|
DEFIB LEAD RELIANCE G PF 0175
|
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 PF 0175
|
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 0176
|
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 PF 0176
|
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 PF 0127
|
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 PF 0127
|
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 PF 0128
|
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 PF 0128
|
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 PF 0147
|
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 PF 0147
|
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 PF 0148
|
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 PF 0148
|
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 PF 0149
|
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 PF 0149
|
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 RELNC G MODEL 0184
|
Facility
|
OP
|
$15,316.80
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.18 |
| Max. Negotiated Rate |
$14,704.13 |
| Rate for Payer: Aetna Commercial |
$11,793.94
|
| Rate for Payer: Anthem Medicaid |
$5,267.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,947.10
|
| Rate for Payer: Cash Price |
$7,658.40
|
| Rate for Payer: Cigna Commercial |
$12,712.94
|
| Rate for Payer: First Health Commercial |
$14,550.96
|
| Rate for Payer: Humana Commercial |
$13,019.28
|
| Rate for Payer: Humana KY Medicaid |
$5,267.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,321.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,559.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,303.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,595.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,373.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,478.78
|
| Rate for Payer: Ohio Health Group HMO |
$11,487.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,991.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,748.21
|
| Rate for Payer: PHCS Commercial |
$14,704.13
|
| Rate for Payer: United Healthcare All Payer |
$13,478.78
|
|
|
DEFIB LEAD RELNC G MODEL 0184
|
Facility
|
IP
|
$15,316.80
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.18 |
| Max. Negotiated Rate |
$14,704.13 |
| Rate for Payer: Aetna Commercial |
$11,793.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,947.10
|
| Rate for Payer: Cash Price |
$7,658.40
|
| Rate for Payer: Cigna Commercial |
$12,712.94
|
| Rate for Payer: First Health Commercial |
$14,550.96
|
| Rate for Payer: Humana Commercial |
$13,019.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,559.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,303.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,595.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,478.78
|
| Rate for Payer: Ohio Health Group HMO |
$11,487.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,991.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,748.21
|
| Rate for Payer: PHCS Commercial |
$14,704.13
|
| Rate for Payer: United Healthcare All Payer |
$13,478.78
|
|
|
DEFIB LEAD SUB 6996SQ58
|
Facility
|
OP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem Medicaid |
$4,272.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Humana KY Medicaid |
$4,272.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,316.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,358.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
DEFIB LEAD SUB 6996SQ58
|
Facility
|
IP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
DEFIB LEXOS DR-T 347 001
|
Facility
|
OP
|
$97,900.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,727.00 |
| Max. Negotiated Rate |
$93,984.00 |
| Rate for Payer: Aetna Commercial |
$75,383.00
|
| Rate for Payer: Anthem Medicaid |
$33,667.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,362.00
|
| Rate for Payer: Cash Price |
$48,950.00
|
| Rate for Payer: Cigna Commercial |
$81,257.00
|
| Rate for Payer: First Health Commercial |
$93,005.00
|
| Rate for Payer: Humana Commercial |
$83,215.00
|
| Rate for Payer: Humana KY Medicaid |
$33,667.81
|
| Rate for Payer: Kentucky WC Medicaid |
$34,010.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,278.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,250.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,370.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,343.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,152.00
|
| Rate for Payer: Ohio Health Group HMO |
$73,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,727.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30,349.00
|
| Rate for Payer: PHCS Commercial |
$93,984.00
|
| Rate for Payer: United Healthcare All Payer |
$86,152.00
|
|
|
DEFIB LEXOS DR-T 347 001
|
Facility
|
IP
|
$97,900.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,727.00 |
| Max. Negotiated Rate |
$93,984.00 |
| Rate for Payer: Aetna Commercial |
$75,383.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,362.00
|
| Rate for Payer: Cash Price |
$48,950.00
|
| Rate for Payer: Cigna Commercial |
$81,257.00
|
| Rate for Payer: First Health Commercial |
$93,005.00
|
| Rate for Payer: Humana Commercial |
$83,215.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,278.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,250.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,370.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,152.00
|
| Rate for Payer: Ohio Health Group HMO |
$73,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,727.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30,349.00
|
| Rate for Payer: PHCS Commercial |
$93,984.00
|
| Rate for Payer: United Healthcare All Payer |
$86,152.00
|
|
|
DEFIB LEXOS VR-T 346 999
|
Facility
|
OP
|
$90,700.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,791.00 |
| Max. Negotiated Rate |
$87,072.00 |
| Rate for Payer: Aetna Commercial |
$69,839.00
|
| Rate for Payer: Anthem Medicaid |
$31,191.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,746.00
|
| Rate for Payer: Cash Price |
$45,350.00
|
| Rate for Payer: Cigna Commercial |
$75,281.00
|
| Rate for Payer: First Health Commercial |
$86,165.00
|
| Rate for Payer: Humana Commercial |
$77,095.00
|
| Rate for Payer: Humana KY Medicaid |
$31,191.73
|
| Rate for Payer: Kentucky WC Medicaid |
$31,509.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,374.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,936.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,210.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,817.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$68,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,791.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,117.00
|
| Rate for Payer: PHCS Commercial |
$87,072.00
|
| Rate for Payer: United Healthcare All Payer |
$79,816.00
|
|
|
DEFIB LEXOS VR-T 346 999
|
Facility
|
IP
|
$90,700.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,791.00 |
| Max. Negotiated Rate |
$87,072.00 |
| Rate for Payer: Aetna Commercial |
$69,839.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,746.00
|
| Rate for Payer: Cash Price |
$45,350.00
|
| Rate for Payer: Cigna Commercial |
$75,281.00
|
| Rate for Payer: First Health Commercial |
$86,165.00
|
| Rate for Payer: Humana Commercial |
$77,095.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,374.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,936.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,210.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$68,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,791.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,117.00
|
| Rate for Payer: PHCS Commercial |
$87,072.00
|
| Rate for Payer: United Healthcare All Payer |
$79,816.00
|
|
|
DEFIB LUMOS VR-T 353 219
|
Facility
|
IP
|
$90,700.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,791.00 |
| Max. Negotiated Rate |
$87,072.00 |
| Rate for Payer: Aetna Commercial |
$69,839.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,746.00
|
| Rate for Payer: Cash Price |
$45,350.00
|
| Rate for Payer: Cigna Commercial |
$75,281.00
|
| Rate for Payer: First Health Commercial |
$86,165.00
|
| Rate for Payer: Humana Commercial |
$77,095.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,374.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,936.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,210.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$68,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,791.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,117.00
|
| Rate for Payer: PHCS Commercial |
$87,072.00
|
| Rate for Payer: United Healthcare All Payer |
$79,816.00
|
|
|
DEFIB LUMOS VR-T 353 219
|
Facility
|
OP
|
$90,700.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,791.00 |
| Max. Negotiated Rate |
$87,072.00 |
| Rate for Payer: Aetna Commercial |
$69,839.00
|
| Rate for Payer: Anthem Medicaid |
$31,191.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,746.00
|
| Rate for Payer: Cash Price |
$45,350.00
|
| Rate for Payer: Cigna Commercial |
$75,281.00
|
| Rate for Payer: First Health Commercial |
$86,165.00
|
| Rate for Payer: Humana Commercial |
$77,095.00
|
| Rate for Payer: Humana KY Medicaid |
$31,191.73
|
| Rate for Payer: Kentucky WC Medicaid |
$31,509.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,374.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,936.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,210.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,817.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$68,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,791.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,117.00
|
| Rate for Payer: PHCS Commercial |
$87,072.00
|
| Rate for Payer: United Healthcare All Payer |
$79,816.00
|
|
|
DEFIB PRIZM HE DR DC 1858
|
Facility
|
OP
|
$79,900.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,387.00 |
| Max. Negotiated Rate |
$76,704.00 |
| Rate for Payer: Aetna Commercial |
$61,523.00
|
| Rate for Payer: Anthem Medicaid |
$27,477.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,322.00
|
| Rate for Payer: Cash Price |
$39,950.00
|
| Rate for Payer: Cigna Commercial |
$66,317.00
|
| Rate for Payer: First Health Commercial |
$75,905.00
|
| Rate for Payer: Humana Commercial |
$67,915.00
|
| Rate for Payer: Humana KY Medicaid |
$27,477.61
|
| Rate for Payer: Kentucky WC Medicaid |
$27,757.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,518.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,966.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,970.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,028.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,312.00
|
| Rate for Payer: Ohio Health Group HMO |
$59,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,387.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,769.00
|
| Rate for Payer: PHCS Commercial |
$76,704.00
|
| Rate for Payer: United Healthcare All Payer |
$70,312.00
|
|
