Rate for Payer: Ohio Health Group HMO |
$168.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.61
|
| Rate for Payer: PHCS Commercial |
$215.56
|
| Rate for Payer: United Healthcare All Payer |
$197.60
|
|
|
DEFIB AMPLIA MRI QUAD DTMB1QQ
|
Facility
|
IP
|
$90,534.40
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,769.47 |
| Max. Negotiated Rate |
$86,913.02 |
| Rate for Payer: Aetna Commercial |
$69,711.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,616.83
|
| Rate for Payer: Cash Price |
$45,267.20
|
| Rate for Payer: Cigna Commercial |
$75,143.55
|
| Rate for Payer: First Health Commercial |
$86,007.68
|
| Rate for Payer: Humana Commercial |
$76,954.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,238.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,814.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,160.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,670.27
|
| Rate for Payer: Ohio Health Group HMO |
$67,900.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,106.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,769.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,065.66
|
| Rate for Payer: PHCS Commercial |
$86,913.02
|
| Rate for Payer: United Healthcare All Payer |
$79,670.27
|
|
|
DEFIB AMPLIA MRI QUAD DTMB1QQ
|
Facility
|
OP
|
$90,534.40
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,769.47 |
| Max. Negotiated Rate |
$86,913.02 |
| Rate for Payer: Aetna Commercial |
$69,711.49
|
| Rate for Payer: Anthem Medicaid |
$31,134.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,616.83
|
| Rate for Payer: Cash Price |
$45,267.20
|
| Rate for Payer: Cigna Commercial |
$75,143.55
|
| Rate for Payer: First Health Commercial |
$86,007.68
|
| Rate for Payer: Humana Commercial |
$76,954.24
|
| Rate for Payer: Humana KY Medicaid |
$31,134.78
|
| Rate for Payer: Kentucky WC Medicaid |
$31,451.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,238.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,814.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,160.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,759.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,670.27
|
| Rate for Payer: Ohio Health Group HMO |
$67,900.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,106.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,769.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,065.66
|
| Rate for Payer: PHCS Commercial |
$86,913.02
|
| Rate for Payer: United Healthcare All Payer |
$79,670.27
|
|
|
DEFIB ATLAS V-343
|
Facility
|
IP
|
$108,700.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$14,131.00 |
| Max. Negotiated Rate |
$104,352.00 |
| Rate for Payer: Aetna Commercial |
$83,699.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84,786.00
|
| Rate for Payer: Cash Price |
$54,350.00
|
| Rate for Payer: Cigna Commercial |
$90,221.00
|
| Rate for Payer: First Health Commercial |
$103,265.00
|
| Rate for Payer: Humana Commercial |
$92,395.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89,134.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80,220.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,610.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$95,656.00
|
| Rate for Payer: Ohio Health Group HMO |
$81,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33,697.00
|
| Rate for Payer: PHCS Commercial |
$104,352.00
|
| Rate for Payer: United Healthcare All Payer |
$95,656.00
|
|
|
DEFIB ATLAS V-343
|
Facility
|
OP
|
$108,700.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$14,131.00 |
| Max. Negotiated Rate |
$104,352.00 |
| Rate for Payer: Aetna Commercial |
$83,699.00
|
| Rate for Payer: Anthem Medicaid |
$37,381.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84,786.00
|
| Rate for Payer: Cash Price |
$54,350.00
|
| Rate for Payer: Cigna Commercial |
$90,221.00
|
| Rate for Payer: First Health Commercial |
$103,265.00
|
| Rate for Payer: Humana Commercial |
$92,395.00
|
| Rate for Payer: Humana KY Medicaid |
$37,381.93
|
| Rate for Payer: Kentucky WC Medicaid |
$37,762.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89,134.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80,220.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,610.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$38,131.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$95,656.00
|
| Rate for Payer: Ohio Health Group HMO |
$81,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33,697.00
|
| Rate for Payer: PHCS Commercial |
$104,352.00
|
| Rate for Payer: United Healthcare All Payer |
$95,656.00
|
|
|
DEFIB CONCRTO II CRT-D D274TRK
|
Facility
|
IP
|
$99,700.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,961.00 |
| Max. Negotiated Rate |
$95,712.00 |
| Rate for Payer: Aetna Commercial |
$76,769.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77,766.00
|
| Rate for Payer: Cash Price |
$49,850.00
|
| Rate for Payer: Cigna Commercial |
$82,751.00
|
| Rate for Payer: First Health Commercial |
$94,715.00
|
| Rate for Payer: Humana Commercial |
$84,745.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81,754.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73,578.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,910.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$87,736.00
|
| Rate for Payer: Ohio Health Group HMO |
$74,775.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,961.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30,907.00
|
| Rate for Payer: PHCS Commercial |
$95,712.00
|
| Rate for Payer: United Healthcare All Payer |
$87,736.00
|
|
|
DEFIB CONCRTO II CRT-D D274TRK
|
Facility
|
OP
|
$99,700.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,961.00 |
| Max. Negotiated Rate |
$95,712.00 |
| Rate for Payer: Aetna Commercial |
$76,769.00
|
| Rate for Payer: Anthem Medicaid |
$34,286.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77,766.00
|
| Rate for Payer: Cash Price |
$49,850.00
|
| Rate for Payer: Cigna Commercial |
$82,751.00
|
| Rate for Payer: First Health Commercial |
$94,715.00
|
| Rate for Payer: Humana Commercial |
$84,745.00
|
| Rate for Payer: Humana KY Medicaid |
$34,286.83
|
| Rate for Payer: Kentucky WC Medicaid |
$34,635.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81,754.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73,578.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,910.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,974.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$87,736.00
|
| Rate for Payer: Ohio Health Group HMO |
$74,775.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,961.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30,907.00
|
| Rate for Payer: PHCS Commercial |
$95,712.00
|
| Rate for Payer: United Healthcare All Payer |
$87,736.00
|
|
|
DEFIB CUR+DR CD2211-36Q
|
Facility
|
IP
|
$82,600.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,738.00 |
| Max. Negotiated Rate |
$79,296.00 |
| Rate for Payer: Aetna Commercial |
$63,602.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,428.00
|
| Rate for Payer: Cash Price |
$41,300.00
|
| Rate for Payer: Cigna Commercial |
$68,558.00
|
| Rate for Payer: First Health Commercial |
$78,470.00
|
| Rate for Payer: Humana Commercial |
$70,210.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,732.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,958.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,780.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,688.00
|
| Rate for Payer: Ohio Health Group HMO |
$61,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,738.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,606.00
|
| Rate for Payer: PHCS Commercial |
$79,296.00
|
| Rate for Payer: United Healthcare All Payer |
$72,688.00
|
|
|
DEFIB CUR+DR CD2211-36Q
|
Facility
|
OP
|
$82,600.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,738.00 |
| Max. Negotiated Rate |
$79,296.00 |
| Rate for Payer: Aetna Commercial |
$63,602.00
|
| Rate for Payer: Anthem Medicaid |
$28,406.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,428.00
|
| Rate for Payer: Cash Price |
$41,300.00
|
| Rate for Payer: Cigna Commercial |
$68,558.00
|
| Rate for Payer: First Health Commercial |
$78,470.00
|
| Rate for Payer: Humana Commercial |
$70,210.00
|
| Rate for Payer: Humana KY Medicaid |
$28,406.14
|
| Rate for Payer: Kentucky WC Medicaid |
$28,695.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,732.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,958.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,780.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,976.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,688.00
|
| Rate for Payer: Ohio Health Group HMO |
$61,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,738.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,606.00
|
| Rate for Payer: PHCS Commercial |
$79,296.00
|
| Rate for Payer: United Healthcare All Payer |
$72,688.00
|
|
|
DEFIB CURR+DR CD2211-36
|
Facility
|
IP
|
$81,700.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,621.00 |
| Max. Negotiated Rate |
$78,432.00 |
| Rate for Payer: Aetna Commercial |
$62,909.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,726.00
|
| Rate for Payer: Cash Price |
$40,850.00
|
| Rate for Payer: Cigna Commercial |
$67,811.00
|
| Rate for Payer: First Health Commercial |
$77,615.00
|
| Rate for Payer: Humana Commercial |
$69,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,994.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,294.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,896.00
|
| Rate for Payer: Ohio Health Group HMO |
$61,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,621.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,327.00
|
| Rate for Payer: PHCS Commercial |
$78,432.00
|
| Rate for Payer: United Healthcare All Payer |
$71,896.00
|
|
|
DEFIB CURR+DR CD2211-36
|
Facility
|
OP
|
$81,700.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,621.00 |
| Max. Negotiated Rate |
$78,432.00 |
| Rate for Payer: Aetna Commercial |
$62,909.00
|
| Rate for Payer: Anthem Medicaid |
$28,096.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,726.00
|
| Rate for Payer: Cash Price |
$40,850.00
|
| Rate for Payer: Cigna Commercial |
$67,811.00
|
| Rate for Payer: First Health Commercial |
$77,615.00
|
| Rate for Payer: Humana Commercial |
$69,445.00
|
| Rate for Payer: Humana KY Medicaid |
$28,096.63
|
| Rate for Payer: Kentucky WC Medicaid |
$28,382.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,994.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,294.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,510.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,660.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,896.00
|
| Rate for Payer: Ohio Health Group HMO |
$61,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,621.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,327.00
|
| Rate for Payer: PHCS Commercial |
$78,432.00
|
| Rate for Payer: United Healthcare All Payer |
$71,896.00
|
|
|
DEFIB CURR+VR CD1211-36
|
Facility
|
IP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,504.00 |
| Max. Negotiated Rate |
$77,568.00 |
| Rate for Payer: Aetna Commercial |
$62,216.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,024.00
|
| Rate for Payer: Cash Price |
$40,400.00
|
| Rate for Payer: Cigna Commercial |
$67,064.00
|
| Rate for Payer: First Health Commercial |
$76,760.00
|
| Rate for Payer: Humana Commercial |
$68,680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,256.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,630.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,104.00
|
| Rate for Payer: Ohio Health Group HMO |
$60,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,504.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,048.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
|
DEFIB CURR+VR CD1211-36
|
Facility
|
OP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,504.00 |
| Max. Negotiated Rate |
$77,568.00 |
| Rate for Payer: Aetna Commercial |
$62,216.00
|
| Rate for Payer: Anthem Medicaid |
$27,787.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,024.00
|
| Rate for Payer: Cash Price |
$40,400.00
|
| Rate for Payer: Cigna Commercial |
$67,064.00
|
| Rate for Payer: First Health Commercial |
$76,760.00
|
| Rate for Payer: Humana Commercial |
$68,680.00
|
| Rate for Payer: Humana KY Medicaid |
$27,787.12
|
| Rate for Payer: Kentucky WC Medicaid |
$28,069.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,256.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,630.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,344.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,104.00
|
| Rate for Payer: Ohio Health Group HMO |
$60,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,504.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,048.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
|
DEFIB CUR+VR CD1211-36Q
|
Facility
|
OP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,504.00 |
| Max. Negotiated Rate |
$77,568.00 |
| Rate for Payer: Aetna Commercial |
$62,216.00
|
| Rate for Payer: Anthem Medicaid |
$27,787.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,024.00
|
| Rate for Payer: Cash Price |
$40,400.00
|
| Rate for Payer: Cigna Commercial |
$67,064.00
|
| Rate for Payer: First Health Commercial |
$76,760.00
|
| Rate for Payer: Humana Commercial |
$68,680.00
|
| Rate for Payer: Humana KY Medicaid |
$27,787.12
|
| Rate for Payer: Kentucky WC Medicaid |
$28,069.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,256.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,630.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,344.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,104.00
|
| Rate for Payer: Ohio Health Group HMO |
$60,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,504.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,048.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
|
DEFIB CUR+VR CD1211-36Q
|
Facility
|
IP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,504.00 |
| Max. Negotiated Rate |
$77,568.00 |
| Rate for Payer: Aetna Commercial |
$62,216.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,024.00
|
| Rate for Payer: Cash Price |
$40,400.00
|
| Rate for Payer: Cigna Commercial |
$67,064.00
|
| Rate for Payer: First Health Commercial |
$76,760.00
|
| Rate for Payer: Humana Commercial |
$68,680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,256.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,630.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,104.00
|
| Rate for Payer: Ohio Health Group HMO |
$60,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,504.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,048.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
|
DEFIB DC ATLAS DR V-242
|
Facility
|
IP
|
$76,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,919.00 |
| Max. Negotiated Rate |
$73,248.00 |
| Rate for Payer: Aetna Commercial |
$58,751.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,514.00
|
| Rate for Payer: Cash Price |
$38,150.00
|
| Rate for Payer: Cigna Commercial |
$63,329.00
|
| Rate for Payer: First Health Commercial |
$72,485.00
|
| Rate for Payer: Humana Commercial |
$64,855.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,566.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,309.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,890.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,919.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,653.00
|
| Rate for Payer: PHCS Commercial |
$73,248.00
|
| Rate for Payer: United Healthcare All Payer |
$67,144.00
|
|
|
DEFIB DC ATLAS DR V-242
|
Facility
|
OP
|
$76,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,919.00 |
| Max. Negotiated Rate |
$73,248.00 |
| Rate for Payer: Aetna Commercial |
$58,751.00
|
| Rate for Payer: Anthem Medicaid |
$26,239.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,514.00
|
| Rate for Payer: Cash Price |
$38,150.00
|
| Rate for Payer: Cigna Commercial |
$63,329.00
|
| Rate for Payer: First Health Commercial |
$72,485.00
|
| Rate for Payer: Humana Commercial |
$64,855.00
|
| Rate for Payer: Humana KY Medicaid |
$26,239.57
|
| Rate for Payer: Kentucky WC Medicaid |
$26,506.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,566.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,309.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,890.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,766.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,919.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,653.00
|
| Rate for Payer: PHCS Commercial |
$73,248.00
|
| Rate for Payer: United Healthcare All Payer |
$67,144.00
|
|
