|
DEFIB LEAD OPTSUR 58CM LDA210Q
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
DEFIB LEAD OPTSUR 65CM LDA210Q
|
Facility
|
IP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
DEFIB LEAD OPTSUR 65CM LDA210Q
|
Facility
|
OP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem Medicaid |
$3,770.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Humana KY Medicaid |
$3,770.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,809.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,846.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
DEFIB LEAD QUATTRO SNG 693558
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
DEFIB LEAD QUATTRO SNG 693558
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
DEFIB LEAD RELIANCE AF 0138
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
DEFIB LEAD RELIANCE AF 0138
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
DEFIB LEAD RELIANCE AF 0157
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
DEFIB LEAD RELIANCE AF 0157
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
DEFIB LEAD RELIANCE AF 0159
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
DEFIB LEAD RELIANCE AF 0159
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
DEFIB LEAD RELIANCE G AF 0180
|
Facility
|
OP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem Medicaid |
$5,468.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Humana KY Medicaid |
$5,468.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,523.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,577.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
DEFIB LEAD RELIANCE G AF 0180
|
Facility
|
IP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
DEFIB LEAD RELIANCE G AF 0181
|
Facility
|
OP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem Medicaid |
$5,468.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Humana KY Medicaid |
$5,468.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,523.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,577.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
DEFIB LEAD RELIANCE G AF 0181
|
Facility
|
IP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
DEFIB LEADRELIANCE G AF 0185
|
Facility
|
OP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem Medicaid |
$5,468.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Humana KY Medicaid |
$5,468.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,523.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,577.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
DEFIB LEADRELIANCE G AF 0185
|
Facility
|
IP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
DEFIB LEAD RELIANCE G AF 0186
|
Facility
|
OP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem Medicaid |
$5,468.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Humana KY Medicaid |
$5,468.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,523.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,577.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
DEFIB LEAD RELIANCE G AF 0186
|
Facility
|
IP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
DEFIB LEAD RELIANCE G PF 0170
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
DEFIB LEAD RELIANCE G PF 0170
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
DEFIB LEAD RELIANCE G PF 0171
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
DEFIB LEAD RELIANCE G PF 0171
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
DEFIB LEAD RELIANCE G PF 0174
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
DEFIB LEAD RELIANCE G PF 0174
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
