|
DEFIB VITALITY DS VR SC T135
|
Facility
|
OP
|
$72,700.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,451.00 |
| Max. Negotiated Rate |
$69,792.00 |
| Rate for Payer: Aetna Commercial |
$55,979.00
|
| Rate for Payer: Anthem Medicaid |
$25,001.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,706.00
|
| Rate for Payer: Cash Price |
$36,350.00
|
| Rate for Payer: Cigna Commercial |
$60,341.00
|
| Rate for Payer: First Health Commercial |
$69,065.00
|
| Rate for Payer: Humana Commercial |
$61,795.00
|
| Rate for Payer: Humana KY Medicaid |
$25,001.53
|
| Rate for Payer: Kentucky WC Medicaid |
$25,255.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,652.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,503.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$54,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,537.00
|
| Rate for Payer: PHCS Commercial |
$69,792.00
|
| Rate for Payer: United Healthcare All Payer |
$63,976.00
|
|
|
DEFIB VITALITY EL DC T127
|
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
|
|
|
DEFIB VITALITY EL DC T127
|
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 VITALITY HE DC T180
|
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
|
|
|
DEFIB VITALITY HE DC T180
|
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 VIVA QUAD XT CRT-D DF1
|
Facility
|
OP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem Medicaid |
$32,429.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Humana KY Medicaid |
$32,429.77
|
| Rate for Payer: Kentucky WC Medicaid |
$32,759.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
DEFIB VIVA QUAD XT CRT-D DF1
|
Facility
|
IP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
DEFIB VIVA QUAD XT CRT-D DF4
|
Facility
|
IP
|
$87,460.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,369.80 |
| Max. Negotiated Rate |
$83,961.60 |
| Rate for Payer: Aetna Commercial |
$67,344.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68,218.80
|
| Rate for Payer: Cash Price |
$43,730.00
|
| Rate for Payer: Cigna Commercial |
$72,591.80
|
| Rate for Payer: First Health Commercial |
$83,087.00
|
| Rate for Payer: Humana Commercial |
$74,341.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71,717.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64,545.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,238.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,964.80
|
| Rate for Payer: Ohio Health Group HMO |
$65,595.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,369.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,112.60
|
| Rate for Payer: PHCS Commercial |
$83,961.60
|
| Rate for Payer: United Healthcare All Payer |
$76,964.80
|
|
|
DEFIB VIVA QUAD XT CRT-D DF4
|
Facility
|
OP
|
$87,460.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,369.80 |
| Max. Negotiated Rate |
$83,961.60 |
| Rate for Payer: Aetna Commercial |
$67,344.20
|
| Rate for Payer: Anthem Medicaid |
$30,077.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68,218.80
|
| Rate for Payer: Cash Price |
$43,730.00
|
| Rate for Payer: Cigna Commercial |
$72,591.80
|
| Rate for Payer: First Health Commercial |
$83,087.00
|
| Rate for Payer: Humana Commercial |
$74,341.00
|
| Rate for Payer: Humana KY Medicaid |
$30,077.49
|
| Rate for Payer: Kentucky WC Medicaid |
$30,383.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71,717.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64,545.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,238.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,680.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,964.80
|
| Rate for Payer: Ohio Health Group HMO |
$65,595.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,369.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,112.60
|
| Rate for Payer: PHCS Commercial |
$83,961.60
|
| Rate for Payer: United Healthcare All Payer |
$76,964.80
|
|
|
DEFIB VIVA S QUAD CRT-D DF1
|
Facility
|
OP
|
$92,500.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,025.00 |
| Max. Negotiated Rate |
$88,800.00 |
| Rate for Payer: Aetna Commercial |
$71,225.00
|
| Rate for Payer: Anthem Medicaid |
$31,810.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72,150.00
|
| Rate for Payer: Cash Price |
$46,250.00
|
| Rate for Payer: Cigna Commercial |
$76,775.00
|
| Rate for Payer: First Health Commercial |
$87,875.00
|
| Rate for Payer: Humana Commercial |
$78,625.00
|
| Rate for Payer: Humana KY Medicaid |
$31,810.75
|
| Rate for Payer: Kentucky WC Medicaid |
$32,134.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75,850.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68,265.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,750.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,449.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$81,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$69,375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,025.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,675.00
|
| Rate for Payer: PHCS Commercial |
$88,800.00
|
| Rate for Payer: United Healthcare All Payer |
$81,400.00
|
|
|
DEFIB VIVA S QUAD CRT-D DF1
|
Facility
|
IP
|
$92,500.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,025.00 |
| Max. Negotiated Rate |
$88,800.00 |
| Rate for Payer: Aetna Commercial |
$71,225.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72,150.00
|
| Rate for Payer: Cash Price |
$46,250.00
|
| Rate for Payer: Cigna Commercial |
$76,775.00
|
| Rate for Payer: First Health Commercial |
$87,875.00
|
| Rate for Payer: Humana Commercial |
$78,625.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75,850.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68,265.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$81,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$69,375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,025.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,675.00
|
| Rate for Payer: PHCS Commercial |
$88,800.00
|
| Rate for Payer: United Healthcare All Payer |
$81,400.00
|
|
|
DEFIB VIVA S QUAD CRT-D DF4
|
Facility
|
IP
|
$92,500.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,025.00 |
| Max. Negotiated Rate |
$88,800.00 |
| Rate for Payer: Aetna Commercial |
$71,225.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72,150.00
|
| Rate for Payer: Cash Price |
$46,250.00
|
| Rate for Payer: Cigna Commercial |
$76,775.00
|
| Rate for Payer: First Health Commercial |
$87,875.00
|
| Rate for Payer: Humana Commercial |
$78,625.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75,850.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68,265.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$81,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$69,375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,025.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,675.00
|
| Rate for Payer: PHCS Commercial |
$88,800.00
|
| Rate for Payer: United Healthcare All Payer |
$81,400.00
|
|
|
DEFIB VIVA S QUAD CRT-D DF4
|
Facility
|
OP
|
$92,500.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,025.00 |
| Max. Negotiated Rate |
$88,800.00 |
| Rate for Payer: Aetna Commercial |
$71,225.00
|
| Rate for Payer: Anthem Medicaid |
$31,810.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72,150.00
|
| Rate for Payer: Cash Price |
$46,250.00
|
| Rate for Payer: Cigna Commercial |
$76,775.00
|
| Rate for Payer: First Health Commercial |
$87,875.00
|
| Rate for Payer: Humana Commercial |
$78,625.00
|
| Rate for Payer: Humana KY Medicaid |
$31,810.75
|
| Rate for Payer: Kentucky WC Medicaid |
$32,134.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75,850.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68,265.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,750.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,449.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$81,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$69,375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,025.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,675.00
|
| Rate for Payer: PHCS Commercial |
$88,800.00
|
| Rate for Payer: United Healthcare All Payer |
$81,400.00
|
|
|
DEFINATIVE ANAEROBIC ID
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 87076
|
| Hospital Charge Code |
30001260
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
DEFINATIVE ANAEROBIC ID
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 87076
|
| Hospital Charge Code |
30001260
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem Medicaid |
$8.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.08
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Humana KY Medicaid |
$8.08
|
| Rate for Payer: Humana Medicare Advantage |
$8.08
|
| Rate for Payer: Kentucky WC Medicaid |
$8.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
DEFINITY 1.1MG/ML(1.5MG V)EAML
|
Facility
|
IP
|
$841.09
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
25002737
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.34 |
| Max. Negotiated Rate |
$807.45 |
| Rate for Payer: Aetna Commercial |
$647.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$656.05
|
| Rate for Payer: Cash Price |
$420.54
|
| Rate for Payer: Cigna Commercial |
$698.10
|
| Rate for Payer: First Health Commercial |
$799.04
|
| Rate for Payer: Humana Commercial |
$714.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$689.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$620.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$740.16
|
| Rate for Payer: Ohio Health Group HMO |
$630.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.74
|
| Rate for Payer: PHCS Commercial |
$807.45
|
| Rate for Payer: United Healthcare All Payer |
$740.16
|
|
|
DEFINITY 1.1MG/ML(1.5MG V)EAML
|
Facility
|
OP
|
$841.09
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
25002737
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.34 |
| Max. Negotiated Rate |
$807.45 |
| Rate for Payer: Cash Price |
$420.54
|
| Rate for Payer: Cigna Commercial |
$698.10
|
| Rate for Payer: First Health Commercial |
$799.04
|
| Rate for Payer: Humana Commercial |
$714.93
|
| Rate for Payer: Humana KY Medicaid |
$289.25
|
| Rate for Payer: Kentucky WC Medicaid |
$292.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$689.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$620.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$295.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$740.16
|
| Rate for Payer: Ohio Health Group HMO |
$630.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.74
|
| Rate for Payer: PHCS Commercial |
$807.45
|
| Rate for Payer: United Healthcare All Payer |
$740.16
|
| Rate for Payer: Aetna Commercial |
$647.64
|
| Rate for Payer: Anthem Medicaid |
$289.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$656.05
|
|
|
DEFRIB FORTIFY CD2257-40
|
Facility
|
IP
|
$78,640.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,223.20 |
| Max. Negotiated Rate |
$75,494.40 |
| Rate for Payer: Aetna Commercial |
$60,552.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,339.20
|
| Rate for Payer: Cash Price |
$39,320.00
|
| Rate for Payer: Cigna Commercial |
$65,271.20
|
| Rate for Payer: First Health Commercial |
$74,708.00
|
| Rate for Payer: Humana Commercial |
$66,844.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,484.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,036.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,203.20
|
| Rate for Payer: Ohio Health Group HMO |
$58,980.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,223.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,378.40
|
| Rate for Payer: PHCS Commercial |
$75,494.40
|
| Rate for Payer: United Healthcare All Payer |
$69,203.20
|
|
|
DEFRIB FORTIFY CD2257-40
|
Facility
|
OP
|
$78,640.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,223.20 |
| Max. Negotiated Rate |
$75,494.40 |
| Rate for Payer: Aetna Commercial |
$60,552.80
|
| Rate for Payer: Anthem Medicaid |
$27,044.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,339.20
|
| Rate for Payer: Cash Price |
$39,320.00
|
| Rate for Payer: Cigna Commercial |
$65,271.20
|
| Rate for Payer: First Health Commercial |
$74,708.00
|
| Rate for Payer: Humana Commercial |
$66,844.00
|
| Rate for Payer: Humana KY Medicaid |
$27,044.30
|
| Rate for Payer: Kentucky WC Medicaid |
$27,319.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,484.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,036.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,586.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,203.20
|
| Rate for Payer: Ohio Health Group HMO |
$58,980.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,223.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,378.40
|
| Rate for Payer: PHCS Commercial |
$75,494.40
|
| Rate for Payer: United Healthcare All Payer |
$69,203.20
|
|
|
DEFYNE
|
Professional
|
Both
|
$600.00
|
|
| Hospital Charge Code |
22200025
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC
|
Facility
|
IP
|
$28,005.50
|
|
|
Service Code
|
MSDRG 056
|
| Min. Negotiated Rate |
$19,003.73 |
| Max. Negotiated Rate |
$28,005.50 |
| Rate for Payer: Anthem Medicaid |
$19,003.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20,003.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28,005.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$27,005.31
|
| Rate for Payer: Humana KY Medicaid |
$19,003.73
|
| Rate for Payer: Humana Medicare Advantage |
$20,003.93
|
| Rate for Payer: Kentucky WC Medicaid |
$19,193.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,004.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,383.81
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$15,946.98
|
|
|
Service Code
|
MSDRG 057
|
| Min. Negotiated Rate |
$10,821.16 |
| Max. Negotiated Rate |
$15,946.98 |
| Rate for Payer: Anthem Medicaid |
$10,821.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,390.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,946.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,377.44
|
| Rate for Payer: Humana KY Medicaid |
$10,821.16
|
| Rate for Payer: Humana Medicare Advantage |
$11,390.70
|
| Rate for Payer: Kentucky WC Medicaid |
$10,929.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,668.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,037.59
|
|
|
DELAYED BREAST PROSTHESIS
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 19342
|
| Hospital Charge Code |
76100312
|
|
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
|
|
|
DELAYED BREAST PROSTHESIS
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 19342
|
| Hospital Charge Code |
76100312
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$651.49 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,333.32
|
| Rate for Payer: Anthem Medicaid |
$651.49
|
| 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 |
$1,258.86
|
| Rate for Payer: Healthspan PPO |
$1,066.11
|
| Rate for Payer: Humana Medicaid |
$651.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,185.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$664.52
|
| Rate for Payer: Molina Healthcare Passport |
$651.49
|
| 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 |
$658.00
|
|
|
DELAYED BREAST PROSTHESIS
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 19342
|
| Hospital Charge Code |
76100312
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$11,412.41 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,151.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,412.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,004.82
|
| Rate for Payer: Cash Price |
$1,000.00
|
| 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: Humana Medicare Advantage |
$8,151.72
|
| 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 |
$9,782.06
|
| 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
|
|
