|
DEFIB LEAD RELIANCE PF 0147
|
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 0147
|
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 0148
|
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 0148
|
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 0149
|
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 0149
|
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 RELNC G MODEL 0184
|
Facility
|
IP
|
$15,825.60
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,747.68 |
| Max. Negotiated Rate |
$15,192.58 |
| Rate for Payer: Aetna Commercial |
$12,185.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,343.97
|
| Rate for Payer: Cash Price |
$7,912.80
|
| Rate for Payer: Cigna Commercial |
$13,135.25
|
| Rate for Payer: First Health Commercial |
$15,034.32
|
| Rate for Payer: Humana Commercial |
$13,451.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,976.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,679.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,747.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,926.53
|
| Rate for Payer: Ohio Health Group HMO |
$11,869.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,660.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,768.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,919.66
|
| Rate for Payer: PHCS Commercial |
$15,192.58
|
| Rate for Payer: United Healthcare All Payer |
$13,926.53
|
|
|
DEFIB LEAD RELNC G MODEL 0184
|
Facility
|
OP
|
$15,825.60
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,747.68 |
| Max. Negotiated Rate |
$15,192.58 |
| Rate for Payer: Aetna Commercial |
$12,185.71
|
| Rate for Payer: Anthem Medicaid |
$5,442.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,343.97
|
| Rate for Payer: Cash Price |
$7,912.80
|
| Rate for Payer: Cigna Commercial |
$13,135.25
|
| Rate for Payer: First Health Commercial |
$15,034.32
|
| Rate for Payer: Humana Commercial |
$13,451.76
|
| Rate for Payer: Humana KY Medicaid |
$5,442.42
|
| Rate for Payer: Kentucky WC Medicaid |
$5,497.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,976.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,679.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,747.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,551.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,926.53
|
| Rate for Payer: Ohio Health Group HMO |
$11,869.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,660.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,768.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,919.66
|
| Rate for Payer: PHCS Commercial |
$15,192.58
|
| Rate for Payer: United Healthcare All Payer |
$13,926.53
|
|
|
DEFIB LEAD SUB 6996SQ58
|
Facility
|
OP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem Medicaid |
$4,358.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Humana KY Medicaid |
$4,358.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,403.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,446.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
DEFIB LEAD SUB 6996SQ58
|
Facility
|
IP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
DEFIB LEXOS DR-T 347 001
|
Facility
|
IP
|
$101,700.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$30,510.00 |
| Max. Negotiated Rate |
$97,632.00 |
| Rate for Payer: Aetna Commercial |
$78,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79,326.00
|
| Rate for Payer: Cash Price |
$50,850.00
|
| Rate for Payer: Cigna Commercial |
$84,411.00
|
| Rate for Payer: First Health Commercial |
$96,615.00
|
| Rate for Payer: Humana Commercial |
$86,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75,054.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$89,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$76,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70,173.00
|
| Rate for Payer: PHCS Commercial |
$97,632.00
|
| Rate for Payer: United Healthcare All Payer |
$89,496.00
|
|
|
DEFIB LEXOS DR-T 347 001
|
Facility
|
OP
|
$101,700.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$30,510.00 |
| Max. Negotiated Rate |
$97,632.00 |
| Rate for Payer: Aetna Commercial |
$78,309.00
|
| Rate for Payer: Anthem Medicaid |
$34,974.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79,326.00
|
| Rate for Payer: Cash Price |
$50,850.00
|
| Rate for Payer: Cigna Commercial |
$84,411.00
|
| Rate for Payer: First Health Commercial |
$96,615.00
|
| Rate for Payer: Humana Commercial |
$86,445.00
|
| Rate for Payer: Humana KY Medicaid |
$34,974.63
|
| Rate for Payer: Kentucky WC Medicaid |
$35,330.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75,054.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,510.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$35,676.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$89,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$76,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70,173.00
|
| Rate for Payer: PHCS Commercial |
$97,632.00
|
| Rate for Payer: United Healthcare All Payer |
$89,496.00
|
|
|
DEFIB LEXOS VR-T 346 999
|
Facility
|
OP
|
$94,100.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
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 LEXOS VR-T 346 999
|
Facility
|
IP
|
$94,100.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
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 LUMOS VR-T 353 219
|
Facility
|
IP
|
$94,100.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
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 LUMOS VR-T 353 219
|
Facility
|
OP
|
$94,100.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
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 PRIZM HE DR DC 1858
|
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 PRIZM HE DR DC 1858
|
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 PRIZM HE VR SC 1857
|
Facility
|
OP
|
$82,700.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
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 PRIZM HE VR SC 1857
|
Facility
|
IP
|
$82,700.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
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 PROMOT+ CD3211-36Q
|
Facility
|
IP
|
$111,200.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$33,360.00 |
| Max. Negotiated Rate |
$106,752.00 |
| Rate for Payer: Aetna Commercial |
$85,624.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86,736.00
|
| Rate for Payer: Cash Price |
$55,600.00
|
| Rate for Payer: Cigna Commercial |
$92,296.00
|
| Rate for Payer: First Health Commercial |
$105,640.00
|
| Rate for Payer: Humana Commercial |
$94,520.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91,184.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82,065.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33,360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$97,856.00
|
| Rate for Payer: Ohio Health Group HMO |
$83,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88,960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96,744.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76,728.00
|
| Rate for Payer: PHCS Commercial |
$106,752.00
|
| Rate for Payer: United Healthcare All Payer |
$97,856.00
|
|
|
DEFIB PROMOT+ CD3211-36Q
|
Facility
|
OP
|
$111,200.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$33,360.00 |
| Max. Negotiated Rate |
$106,752.00 |
| Rate for Payer: Aetna Commercial |
$85,624.00
|
| Rate for Payer: Anthem Medicaid |
$38,241.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86,736.00
|
| Rate for Payer: Cash Price |
$55,600.00
|
| Rate for Payer: Cigna Commercial |
$92,296.00
|
| Rate for Payer: First Health Commercial |
$105,640.00
|
| Rate for Payer: Humana Commercial |
$94,520.00
|
| Rate for Payer: Humana KY Medicaid |
$38,241.68
|
| Rate for Payer: Kentucky WC Medicaid |
$38,630.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91,184.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82,065.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33,360.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$39,008.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$97,856.00
|
| Rate for Payer: Ohio Health Group HMO |
$83,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88,960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96,744.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76,728.00
|
| Rate for Payer: PHCS Commercial |
$106,752.00
|
| Rate for Payer: United Healthcare All Payer |
$97,856.00
|
|
|
DEFIB PROMOTE+ CD3211-36
|
Facility
|
IP
|
$109,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$32,790.00 |
| Max. Negotiated Rate |
$104,928.00 |
| Rate for Payer: Aetna Commercial |
$84,161.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85,254.00
|
| Rate for Payer: Cash Price |
$54,650.00
|
| Rate for Payer: Cigna Commercial |
$90,719.00
|
| Rate for Payer: First Health Commercial |
$103,835.00
|
| Rate for Payer: Humana Commercial |
$92,905.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89,626.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80,663.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,790.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$96,184.00
|
| Rate for Payer: Ohio Health Group HMO |
$81,975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95,091.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75,417.00
|
| Rate for Payer: PHCS Commercial |
$104,928.00
|
| Rate for Payer: United Healthcare All Payer |
$96,184.00
|
|
|
DEFIB PROMOTE+ CD3211-36
|
Facility
|
OP
|
$109,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$32,790.00 |
| Max. Negotiated Rate |
$104,928.00 |
| Rate for Payer: Aetna Commercial |
$84,161.00
|
| Rate for Payer: Anthem Medicaid |
$37,588.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85,254.00
|
| Rate for Payer: Cash Price |
$54,650.00
|
| Rate for Payer: Cigna Commercial |
$90,719.00
|
| Rate for Payer: First Health Commercial |
$103,835.00
|
| Rate for Payer: Humana Commercial |
$92,905.00
|
| Rate for Payer: Humana KY Medicaid |
$37,588.27
|
| Rate for Payer: Kentucky WC Medicaid |
$37,970.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89,626.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80,663.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,790.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$38,342.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$96,184.00
|
| Rate for Payer: Ohio Health Group HMO |
$81,975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95,091.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75,417.00
|
| Rate for Payer: PHCS Commercial |
$104,928.00
|
| Rate for Payer: United Healthcare All Payer |
$96,184.00
|
|
|
DEFIB PROTECTA DR D334DR
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
