|
DEFIB DC ATLAS+ DR V-243
|
Facility
|
IP
|
$78,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,153.00 |
| Max. Negotiated Rate |
$74,976.00 |
| Rate for Payer: Aetna Commercial |
$60,137.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,918.00
|
| Rate for Payer: Cash Price |
$39,050.00
|
| Rate for Payer: Cigna Commercial |
$64,823.00
|
| Rate for Payer: First Health Commercial |
$74,195.00
|
| Rate for Payer: Humana Commercial |
$66,385.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,042.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,637.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,430.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$58,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,153.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,211.00
|
| Rate for Payer: PHCS Commercial |
$74,976.00
|
| Rate for Payer: United Healthcare All Payer |
$68,728.00
|
|
|
DEFIB DC ATLAS+ DR V-243
|
Facility
|
OP
|
$78,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,153.00 |
| Max. Negotiated Rate |
$74,976.00 |
| Rate for Payer: Aetna Commercial |
$60,137.00
|
| Rate for Payer: Anthem Medicaid |
$26,858.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,918.00
|
| Rate for Payer: Cash Price |
$39,050.00
|
| Rate for Payer: Cigna Commercial |
$64,823.00
|
| Rate for Payer: First Health Commercial |
$74,195.00
|
| Rate for Payer: Humana Commercial |
$66,385.00
|
| Rate for Payer: Humana KY Medicaid |
$26,858.59
|
| Rate for Payer: Kentucky WC Medicaid |
$27,131.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,042.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,637.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,430.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,397.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$58,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,153.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,211.00
|
| Rate for Payer: PHCS Commercial |
$74,976.00
|
| Rate for Payer: United Healthcare All Payer |
$68,728.00
|
|
|
DEFIB DC ATLAS II DR V-265
|
Facility
|
OP
|
$78,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,153.00 |
| Max. Negotiated Rate |
$74,976.00 |
| Rate for Payer: Aetna Commercial |
$60,137.00
|
| Rate for Payer: Anthem Medicaid |
$26,858.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,918.00
|
| Rate for Payer: Cash Price |
$39,050.00
|
| Rate for Payer: Cigna Commercial |
$64,823.00
|
| Rate for Payer: First Health Commercial |
$74,195.00
|
| Rate for Payer: Humana Commercial |
$66,385.00
|
| Rate for Payer: Humana KY Medicaid |
$26,858.59
|
| Rate for Payer: Kentucky WC Medicaid |
$27,131.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,042.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,637.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,430.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,397.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$58,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,153.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,211.00
|
| Rate for Payer: PHCS Commercial |
$74,976.00
|
| Rate for Payer: United Healthcare All Payer |
$68,728.00
|
|
|
DEFIB DC ATLAS II DR V-265
|
Facility
|
IP
|
$78,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,153.00 |
| Max. Negotiated Rate |
$74,976.00 |
| Rate for Payer: Aetna Commercial |
$60,137.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,918.00
|
| Rate for Payer: Cash Price |
$39,050.00
|
| Rate for Payer: Cigna Commercial |
$64,823.00
|
| Rate for Payer: First Health Commercial |
$74,195.00
|
| Rate for Payer: Humana Commercial |
$66,385.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,042.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,637.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,430.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$58,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,153.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,211.00
|
| Rate for Payer: PHCS Commercial |
$74,976.00
|
| Rate for Payer: United Healthcare All Payer |
$68,728.00
|
|
|
DEFIB DC ATLAS II+ DR V-268
|
Facility
|
IP
|
$78,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,153.00 |
| Max. Negotiated Rate |
$74,976.00 |
| Rate for Payer: Aetna Commercial |
$60,137.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,918.00
|
| Rate for Payer: Cash Price |
$39,050.00
|
| Rate for Payer: Cigna Commercial |
$64,823.00
|
| Rate for Payer: First Health Commercial |
$74,195.00
|
| Rate for Payer: Humana Commercial |
$66,385.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,042.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,637.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,430.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$58,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,153.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,211.00
|
| Rate for Payer: PHCS Commercial |
$74,976.00
|
| Rate for Payer: United Healthcare All Payer |
$68,728.00
|
|
|
DEFIB DC ATLAS II+ DR V-268
|
Facility
|
OP
|
$78,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,153.00 |
| Max. Negotiated Rate |
$74,976.00 |
| Rate for Payer: Aetna Commercial |
$60,137.00
|
| Rate for Payer: Anthem Medicaid |
$26,858.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,918.00
|
| Rate for Payer: Cash Price |
$39,050.00
|
| Rate for Payer: Cigna Commercial |
$64,823.00
|
| Rate for Payer: First Health Commercial |
$74,195.00
|
| Rate for Payer: Humana Commercial |
$66,385.00
|
| Rate for Payer: Humana KY Medicaid |
$26,858.59
|
| Rate for Payer: Kentucky WC Medicaid |
$27,131.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,042.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,637.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,430.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,397.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$58,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,153.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,211.00
|
| Rate for Payer: PHCS Commercial |
$74,976.00
|
| Rate for Payer: United Healthcare All Payer |
$68,728.00
|
|
|
DEFIB DC ATLAS VR V-193
|
Facility
|
IP
|
$76,300.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,919.00 |
| Max. Negotiated Rate |
$73,248.00 |
| Rate for Payer: Aetna Commercial |
$58,751.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,514.00
|
| Rate for Payer: Cash Price |
$38,150.00
|
| Rate for Payer: Cigna Commercial |
$63,329.00
|
| Rate for Payer: First Health Commercial |
$72,485.00
|
| Rate for Payer: Humana Commercial |
$64,855.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,566.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,309.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,890.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,919.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,653.00
|
| Rate for Payer: PHCS Commercial |
$73,248.00
|
| Rate for Payer: United Healthcare All Payer |
$67,144.00
|
|
|
DEFIB DC ATLAS VR V-193
|
Facility
|
OP
|
$76,300.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,919.00 |
| Max. Negotiated Rate |
$73,248.00 |
| Rate for Payer: Aetna Commercial |
$58,751.00
|
| Rate for Payer: Anthem Medicaid |
$26,239.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,514.00
|
| Rate for Payer: Cash Price |
$38,150.00
|
| Rate for Payer: Cigna Commercial |
$63,329.00
|
| Rate for Payer: First Health Commercial |
$72,485.00
|
| Rate for Payer: Humana Commercial |
$64,855.00
|
| Rate for Payer: Humana KY Medicaid |
$26,239.57
|
| Rate for Payer: Kentucky WC Medicaid |
$26,506.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,566.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,309.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,890.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,766.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,919.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,653.00
|
| Rate for Payer: PHCS Commercial |
$73,248.00
|
| Rate for Payer: United Healthcare All Payer |
$67,144.00
|
|
|
DEFIB DC CURRENT DR 2107-30
|
Facility
|
OP
|
$173,500.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,555.00 |
| Max. Negotiated Rate |
$166,560.00 |
| Rate for Payer: Aetna Commercial |
$133,595.00
|
| Rate for Payer: Anthem Medicaid |
$59,666.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$135,330.00
|
| Rate for Payer: Cash Price |
$86,750.00
|
| Rate for Payer: Cigna Commercial |
$144,005.00
|
| Rate for Payer: First Health Commercial |
$164,825.00
|
| Rate for Payer: Humana Commercial |
$147,475.00
|
| Rate for Payer: Humana KY Medicaid |
$59,666.65
|
| Rate for Payer: Kentucky WC Medicaid |
$60,273.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142,270.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128,043.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52,050.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$60,863.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$152,680.00
|
| Rate for Payer: Ohio Health Group HMO |
$130,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,555.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,785.00
|
| Rate for Payer: PHCS Commercial |
$166,560.00
|
| Rate for Payer: United Healthcare All Payer |
$152,680.00
|
|
|
DEFIB DC CURRENT DR 2107-30
|
Facility
|
IP
|
$173,500.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,555.00 |
| Max. Negotiated Rate |
$166,560.00 |
| Rate for Payer: Aetna Commercial |
$133,595.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$135,330.00
|
| Rate for Payer: Cash Price |
$86,750.00
|
| Rate for Payer: Cigna Commercial |
$144,005.00
|
| Rate for Payer: First Health Commercial |
$164,825.00
|
| Rate for Payer: Humana Commercial |
$147,475.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142,270.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128,043.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$152,680.00
|
| Rate for Payer: Ohio Health Group HMO |
$130,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,555.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,785.00
|
| Rate for Payer: PHCS Commercial |
$166,560.00
|
| Rate for Payer: United Healthcare All Payer |
$152,680.00
|
|
|
DEFIB DC CURRENT DR 2107-36
|
Facility
|
OP
|
$181,600.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,608.00 |
| Max. Negotiated Rate |
$174,336.00 |
| Rate for Payer: Aetna Commercial |
$139,832.00
|
| Rate for Payer: Anthem Medicaid |
$62,452.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141,648.00
|
| Rate for Payer: Cash Price |
$90,800.00
|
| Rate for Payer: Cigna Commercial |
$150,728.00
|
| Rate for Payer: First Health Commercial |
$172,520.00
|
| Rate for Payer: Humana Commercial |
$154,360.00
|
| Rate for Payer: Humana KY Medicaid |
$62,452.24
|
| Rate for Payer: Kentucky WC Medicaid |
$63,087.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134,020.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54,480.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$63,705.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$159,808.00
|
| Rate for Payer: Ohio Health Group HMO |
$136,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,608.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,296.00
|
| Rate for Payer: PHCS Commercial |
$174,336.00
|
| Rate for Payer: United Healthcare All Payer |
$159,808.00
|
|
|
DEFIB DC CURRENT DR 2107-36
|
Facility
|
IP
|
$181,600.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,608.00 |
| Max. Negotiated Rate |
$174,336.00 |
| Rate for Payer: Aetna Commercial |
$139,832.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141,648.00
|
| Rate for Payer: Cash Price |
$90,800.00
|
| Rate for Payer: Cigna Commercial |
$150,728.00
|
| Rate for Payer: First Health Commercial |
$172,520.00
|
| Rate for Payer: Humana Commercial |
$154,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134,020.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54,480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$159,808.00
|
| Rate for Payer: Ohio Health Group HMO |
$136,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,608.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,296.00
|
| Rate for Payer: PHCS Commercial |
$174,336.00
|
| Rate for Payer: United Healthcare All Payer |
$159,808.00
|
|
|
DEFIB DC CURRENT RF DR 2207-30
|
Facility
|
IP
|
$87,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,323.00 |
| Max. Negotiated Rate |
$83,616.00 |
| Rate for Payer: Aetna Commercial |
$67,067.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,938.00
|
| Rate for Payer: Cash Price |
$43,550.00
|
| Rate for Payer: Cigna Commercial |
$72,293.00
|
| Rate for Payer: First Health Commercial |
$82,745.00
|
| Rate for Payer: Humana Commercial |
$74,035.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71,422.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64,279.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,130.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,648.00
|
| Rate for Payer: Ohio Health Group HMO |
$65,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,323.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,001.00
|
| Rate for Payer: PHCS Commercial |
$83,616.00
|
| Rate for Payer: United Healthcare All Payer |
$76,648.00
|
|
|
DEFIB DC CURRENT RF DR 2207-30
|
Facility
|
OP
|
$87,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,323.00 |
| Max. Negotiated Rate |
$83,616.00 |
| Rate for Payer: Aetna Commercial |
$67,067.00
|
| Rate for Payer: Anthem Medicaid |
$29,953.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,938.00
|
| Rate for Payer: Cash Price |
$43,550.00
|
| Rate for Payer: Cigna Commercial |
$72,293.00
|
| Rate for Payer: First Health Commercial |
$82,745.00
|
| Rate for Payer: Humana Commercial |
$74,035.00
|
| Rate for Payer: Humana KY Medicaid |
$29,953.69
|
| Rate for Payer: Kentucky WC Medicaid |
$30,258.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71,422.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64,279.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,130.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,554.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,648.00
|
| Rate for Payer: Ohio Health Group HMO |
$65,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,323.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,001.00
|
| Rate for Payer: PHCS Commercial |
$83,616.00
|
| Rate for Payer: United Healthcare All Payer |
$76,648.00
|
|
|
DEFIB DC CURRENT RF DR 2207-36
|
Facility
|
OP
|
$81,700.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,621.00 |
| Max. Negotiated Rate |
$78,432.00 |
| Rate for Payer: Aetna Commercial |
$62,909.00
|
| Rate for Payer: Anthem Medicaid |
$28,096.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,726.00
|
| Rate for Payer: Cash Price |
$40,850.00
|
| Rate for Payer: Cigna Commercial |
$67,811.00
|
| Rate for Payer: First Health Commercial |
$77,615.00
|
| Rate for Payer: Humana Commercial |
$69,445.00
|
| Rate for Payer: Humana KY Medicaid |
$28,096.63
|
| Rate for Payer: Kentucky WC Medicaid |
$28,382.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,994.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,294.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,510.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,660.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,896.00
|
| Rate for Payer: Ohio Health Group HMO |
$61,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,621.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,327.00
|
| Rate for Payer: PHCS Commercial |
$78,432.00
|
| Rate for Payer: United Healthcare All Payer |
$71,896.00
|
|
|
DEFIB DC CURRENT RF DR 2207-36
|
Facility
|
IP
|
$81,700.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,621.00 |
| Max. Negotiated Rate |
$78,432.00 |
| Rate for Payer: Aetna Commercial |
$62,909.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,726.00
|
| Rate for Payer: Cash Price |
$40,850.00
|
| Rate for Payer: Cigna Commercial |
$67,811.00
|
| Rate for Payer: First Health Commercial |
$77,615.00
|
| Rate for Payer: Humana Commercial |
$69,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,994.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,294.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,896.00
|
| Rate for Payer: Ohio Health Group HMO |
$61,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,621.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,327.00
|
| Rate for Payer: PHCS Commercial |
$78,432.00
|
| Rate for Payer: United Healthcare All Payer |
$71,896.00
|
|
|
DEFIB DC EPIC DR V-233
|
Facility
|
OP
|
$76,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,919.00 |
| Max. Negotiated Rate |
$73,248.00 |
| Rate for Payer: Aetna Commercial |
$58,751.00
|
| Rate for Payer: Anthem Medicaid |
$26,239.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,514.00
|
| Rate for Payer: Cash Price |
$38,150.00
|
| Rate for Payer: Cigna Commercial |
$63,329.00
|
| Rate for Payer: First Health Commercial |
$72,485.00
|
| Rate for Payer: Humana Commercial |
$64,855.00
|
| Rate for Payer: Humana KY Medicaid |
$26,239.57
|
| Rate for Payer: Kentucky WC Medicaid |
$26,506.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,566.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,309.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,890.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,766.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,919.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,653.00
|
| Rate for Payer: PHCS Commercial |
$73,248.00
|
| Rate for Payer: United Healthcare All Payer |
$67,144.00
|
|
|
DEFIB DC EPIC DR V-233
|
Facility
|
IP
|
$76,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,919.00 |
| Max. Negotiated Rate |
$73,248.00 |
| Rate for Payer: Aetna Commercial |
$58,751.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,514.00
|
| Rate for Payer: Cash Price |
$38,150.00
|
| Rate for Payer: Cigna Commercial |
$63,329.00
|
| Rate for Payer: First Health Commercial |
$72,485.00
|
| Rate for Payer: Humana Commercial |
$64,855.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,566.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,309.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,890.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,919.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,653.00
|
| Rate for Payer: PHCS Commercial |
$73,248.00
|
| Rate for Payer: United Healthcare All Payer |
$67,144.00
|
|
|
DEFIB DC EPIC+ DR V-239
|
Facility
|
IP
|
$78,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,153.00 |
| Max. Negotiated Rate |
$74,976.00 |
| Rate for Payer: Aetna Commercial |
$60,137.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,918.00
|
| Rate for Payer: Cash Price |
$39,050.00
|
| Rate for Payer: Cigna Commercial |
$64,823.00
|
| Rate for Payer: First Health Commercial |
$74,195.00
|
| Rate for Payer: Humana Commercial |
$66,385.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,042.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,637.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,430.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$58,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,153.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,211.00
|
| Rate for Payer: PHCS Commercial |
$74,976.00
|
| Rate for Payer: United Healthcare All Payer |
$68,728.00
|
|
|
DEFIB DC EPIC+ DR V-239
|
Facility
|
OP
|
$78,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,153.00 |
| Max. Negotiated Rate |
$74,976.00 |
| Rate for Payer: Aetna Commercial |
$60,137.00
|
| Rate for Payer: Anthem Medicaid |
$26,858.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,918.00
|
| Rate for Payer: Cash Price |
$39,050.00
|
| Rate for Payer: Cigna Commercial |
$64,823.00
|
| Rate for Payer: First Health Commercial |
$74,195.00
|
| Rate for Payer: Humana Commercial |
$66,385.00
|
| Rate for Payer: Humana KY Medicaid |
$26,858.59
|
| Rate for Payer: Kentucky WC Medicaid |
$27,131.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,042.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,637.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,430.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,397.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$58,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,153.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,211.00
|
| Rate for Payer: PHCS Commercial |
$74,976.00
|
| Rate for Payer: United Healthcare All Payer |
$68,728.00
|
|
|
DEFIB DC EPIC II DR V-253
|
Facility
|
OP
|
$78,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,153.00 |
| Max. Negotiated Rate |
$74,976.00 |
| Rate for Payer: Aetna Commercial |
$60,137.00
|
| Rate for Payer: Anthem Medicaid |
$26,858.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,918.00
|
| Rate for Payer: Cash Price |
$39,050.00
|
| Rate for Payer: Cigna Commercial |
$64,823.00
|
| Rate for Payer: First Health Commercial |
$74,195.00
|
| Rate for Payer: Humana Commercial |
$66,385.00
|
| Rate for Payer: Humana KY Medicaid |
$26,858.59
|
| Rate for Payer: Kentucky WC Medicaid |
$27,131.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,042.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,637.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,430.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,397.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$58,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,153.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,211.00
|
| Rate for Payer: PHCS Commercial |
$74,976.00
|
| Rate for Payer: United Healthcare All Payer |
$68,728.00
|
|
|
DEFIB DC EPIC II DR V-253
|
Facility
|
IP
|
$78,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,153.00 |
| Max. Negotiated Rate |
$74,976.00 |
| Rate for Payer: Aetna Commercial |
$60,137.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,918.00
|
| Rate for Payer: Cash Price |
$39,050.00
|
| Rate for Payer: Cigna Commercial |
$64,823.00
|
| Rate for Payer: First Health Commercial |
$74,195.00
|
| Rate for Payer: Humana Commercial |
$66,385.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,042.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,637.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,430.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$58,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,153.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,211.00
|
| Rate for Payer: PHCS Commercial |
$74,976.00
|
| Rate for Payer: United Healthcare All Payer |
$68,728.00
|
|
|
DEFIB DC EPIC II+ DR V-258
|
Facility
|
IP
|
$78,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,153.00 |
| Max. Negotiated Rate |
$74,976.00 |
| Rate for Payer: Aetna Commercial |
$60,137.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,918.00
|
| Rate for Payer: Cash Price |
$39,050.00
|
| Rate for Payer: Cigna Commercial |
$64,823.00
|
| Rate for Payer: First Health Commercial |
$74,195.00
|
| Rate for Payer: Humana Commercial |
$66,385.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,042.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,637.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,430.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$58,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,153.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,211.00
|
| Rate for Payer: PHCS Commercial |
$74,976.00
|
| Rate for Payer: United Healthcare All Payer |
$68,728.00
|
|
|
DEFIB DC EPIC II+ DR V-258
|
Facility
|
OP
|
$78,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,153.00 |
| Max. Negotiated Rate |
$74,976.00 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,918.00
|
| Rate for Payer: Cash Price |
$39,050.00
|
| Rate for Payer: Cigna Commercial |
$64,823.00
|
| Rate for Payer: First Health Commercial |
$74,195.00
|
| Rate for Payer: Humana Commercial |
$66,385.00
|
| Rate for Payer: Humana KY Medicaid |
$26,858.59
|
| Rate for Payer: Kentucky WC Medicaid |
$27,131.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,042.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,637.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,430.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,397.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$58,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,153.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,211.00
|
| Rate for Payer: PHCS Commercial |
$74,976.00
|
| Rate for Payer: United Healthcare All Payer |
$68,728.00
|
| Rate for Payer: Aetna Commercial |
$60,137.00
|
| Rate for Payer: Anthem Medicaid |
$26,858.59
|
|
|
DEFIB DC INTRINSIC 7288
|
Facility
|
OP
|
$94,660.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,305.80 |
| Max. Negotiated Rate |
$90,873.60 |
| Rate for Payer: Aetna Commercial |
$72,888.20
|
| Rate for Payer: Anthem Medicaid |
$32,553.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,834.80
|
| Rate for Payer: Cash Price |
$47,330.00
|
| Rate for Payer: Cigna Commercial |
$78,567.80
|
| Rate for Payer: First Health Commercial |
$89,927.00
|
| Rate for Payer: Humana Commercial |
$80,461.00
|
| Rate for Payer: Humana KY Medicaid |
$32,553.57
|
| Rate for Payer: Kentucky WC Medicaid |
$32,884.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,621.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,859.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,398.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,206.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$83,300.80
|
| Rate for Payer: Ohio Health Group HMO |
$70,995.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,932.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,305.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,344.60
|
| Rate for Payer: PHCS Commercial |
$90,873.60
|
| Rate for Payer: United Healthcare All Payer |
$83,300.80
|
|
