|
DEFIB FORTFYASRA DR CD2357-40C
|
Facility
|
IP
|
$33,125.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,937.50 |
| Max. Negotiated Rate |
$31,800.00 |
| Rate for Payer: Aetna Commercial |
$25,506.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,837.50
|
| Rate for Payer: Cash Price |
$16,562.50
|
| Rate for Payer: Cigna Commercial |
$27,493.75
|
| Rate for Payer: First Health Commercial |
$31,468.75
|
| Rate for Payer: Humana Commercial |
$28,156.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,162.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,446.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,150.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,818.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,856.25
|
| Rate for Payer: PHCS Commercial |
$31,800.00
|
| Rate for Payer: United Healthcare All Payer |
$29,150.00
|
|
|
DEFIB FORTFYASRA DR CD2357-40C
|
Facility
|
OP
|
$33,125.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,937.50 |
| Max. Negotiated Rate |
$31,800.00 |
| Rate for Payer: Aetna Commercial |
$25,506.25
|
| Rate for Payer: Anthem Medicaid |
$11,391.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,837.50
|
| Rate for Payer: Cash Price |
$16,562.50
|
| Rate for Payer: Cigna Commercial |
$27,493.75
|
| Rate for Payer: First Health Commercial |
$31,468.75
|
| Rate for Payer: Humana Commercial |
$28,156.25
|
| Rate for Payer: Humana KY Medicaid |
$11,391.69
|
| Rate for Payer: Kentucky WC Medicaid |
$11,507.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,162.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,446.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,620.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,150.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,818.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,856.25
|
| Rate for Payer: PHCS Commercial |
$31,800.00
|
| Rate for Payer: United Healthcare All Payer |
$29,150.00
|
|
|
DEFIB FORTFY ASSUR VR CD1357-4
|
Facility
|
IP
|
$32,000.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,600.00 |
| Max. Negotiated Rate |
$30,720.00 |
| Rate for Payer: Aetna Commercial |
$24,640.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,960.00
|
| Rate for Payer: Cash Price |
$16,000.00
|
| Rate for Payer: Cigna Commercial |
$26,560.00
|
| Rate for Payer: First Health Commercial |
$30,400.00
|
| Rate for Payer: Humana Commercial |
$27,200.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,240.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,616.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,160.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,840.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,080.00
|
| Rate for Payer: PHCS Commercial |
$30,720.00
|
| Rate for Payer: United Healthcare All Payer |
$28,160.00
|
|
|
DEFIB FORTFY ASSUR VR CD1357-4
|
Facility
|
OP
|
$32,000.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,600.00 |
| Max. Negotiated Rate |
$30,720.00 |
| Rate for Payer: Aetna Commercial |
$24,640.00
|
| Rate for Payer: Anthem Medicaid |
$11,004.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,960.00
|
| Rate for Payer: Cash Price |
$16,000.00
|
| Rate for Payer: Cigna Commercial |
$26,560.00
|
| Rate for Payer: First Health Commercial |
$30,400.00
|
| Rate for Payer: Humana Commercial |
$27,200.00
|
| Rate for Payer: Humana KY Medicaid |
$11,004.80
|
| Rate for Payer: Kentucky WC Medicaid |
$11,116.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,240.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,616.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,225.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,160.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,840.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,080.00
|
| Rate for Payer: PHCS Commercial |
$30,720.00
|
| Rate for Payer: United Healthcare All Payer |
$28,160.00
|
|
|
DEFIB FORTIFYASSRA DR CD2357-4
|
Facility
|
IP
|
$33,125.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,937.50 |
| Max. Negotiated Rate |
$31,800.00 |
| Rate for Payer: Aetna Commercial |
$25,506.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,837.50
|
| Rate for Payer: Cash Price |
$16,562.50
|
| Rate for Payer: Cigna Commercial |
$27,493.75
|
| Rate for Payer: First Health Commercial |
$31,468.75
|
| Rate for Payer: Humana Commercial |
$28,156.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,162.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,446.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,150.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,818.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,856.25
|
| Rate for Payer: PHCS Commercial |
$31,800.00
|
| Rate for Payer: United Healthcare All Payer |
$29,150.00
|
|
|
DEFIB FORTIFYASSRA DR CD2357-4
|
Facility
|
OP
|
$33,125.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,937.50 |
| Max. Negotiated Rate |
$31,800.00 |
| Rate for Payer: Aetna Commercial |
$25,506.25
|
| Rate for Payer: Anthem Medicaid |
$11,391.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,837.50
|
| Rate for Payer: Cash Price |
$16,562.50
|
| Rate for Payer: Cigna Commercial |
$27,493.75
|
| Rate for Payer: First Health Commercial |
$31,468.75
|
| Rate for Payer: Humana Commercial |
$28,156.25
|
| Rate for Payer: Humana KY Medicaid |
$11,391.69
|
| Rate for Payer: Kentucky WC Medicaid |
$11,507.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,162.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,446.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,620.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,150.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,818.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,856.25
|
| Rate for Payer: PHCS Commercial |
$31,800.00
|
| Rate for Payer: United Healthcare All Payer |
$29,150.00
|
|
|
DEFIB FORTIFY CD1231-40Q
|
Facility
|
IP
|
$83,365.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$25,009.50 |
| Max. Negotiated Rate |
$80,030.40 |
| Rate for Payer: Aetna Commercial |
$64,191.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,024.70
|
| Rate for Payer: Cash Price |
$41,682.50
|
| Rate for Payer: Cigna Commercial |
$69,192.95
|
| Rate for Payer: First Health Commercial |
$79,196.75
|
| Rate for Payer: Humana Commercial |
$70,860.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,359.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,523.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,009.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,361.20
|
| Rate for Payer: Ohio Health Group HMO |
$62,523.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72,527.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,521.85
|
| Rate for Payer: PHCS Commercial |
$80,030.40
|
| Rate for Payer: United Healthcare All Payer |
$73,361.20
|
|
|
DEFIB FORTIFY CD1231-40Q
|
Facility
|
OP
|
$83,365.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$25,009.50 |
| Max. Negotiated Rate |
$80,030.40 |
| Rate for Payer: Aetna Commercial |
$64,191.05
|
| Rate for Payer: Anthem Medicaid |
$28,669.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,024.70
|
| Rate for Payer: Cash Price |
$41,682.50
|
| Rate for Payer: Cigna Commercial |
$69,192.95
|
| Rate for Payer: First Health Commercial |
$79,196.75
|
| Rate for Payer: Humana Commercial |
$70,860.25
|
| Rate for Payer: Humana KY Medicaid |
$28,669.22
|
| Rate for Payer: Kentucky WC Medicaid |
$28,961.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,359.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,523.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,009.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,244.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,361.20
|
| Rate for Payer: Ohio Health Group HMO |
$62,523.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72,527.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,521.85
|
| Rate for Payer: PHCS Commercial |
$80,030.40
|
| Rate for Payer: United Healthcare All Payer |
$73,361.20
|
|
|
DEFIB FRTFYASSR DR CD2357-40Q
|
Facility
|
IP
|
$38,750.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,625.00 |
| Max. Negotiated Rate |
$37,200.00 |
| Rate for Payer: Aetna Commercial |
$29,837.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,225.00
|
| Rate for Payer: Cash Price |
$19,375.00
|
| Rate for Payer: Cigna Commercial |
$32,162.50
|
| Rate for Payer: First Health Commercial |
$36,812.50
|
| Rate for Payer: Humana Commercial |
$32,937.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,775.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,597.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,625.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$29,062.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,712.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,737.50
|
| Rate for Payer: PHCS Commercial |
$37,200.00
|
| Rate for Payer: United Healthcare All Payer |
$34,100.00
|
|
|
DEFIB FRTFYASSR DR CD2357-40Q
|
Facility
|
OP
|
$38,750.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,625.00 |
| Max. Negotiated Rate |
$37,200.00 |
| Rate for Payer: Aetna Commercial |
$29,837.50
|
| Rate for Payer: Anthem Medicaid |
$13,326.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,225.00
|
| Rate for Payer: Cash Price |
$19,375.00
|
| Rate for Payer: Cigna Commercial |
$32,162.50
|
| Rate for Payer: First Health Commercial |
$36,812.50
|
| Rate for Payer: Humana Commercial |
$32,937.50
|
| Rate for Payer: Humana KY Medicaid |
$13,326.12
|
| Rate for Payer: Kentucky WC Medicaid |
$13,461.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,775.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,597.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,625.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,593.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$29,062.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,712.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,737.50
|
| Rate for Payer: PHCS Commercial |
$37,200.00
|
| Rate for Payer: United Healthcare All Payer |
$34,100.00
|
|
|
DEFIB ILESTO 7 DR-T
|
Facility
|
OP
|
$82,700.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,810.00 |
| Max. Negotiated Rate |
$79,392.00 |
| Rate for Payer: Aetna Commercial |
$63,679.00
|
| Rate for Payer: Anthem Medicaid |
$28,440.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,506.00
|
| Rate for Payer: Cash Price |
$41,350.00
|
| Rate for Payer: Cigna Commercial |
$68,641.00
|
| Rate for Payer: First Health Commercial |
$78,565.00
|
| Rate for Payer: Humana Commercial |
$70,295.00
|
| Rate for Payer: Humana KY Medicaid |
$28,440.53
|
| Rate for Payer: Kentucky WC Medicaid |
$28,729.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,814.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,032.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,011.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,776.00
|
| Rate for Payer: Ohio Health Group HMO |
$62,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,949.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,063.00
|
| Rate for Payer: PHCS Commercial |
$79,392.00
|
| Rate for Payer: United Healthcare All Payer |
$72,776.00
|
|
|
DEFIB ILESTO 7 DR-T
|
Facility
|
IP
|
$82,700.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,810.00 |
| Max. Negotiated Rate |
$79,392.00 |
| Rate for Payer: Aetna Commercial |
$63,679.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,506.00
|
| Rate for Payer: Cash Price |
$41,350.00
|
| Rate for Payer: Cigna Commercial |
$68,641.00
|
| Rate for Payer: First Health Commercial |
$78,565.00
|
| Rate for Payer: Humana Commercial |
$70,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,814.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,032.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,776.00
|
| Rate for Payer: Ohio Health Group HMO |
$62,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,949.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,063.00
|
| Rate for Payer: PHCS Commercial |
$79,392.00
|
| Rate for Payer: United Healthcare All Payer |
$72,776.00
|
|
|
DEFIB ILESTO 7 HF-T
|
Facility
|
IP
|
$94,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$28,230.00 |
| Max. Negotiated Rate |
$90,336.00 |
| Rate for Payer: Aetna Commercial |
$72,457.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,398.00
|
| Rate for Payer: Cash Price |
$47,050.00
|
| Rate for Payer: Cigna Commercial |
$78,103.00
|
| Rate for Payer: First Health Commercial |
$89,395.00
|
| Rate for Payer: Humana Commercial |
$79,985.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,162.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,445.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,230.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,808.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81,867.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64,929.00
|
| Rate for Payer: PHCS Commercial |
$90,336.00
|
| Rate for Payer: United Healthcare All Payer |
$82,808.00
|
|
|
DEFIB ILESTO 7 HF-T
|
Facility
|
OP
|
$94,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$28,230.00 |
| Max. Negotiated Rate |
$90,336.00 |
| Rate for Payer: Aetna Commercial |
$72,457.00
|
| Rate for Payer: Anthem Medicaid |
$32,360.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,398.00
|
| Rate for Payer: Cash Price |
$47,050.00
|
| Rate for Payer: Cigna Commercial |
$78,103.00
|
| Rate for Payer: First Health Commercial |
$89,395.00
|
| Rate for Payer: Humana Commercial |
$79,985.00
|
| Rate for Payer: Humana KY Medicaid |
$32,360.99
|
| Rate for Payer: Kentucky WC Medicaid |
$32,690.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,162.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,445.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,230.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,010.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,808.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81,867.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64,929.00
|
| Rate for Payer: PHCS Commercial |
$90,336.00
|
| Rate for Payer: United Healthcare All Payer |
$82,808.00
|
|
|
DEFIB INOGEN EL ICD VR D140
|
Facility
|
OP
|
$73,390.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,017.00 |
| Max. Negotiated Rate |
$70,454.40 |
| Rate for Payer: Aetna Commercial |
$56,510.30
|
| Rate for Payer: Anthem Medicaid |
$25,238.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,244.20
|
| Rate for Payer: Cash Price |
$36,695.00
|
| Rate for Payer: Cigna Commercial |
$60,913.70
|
| Rate for Payer: First Health Commercial |
$69,720.50
|
| Rate for Payer: Humana Commercial |
$62,381.50
|
| Rate for Payer: Humana KY Medicaid |
$25,238.82
|
| Rate for Payer: Kentucky WC Medicaid |
$25,495.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,179.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,161.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,017.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,745.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,583.20
|
| Rate for Payer: Ohio Health Group HMO |
$55,042.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,712.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,849.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,639.10
|
| Rate for Payer: PHCS Commercial |
$70,454.40
|
| Rate for Payer: United Healthcare All Payer |
$64,583.20
|
|
|
DEFIB INOGEN EL ICD VR D140
|
Facility
|
IP
|
$73,390.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,017.00 |
| Max. Negotiated Rate |
$70,454.40 |
| Rate for Payer: Aetna Commercial |
$56,510.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,244.20
|
| Rate for Payer: Cash Price |
$36,695.00
|
| Rate for Payer: Cigna Commercial |
$60,913.70
|
| Rate for Payer: First Health Commercial |
$69,720.50
|
| Rate for Payer: Humana Commercial |
$62,381.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,179.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,161.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,017.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,583.20
|
| Rate for Payer: Ohio Health Group HMO |
$55,042.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,712.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,849.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,639.10
|
| Rate for Payer: PHCS Commercial |
$70,454.40
|
| Rate for Payer: United Healthcare All Payer |
$64,583.20
|
|
|
DEFIB LEAD OPTSUR 58CM LDA210Q
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
DEFIB LEAD OPTSUR 58CM LDA210Q
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
DEFIB LEAD OPTSUR 65CM LDA210Q
|
Facility
|
OP
|
$11,207.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem Medicaid |
$3,854.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Humana KY Medicaid |
$3,854.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,893.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,931.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
DEFIB LEAD OPTSUR 65CM LDA210Q
|
Facility
|
IP
|
$11,207.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
DEFIB LEAD QUATTRO SNG 693558
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
DEFIB LEAD QUATTRO SNG 693558
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
DEFIB LEAD RELIANCE AF 0138
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
DEFIB LEAD RELIANCE AF 0138
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
DEFIB LEAD RELIANCE AF 0157
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
