|
DEFIB LEAD RELIANCE AF 0157
|
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 0159
|
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 0159
|
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 G AF 0180
|
Facility
|
IP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
DEFIB LEAD RELIANCE G AF 0180
|
Facility
|
OP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem Medicaid |
$5,648.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Humana KY Medicaid |
$5,648.56
|
| Rate for Payer: Kentucky WC Medicaid |
$5,706.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,761.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
DEFIB LEAD RELIANCE G AF 0181
|
Facility
|
IP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
DEFIB LEAD RELIANCE G AF 0181
|
Facility
|
OP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem Medicaid |
$5,648.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Humana KY Medicaid |
$5,648.56
|
| Rate for Payer: Kentucky WC Medicaid |
$5,706.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,761.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
DEFIB LEADRELIANCE G AF 0185
|
Facility
|
OP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem Medicaid |
$5,648.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Humana KY Medicaid |
$5,648.56
|
| Rate for Payer: Kentucky WC Medicaid |
$5,706.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,761.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
DEFIB LEADRELIANCE G AF 0185
|
Facility
|
IP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
DEFIB LEAD RELIANCE G AF 0186
|
Facility
|
IP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
DEFIB LEAD RELIANCE G AF 0186
|
Facility
|
OP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem Medicaid |
$5,648.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Humana KY Medicaid |
$5,648.56
|
| Rate for Payer: Kentucky WC Medicaid |
$5,706.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,761.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
DEFIB LEAD RELIANCE G PF 0170
|
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 G PF 0170
|
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 G PF 0171
|
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 G PF 0171
|
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 G PF 0174
|
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 G PF 0174
|
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 G PF 0175
|
Facility
|
OP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem Medicaid |
$5,648.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Humana KY Medicaid |
$5,648.56
|
| Rate for Payer: Kentucky WC Medicaid |
$5,706.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,761.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
DEFIB LEAD RELIANCE G PF 0175
|
Facility
|
IP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
DEFIB LEAD RELIANCE G PF 0176
|
Facility
|
IP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
DEFIB LEAD RELIANCE G PF 0176
|
Facility
|
OP
|
$16,425.00
|
|
|
Service Code
|
HCPCS C1899
|
| Hospital Charge Code |
27000067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,927.50 |
| Max. Negotiated Rate |
$15,768.00 |
| Rate for Payer: Aetna Commercial |
$12,647.25
|
| Rate for Payer: Anthem Medicaid |
$5,648.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,811.50
|
| Rate for Payer: Cash Price |
$8,212.50
|
| Rate for Payer: Cigna Commercial |
$13,632.75
|
| Rate for Payer: First Health Commercial |
$15,603.75
|
| Rate for Payer: Humana Commercial |
$13,961.25
|
| Rate for Payer: Humana KY Medicaid |
$5,648.56
|
| Rate for Payer: Kentucky WC Medicaid |
$5,706.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,468.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,121.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,927.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,761.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,454.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,289.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,333.25
|
| Rate for Payer: PHCS Commercial |
$15,768.00
|
| Rate for Payer: United Healthcare All Payer |
$14,454.00
|
|
|
DEFIB LEAD RELIANCE PF 0127
|
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 PF 0127
|
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 PF 0128
|
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 PF 0128
|
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
|
|
