|
DEFEROXAMINE 500mg(2gm) IV SDV
|
Facility
|
IP
|
$224.54
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
25004296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.36 |
| Max. Negotiated Rate |
$215.56 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.14
|
| Rate for Payer: Cash Price |
$112.27
|
| Rate for Payer: Cigna Commercial |
$186.37
|
| Rate for Payer: First Health Commercial |
$213.31
|
| Rate for Payer: Humana Commercial |
$190.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$165.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$197.60
|
| Rate for Payer: Ohio Health Group HMO |
$168.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.93
|
| Rate for Payer: PHCS Commercial |
$215.56
|
| Rate for Payer: United Healthcare All Payer |
$197.60
|
|
|
DEFIB AMPLIA MRI QUAD DTMB1QQ
|
Facility
|
OP
|
$93,925.20
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$28,177.56 |
| Max. Negotiated Rate |
$90,168.19 |
| Rate for Payer: Aetna Commercial |
$72,322.40
|
| Rate for Payer: Anthem Medicaid |
$32,300.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,261.66
|
| Rate for Payer: Cash Price |
$46,962.60
|
| Rate for Payer: Cigna Commercial |
$77,957.92
|
| Rate for Payer: First Health Commercial |
$89,228.94
|
| Rate for Payer: Humana Commercial |
$79,836.42
|
| Rate for Payer: Humana KY Medicaid |
$32,300.88
|
| Rate for Payer: Kentucky WC Medicaid |
$32,629.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,018.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,316.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,177.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,948.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,654.18
|
| Rate for Payer: Ohio Health Group HMO |
$70,443.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75,140.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81,714.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64,808.39
|
| Rate for Payer: PHCS Commercial |
$90,168.19
|
| Rate for Payer: United Healthcare All Payer |
$82,654.18
|
|
|
DEFIB AMPLIA MRI QUAD DTMB1QQ
|
Facility
|
IP
|
$93,925.20
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$28,177.56 |
| Max. Negotiated Rate |
$90,168.19 |
| Rate for Payer: Aetna Commercial |
$72,322.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,261.66
|
| Rate for Payer: Cash Price |
$46,962.60
|
| Rate for Payer: Cigna Commercial |
$77,957.92
|
| Rate for Payer: First Health Commercial |
$89,228.94
|
| Rate for Payer: Humana Commercial |
$79,836.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,018.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,316.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,177.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,654.18
|
| Rate for Payer: Ohio Health Group HMO |
$70,443.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75,140.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81,714.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64,808.39
|
| Rate for Payer: PHCS Commercial |
$90,168.19
|
| Rate for Payer: United Healthcare All Payer |
$82,654.18
|
|
|
DEFIB ATLAS V-343
|
Facility
|
OP
|
$113,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$33,930.00 |
| Max. Negotiated Rate |
$108,576.00 |
| Rate for Payer: Aetna Commercial |
$87,087.00
|
| Rate for Payer: Anthem Medicaid |
$38,895.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88,218.00
|
| Rate for Payer: Cash Price |
$56,550.00
|
| Rate for Payer: Cigna Commercial |
$93,873.00
|
| Rate for Payer: First Health Commercial |
$107,445.00
|
| Rate for Payer: Humana Commercial |
$96,135.00
|
| Rate for Payer: Humana KY Medicaid |
$38,895.09
|
| Rate for Payer: Kentucky WC Medicaid |
$39,290.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92,742.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83,467.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33,930.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$39,675.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$99,528.00
|
| Rate for Payer: Ohio Health Group HMO |
$84,825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98,397.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78,039.00
|
| Rate for Payer: PHCS Commercial |
$108,576.00
|
| Rate for Payer: United Healthcare All Payer |
$99,528.00
|
|
|
DEFIB ATLAS V-343
|
Facility
|
IP
|
$113,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$33,930.00 |
| Max. Negotiated Rate |
$108,576.00 |
| Rate for Payer: Aetna Commercial |
$87,087.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88,218.00
|
| Rate for Payer: Cash Price |
$56,550.00
|
| Rate for Payer: Cigna Commercial |
$93,873.00
|
| Rate for Payer: First Health Commercial |
$107,445.00
|
| Rate for Payer: Humana Commercial |
$96,135.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92,742.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83,467.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33,930.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$99,528.00
|
| Rate for Payer: Ohio Health Group HMO |
$84,825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98,397.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78,039.00
|
| Rate for Payer: PHCS Commercial |
$108,576.00
|
| Rate for Payer: United Healthcare All Payer |
$99,528.00
|
|
|
DEFIB CONCRTO II CRT-D D274TRK
|
Facility
|
OP
|
$103,600.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$31,080.00 |
| Max. Negotiated Rate |
$99,456.00 |
| Rate for Payer: Aetna Commercial |
$79,772.00
|
| Rate for Payer: Anthem Medicaid |
$35,628.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80,808.00
|
| Rate for Payer: Cash Price |
$51,800.00
|
| Rate for Payer: Cigna Commercial |
$85,988.00
|
| Rate for Payer: First Health Commercial |
$98,420.00
|
| Rate for Payer: Humana Commercial |
$88,060.00
|
| Rate for Payer: Humana KY Medicaid |
$35,628.04
|
| Rate for Payer: Kentucky WC Medicaid |
$35,990.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$84,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76,456.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31,080.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$36,342.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$91,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$77,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90,132.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71,484.00
|
| Rate for Payer: PHCS Commercial |
$99,456.00
|
| Rate for Payer: United Healthcare All Payer |
$91,168.00
|
|
|
DEFIB CONCRTO II CRT-D D274TRK
|
Facility
|
IP
|
$103,600.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$31,080.00 |
| Max. Negotiated Rate |
$99,456.00 |
| Rate for Payer: Aetna Commercial |
$79,772.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80,808.00
|
| Rate for Payer: Cash Price |
$51,800.00
|
| Rate for Payer: Cigna Commercial |
$85,988.00
|
| Rate for Payer: First Health Commercial |
$98,420.00
|
| Rate for Payer: Humana Commercial |
$88,060.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$84,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76,456.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31,080.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$91,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$77,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90,132.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71,484.00
|
| Rate for Payer: PHCS Commercial |
$99,456.00
|
| Rate for Payer: United Healthcare All Payer |
$91,168.00
|
|
|
DEFIB CUR+DR CD2211-36Q
|
Facility
|
IP
|
$85,550.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$25,665.00 |
| Max. Negotiated Rate |
$82,128.00 |
| Rate for Payer: Aetna Commercial |
$65,873.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66,729.00
|
| Rate for Payer: Cash Price |
$42,775.00
|
| Rate for Payer: Cigna Commercial |
$71,006.50
|
| Rate for Payer: First Health Commercial |
$81,272.50
|
| Rate for Payer: Humana Commercial |
$72,717.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,151.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,135.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,665.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$75,284.00
|
| Rate for Payer: Ohio Health Group HMO |
$64,162.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74,428.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,029.50
|
| Rate for Payer: PHCS Commercial |
$82,128.00
|
| Rate for Payer: United Healthcare All Payer |
$75,284.00
|
|
|
DEFIB CUR+DR CD2211-36Q
|
Facility
|
OP
|
$85,550.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$25,665.00 |
| Max. Negotiated Rate |
$82,128.00 |
| Rate for Payer: Aetna Commercial |
$65,873.50
|
| Rate for Payer: Anthem Medicaid |
$29,420.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66,729.00
|
| Rate for Payer: Cash Price |
$42,775.00
|
| Rate for Payer: Cigna Commercial |
$71,006.50
|
| Rate for Payer: First Health Commercial |
$81,272.50
|
| Rate for Payer: Humana Commercial |
$72,717.50
|
| Rate for Payer: Humana KY Medicaid |
$29,420.65
|
| Rate for Payer: Kentucky WC Medicaid |
$29,720.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,151.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,135.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,665.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,010.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$75,284.00
|
| Rate for Payer: Ohio Health Group HMO |
$64,162.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74,428.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,029.50
|
| Rate for Payer: PHCS Commercial |
$82,128.00
|
| Rate for Payer: United Healthcare All Payer |
$75,284.00
|
|
|
DEFIB CURR+DR CD2211-36
|
Facility
|
IP
|
$84,600.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$25,380.00 |
| Max. Negotiated Rate |
$81,216.00 |
| Rate for Payer: Aetna Commercial |
$65,142.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,988.00
|
| Rate for Payer: Cash Price |
$42,300.00
|
| Rate for Payer: Cigna Commercial |
$70,218.00
|
| Rate for Payer: First Health Commercial |
$80,370.00
|
| Rate for Payer: Humana Commercial |
$71,910.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69,372.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62,434.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,380.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$74,448.00
|
| Rate for Payer: Ohio Health Group HMO |
$63,450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73,602.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58,374.00
|
| Rate for Payer: PHCS Commercial |
$81,216.00
|
| Rate for Payer: United Healthcare All Payer |
$74,448.00
|
|
|
DEFIB CURR+DR CD2211-36
|
Facility
|
OP
|
$84,600.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$25,380.00 |
| Max. Negotiated Rate |
$81,216.00 |
| Rate for Payer: Aetna Commercial |
$65,142.00
|
| Rate for Payer: Anthem Medicaid |
$29,093.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,988.00
|
| Rate for Payer: Cash Price |
$42,300.00
|
| Rate for Payer: Cigna Commercial |
$70,218.00
|
| Rate for Payer: First Health Commercial |
$80,370.00
|
| Rate for Payer: Humana Commercial |
$71,910.00
|
| Rate for Payer: Humana KY Medicaid |
$29,093.94
|
| Rate for Payer: Kentucky WC Medicaid |
$29,390.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69,372.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62,434.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,380.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,677.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$74,448.00
|
| Rate for Payer: Ohio Health Group HMO |
$63,450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73,602.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58,374.00
|
| Rate for Payer: PHCS Commercial |
$81,216.00
|
| Rate for Payer: United Healthcare All Payer |
$74,448.00
|
|
|
DEFIB CURR+VR CD1211-36
|
Facility
|
OP
|
$83,650.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$25,095.00 |
| Max. Negotiated Rate |
$80,304.00 |
| Rate for Payer: Aetna Commercial |
$64,410.50
|
| Rate for Payer: Anthem Medicaid |
$28,767.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,247.00
|
| Rate for Payer: Cash Price |
$41,825.00
|
| Rate for Payer: Cigna Commercial |
$69,429.50
|
| Rate for Payer: First Health Commercial |
$79,467.50
|
| Rate for Payer: Humana Commercial |
$71,102.50
|
| Rate for Payer: Humana KY Medicaid |
$28,767.24
|
| Rate for Payer: Kentucky WC Medicaid |
$29,060.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,593.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,733.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,095.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,344.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,612.00
|
| Rate for Payer: Ohio Health Group HMO |
$62,737.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72,775.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,718.50
|
| Rate for Payer: PHCS Commercial |
$80,304.00
|
| Rate for Payer: United Healthcare All Payer |
$73,612.00
|
|
|
DEFIB CURR+VR CD1211-36
|
Facility
|
IP
|
$83,650.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$25,095.00 |
| Max. Negotiated Rate |
$80,304.00 |
| Rate for Payer: Aetna Commercial |
$64,410.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,247.00
|
| Rate for Payer: Cash Price |
$41,825.00
|
| Rate for Payer: Cigna Commercial |
$69,429.50
|
| Rate for Payer: First Health Commercial |
$79,467.50
|
| Rate for Payer: Humana Commercial |
$71,102.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,593.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,733.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,095.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,612.00
|
| Rate for Payer: Ohio Health Group HMO |
$62,737.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72,775.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,718.50
|
| Rate for Payer: PHCS Commercial |
$80,304.00
|
| Rate for Payer: United Healthcare All Payer |
$73,612.00
|
|
|
DEFIB CUR+VR CD1211-36Q
|
Facility
|
OP
|
$83,650.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$25,095.00 |
| Max. Negotiated Rate |
$80,304.00 |
| Rate for Payer: Aetna Commercial |
$64,410.50
|
| Rate for Payer: Anthem Medicaid |
$28,767.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,247.00
|
| Rate for Payer: Cash Price |
$41,825.00
|
| Rate for Payer: Cigna Commercial |
$69,429.50
|
| Rate for Payer: First Health Commercial |
$79,467.50
|
| Rate for Payer: Humana Commercial |
$71,102.50
|
| Rate for Payer: Humana KY Medicaid |
$28,767.24
|
| Rate for Payer: Kentucky WC Medicaid |
$29,060.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,593.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,733.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,095.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,344.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,612.00
|
| Rate for Payer: Ohio Health Group HMO |
$62,737.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72,775.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,718.50
|
| Rate for Payer: PHCS Commercial |
$80,304.00
|
| Rate for Payer: United Healthcare All Payer |
$73,612.00
|
|
|
DEFIB CUR+VR CD1211-36Q
|
Facility
|
IP
|
$83,650.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$25,095.00 |
| Max. Negotiated Rate |
$80,304.00 |
| Rate for Payer: Aetna Commercial |
$64,410.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,247.00
|
| Rate for Payer: Cash Price |
$41,825.00
|
| Rate for Payer: Cigna Commercial |
$69,429.50
|
| Rate for Payer: First Health Commercial |
$79,467.50
|
| Rate for Payer: Humana Commercial |
$71,102.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,593.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,733.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,095.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,612.00
|
| Rate for Payer: Ohio Health Group HMO |
$62,737.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72,775.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,718.50
|
| Rate for Payer: PHCS Commercial |
$80,304.00
|
| Rate for Payer: United Healthcare All Payer |
$73,612.00
|
|
|
DEFIB DC ATLAS DR V-242
|
Facility
|
IP
|
$78,900.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,670.00 |
| Max. Negotiated Rate |
$75,744.00 |
| Rate for Payer: Aetna Commercial |
$60,753.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,542.00
|
| Rate for Payer: Cash Price |
$39,450.00
|
| Rate for Payer: Cigna Commercial |
$65,487.00
|
| Rate for Payer: First Health Commercial |
$74,955.00
|
| Rate for Payer: Humana Commercial |
$67,065.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,698.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,228.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,670.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,432.00
|
| Rate for Payer: Ohio Health Group HMO |
$59,175.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,643.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,441.00
|
| Rate for Payer: PHCS Commercial |
$75,744.00
|
| Rate for Payer: United Healthcare All Payer |
$69,432.00
|
|
|
DEFIB DC ATLAS DR V-242
|
Facility
|
OP
|
$78,900.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,670.00 |
| Max. Negotiated Rate |
$75,744.00 |
| Rate for Payer: Aetna Commercial |
$60,753.00
|
| Rate for Payer: Anthem Medicaid |
$27,133.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,542.00
|
| Rate for Payer: Cash Price |
$39,450.00
|
| Rate for Payer: Cigna Commercial |
$65,487.00
|
| Rate for Payer: First Health Commercial |
$74,955.00
|
| Rate for Payer: Humana Commercial |
$67,065.00
|
| Rate for Payer: Humana KY Medicaid |
$27,133.71
|
| Rate for Payer: Kentucky WC Medicaid |
$27,409.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,698.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,228.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,670.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,678.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,432.00
|
| Rate for Payer: Ohio Health Group HMO |
$59,175.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,643.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,441.00
|
| Rate for Payer: PHCS Commercial |
$75,744.00
|
| Rate for Payer: United Healthcare All Payer |
$69,432.00
|
|
|
DEFIB DC ATLAS+ DR V-243
|
Facility
|
OP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,240.00 |
| Max. Negotiated Rate |
$77,568.00 |
| Rate for Payer: Aetna Commercial |
$62,216.00
|
| Rate for Payer: Anthem Medicaid |
$27,787.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,024.00
|
| Rate for Payer: Cash Price |
$40,400.00
|
| Rate for Payer: Cigna Commercial |
$67,064.00
|
| Rate for Payer: First Health Commercial |
$76,760.00
|
| Rate for Payer: Humana Commercial |
$68,680.00
|
| Rate for Payer: Humana KY Medicaid |
$27,787.12
|
| Rate for Payer: Kentucky WC Medicaid |
$28,069.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,256.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,630.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,344.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,104.00
|
| Rate for Payer: Ohio Health Group HMO |
$60,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,296.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,752.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
|
DEFIB DC ATLAS+ DR V-243
|
Facility
|
IP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,240.00 |
| Max. Negotiated Rate |
$77,568.00 |
| Rate for Payer: Aetna Commercial |
$62,216.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,024.00
|
| Rate for Payer: Cash Price |
$40,400.00
|
| Rate for Payer: Cigna Commercial |
$67,064.00
|
| Rate for Payer: First Health Commercial |
$76,760.00
|
| Rate for Payer: Humana Commercial |
$68,680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,256.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,630.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,104.00
|
| Rate for Payer: Ohio Health Group HMO |
$60,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,296.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,752.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
|
DEFIB DC ATLAS II DR V-265
|
Facility
|
OP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,240.00 |
| Max. Negotiated Rate |
$77,568.00 |
| Rate for Payer: Aetna Commercial |
$62,216.00
|
| Rate for Payer: Anthem Medicaid |
$27,787.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,024.00
|
| Rate for Payer: Cash Price |
$40,400.00
|
| Rate for Payer: Cigna Commercial |
$67,064.00
|
| Rate for Payer: First Health Commercial |
$76,760.00
|
| Rate for Payer: Humana Commercial |
$68,680.00
|
| Rate for Payer: Humana KY Medicaid |
$27,787.12
|
| Rate for Payer: Kentucky WC Medicaid |
$28,069.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,256.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,630.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,344.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,104.00
|
| Rate for Payer: Ohio Health Group HMO |
$60,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,296.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,752.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
|
DEFIB DC ATLAS II DR V-265
|
Facility
|
IP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,240.00 |
| Max. Negotiated Rate |
$77,568.00 |
| Rate for Payer: Aetna Commercial |
$62,216.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,024.00
|
| Rate for Payer: Cash Price |
$40,400.00
|
| Rate for Payer: Cigna Commercial |
$67,064.00
|
| Rate for Payer: First Health Commercial |
$76,760.00
|
| Rate for Payer: Humana Commercial |
$68,680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,256.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,630.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,104.00
|
| Rate for Payer: Ohio Health Group HMO |
$60,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,296.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,752.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
|
DEFIB DC ATLAS II+ DR V-268
|
Facility
|
IP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,240.00 |
| Max. Negotiated Rate |
$77,568.00 |
| Rate for Payer: Aetna Commercial |
$62,216.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,024.00
|
| Rate for Payer: Cash Price |
$40,400.00
|
| Rate for Payer: Cigna Commercial |
$67,064.00
|
| Rate for Payer: First Health Commercial |
$76,760.00
|
| Rate for Payer: Humana Commercial |
$68,680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,256.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,630.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,104.00
|
| Rate for Payer: Ohio Health Group HMO |
$60,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,296.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,752.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
|
DEFIB DC ATLAS II+ DR V-268
|
Facility
|
OP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,240.00 |
| Max. Negotiated Rate |
$77,568.00 |
| Rate for Payer: Aetna Commercial |
$62,216.00
|
| Rate for Payer: Anthem Medicaid |
$27,787.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,024.00
|
| Rate for Payer: Cash Price |
$40,400.00
|
| Rate for Payer: Cigna Commercial |
$67,064.00
|
| Rate for Payer: First Health Commercial |
$76,760.00
|
| Rate for Payer: Humana Commercial |
$68,680.00
|
| Rate for Payer: Humana KY Medicaid |
$27,787.12
|
| Rate for Payer: Kentucky WC Medicaid |
$28,069.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,256.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,630.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,344.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,104.00
|
| Rate for Payer: Ohio Health Group HMO |
$60,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,296.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,752.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
|
DEFIB DC ATLAS VR V-193
|
Facility
|
OP
|
$78,900.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,670.00 |
| Max. Negotiated Rate |
$75,744.00 |
| Rate for Payer: Aetna Commercial |
$60,753.00
|
| Rate for Payer: Anthem Medicaid |
$27,133.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,542.00
|
| Rate for Payer: Cash Price |
$39,450.00
|
| Rate for Payer: Cigna Commercial |
$65,487.00
|
| Rate for Payer: First Health Commercial |
$74,955.00
|
| Rate for Payer: Humana Commercial |
$67,065.00
|
| Rate for Payer: Humana KY Medicaid |
$27,133.71
|
| Rate for Payer: Kentucky WC Medicaid |
$27,409.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,698.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,228.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,670.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,678.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,432.00
|
| Rate for Payer: Ohio Health Group HMO |
$59,175.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,643.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,441.00
|
| Rate for Payer: PHCS Commercial |
$75,744.00
|
| Rate for Payer: United Healthcare All Payer |
$69,432.00
|
|
|
DEFIB DC ATLAS VR V-193
|
Facility
|
IP
|
$78,900.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,670.00 |
| Max. Negotiated Rate |
$75,744.00 |
| Rate for Payer: Aetna Commercial |
$60,753.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,542.00
|
| Rate for Payer: Cash Price |
$39,450.00
|
| Rate for Payer: Cigna Commercial |
$65,487.00
|
| Rate for Payer: First Health Commercial |
$74,955.00
|
| Rate for Payer: Humana Commercial |
$67,065.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,698.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,228.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,670.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,432.00
|
| Rate for Payer: Ohio Health Group HMO |
$59,175.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,643.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,441.00
|
| Rate for Payer: PHCS Commercial |
$75,744.00
|
| Rate for Payer: United Healthcare All Payer |
$69,432.00
|
|
