|
DEFIB DC INTRINSIC 7288
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
DEFIB DC VIRTUOSO DR D154AW
|
Facility
|
OP
|
$107,620.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$13,990.60 |
| Max. Negotiated Rate |
$103,315.20 |
| Rate for Payer: Aetna Commercial |
$82,867.40
|
| Rate for Payer: Anthem Medicaid |
$37,010.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83,943.60
|
| Rate for Payer: Cash Price |
$53,810.00
|
| Rate for Payer: Cigna Commercial |
$89,324.60
|
| Rate for Payer: First Health Commercial |
$102,239.00
|
| Rate for Payer: Humana Commercial |
$91,477.00
|
| Rate for Payer: Humana KY Medicaid |
$37,010.52
|
| Rate for Payer: Kentucky WC Medicaid |
$37,387.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88,248.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79,423.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,286.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$37,753.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$94,705.60
|
| Rate for Payer: Ohio Health Group HMO |
$80,715.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,524.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,990.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33,362.20
|
| Rate for Payer: PHCS Commercial |
$103,315.20
|
| Rate for Payer: United Healthcare All Payer |
$94,705.60
|
|
|
DEFIB DC VIRTUOSO DR D154AW
|
Facility
|
IP
|
$107,620.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$13,990.60 |
| Max. Negotiated Rate |
$103,315.20 |
| Rate for Payer: Aetna Commercial |
$82,867.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83,943.60
|
| Rate for Payer: Cash Price |
$53,810.00
|
| Rate for Payer: Cigna Commercial |
$89,324.60
|
| Rate for Payer: First Health Commercial |
$102,239.00
|
| Rate for Payer: Humana Commercial |
$91,477.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88,248.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79,423.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,286.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$94,705.60
|
| Rate for Payer: Ohio Health Group HMO |
$80,715.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,524.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,990.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33,362.20
|
| Rate for Payer: PHCS Commercial |
$103,315.20
|
| Rate for Payer: United Healthcare All Payer |
$94,705.60
|
|
|
DEFIB ELIP DCRR CD2411-36C CEL
|
Facility
|
OP
|
$73,420.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,544.60 |
| Max. Negotiated Rate |
$70,483.20 |
| Rate for Payer: Aetna Commercial |
$56,533.40
|
| Rate for Payer: Anthem Medicaid |
$25,249.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,267.60
|
| Rate for Payer: Cash Price |
$36,710.00
|
| Rate for Payer: Cigna Commercial |
$60,938.60
|
| Rate for Payer: First Health Commercial |
$69,749.00
|
| Rate for Payer: Humana Commercial |
$62,407.00
|
| Rate for Payer: Humana KY Medicaid |
$25,249.14
|
| Rate for Payer: Kentucky WC Medicaid |
$25,506.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,204.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,183.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,026.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,755.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,609.60
|
| Rate for Payer: Ohio Health Group HMO |
$55,065.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,684.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,544.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,760.20
|
| Rate for Payer: PHCS Commercial |
$70,483.20
|
| Rate for Payer: United Healthcare All Payer |
$64,609.60
|
|
|
DEFIB ELIP DCRR CD2411-36C CEL
|
Facility
|
IP
|
$73,420.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,544.60 |
| Max. Negotiated Rate |
$70,483.20 |
| Rate for Payer: Aetna Commercial |
$56,533.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,267.60
|
| Rate for Payer: Cash Price |
$36,710.00
|
| Rate for Payer: Cigna Commercial |
$60,938.60
|
| Rate for Payer: First Health Commercial |
$69,749.00
|
| Rate for Payer: Humana Commercial |
$62,407.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,204.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,183.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,026.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,609.60
|
| Rate for Payer: Ohio Health Group HMO |
$55,065.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,684.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,544.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,760.20
|
| Rate for Payer: PHCS Commercial |
$70,483.20
|
| Rate for Payer: United Healthcare All Payer |
$64,609.60
|
|
|
DEFIB ELIP DCRR CD2411-36Q CEL
|
Facility
|
IP
|
$73,420.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,544.60 |
| Max. Negotiated Rate |
$70,483.20 |
| Rate for Payer: Aetna Commercial |
$56,533.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,267.60
|
| Rate for Payer: Cash Price |
$36,710.00
|
| Rate for Payer: Cigna Commercial |
$60,938.60
|
| Rate for Payer: First Health Commercial |
$69,749.00
|
| Rate for Payer: Humana Commercial |
$62,407.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,204.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,183.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,026.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,609.60
|
| Rate for Payer: Ohio Health Group HMO |
$55,065.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,684.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,544.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,760.20
|
| Rate for Payer: PHCS Commercial |
$70,483.20
|
| Rate for Payer: United Healthcare All Payer |
$64,609.60
|
|
|
DEFIB ELIP DCRR CD2411-36Q CEL
|
Facility
|
OP
|
$73,420.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,544.60 |
| Max. Negotiated Rate |
$70,483.20 |
| Rate for Payer: Aetna Commercial |
$56,533.40
|
| Rate for Payer: Anthem Medicaid |
$25,249.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,267.60
|
| Rate for Payer: Cash Price |
$36,710.00
|
| Rate for Payer: Cigna Commercial |
$60,938.60
|
| Rate for Payer: First Health Commercial |
$69,749.00
|
| Rate for Payer: Humana Commercial |
$62,407.00
|
| Rate for Payer: Humana KY Medicaid |
$25,249.14
|
| Rate for Payer: Kentucky WC Medicaid |
$25,506.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,204.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,183.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,026.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,755.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,609.60
|
| Rate for Payer: Ohio Health Group HMO |
$55,065.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,684.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,544.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,760.20
|
| Rate for Payer: PHCS Commercial |
$70,483.20
|
| Rate for Payer: United Healthcare All Payer |
$64,609.60
|
|
|
DEFIB ELIPSE DCRR CD2411-36C
|
Facility
|
IP
|
$72,700.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,451.00 |
| Max. Negotiated Rate |
$69,792.00 |
| Rate for Payer: Aetna Commercial |
$55,979.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,706.00
|
| Rate for Payer: Cash Price |
$36,350.00
|
| Rate for Payer: Cigna Commercial |
$60,341.00
|
| Rate for Payer: First Health Commercial |
$69,065.00
|
| Rate for Payer: Humana Commercial |
$61,795.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,652.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$54,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,537.00
|
| Rate for Payer: PHCS Commercial |
$69,792.00
|
| Rate for Payer: United Healthcare All Payer |
$63,976.00
|
|
|
DEFIB ELIPSE DCRR CD2411-36C
|
Facility
|
OP
|
$72,700.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,451.00 |
| Max. Negotiated Rate |
$69,792.00 |
| Rate for Payer: Aetna Commercial |
$55,979.00
|
| Rate for Payer: Anthem Medicaid |
$25,001.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,706.00
|
| Rate for Payer: Cash Price |
$36,350.00
|
| Rate for Payer: Cigna Commercial |
$60,341.00
|
| Rate for Payer: First Health Commercial |
$69,065.00
|
| Rate for Payer: Humana Commercial |
$61,795.00
|
| Rate for Payer: Humana KY Medicaid |
$25,001.53
|
| Rate for Payer: Kentucky WC Medicaid |
$25,255.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,652.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,503.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$54,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,537.00
|
| Rate for Payer: PHCS Commercial |
$69,792.00
|
| Rate for Payer: United Healthcare All Payer |
$63,976.00
|
|
|
DEFIB ELIPSE DCRR CD2411-36Q
|
Facility
|
OP
|
$74,708.80
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,712.14 |
| Max. Negotiated Rate |
$71,720.45 |
| Rate for Payer: Aetna Commercial |
$57,525.78
|
| Rate for Payer: Anthem Medicaid |
$25,692.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,272.86
|
| Rate for Payer: Cash Price |
$37,354.40
|
| Rate for Payer: Cigna Commercial |
$62,008.30
|
| Rate for Payer: First Health Commercial |
$70,973.36
|
| Rate for Payer: Humana Commercial |
$63,502.48
|
| Rate for Payer: Humana KY Medicaid |
$25,692.36
|
| Rate for Payer: Kentucky WC Medicaid |
$25,953.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,261.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,135.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,412.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,207.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,743.74
|
| Rate for Payer: Ohio Health Group HMO |
$56,031.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,941.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,712.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,159.73
|
| Rate for Payer: PHCS Commercial |
$71,720.45
|
| Rate for Payer: United Healthcare All Payer |
$65,743.74
|
|
|
DEFIB ELIPSE DCRR CD2411-36Q
|
Facility
|
IP
|
$74,708.80
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,712.14 |
| Max. Negotiated Rate |
$71,720.45 |
| Rate for Payer: Aetna Commercial |
$57,525.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,272.86
|
| Rate for Payer: Cash Price |
$37,354.40
|
| Rate for Payer: Cigna Commercial |
$62,008.30
|
| Rate for Payer: First Health Commercial |
$70,973.36
|
| Rate for Payer: Humana Commercial |
$63,502.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,261.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,135.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,412.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,743.74
|
| Rate for Payer: Ohio Health Group HMO |
$56,031.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,941.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,712.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,159.73
|
| Rate for Payer: PHCS Commercial |
$71,720.45
|
| Rate for Payer: United Healthcare All Payer |
$65,743.74
|
|
|
DEFIB ELLIPSE CD1411-36C
|
Facility
|
IP
|
$69,100.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,983.00 |
| Max. Negotiated Rate |
$66,336.00 |
| Rate for Payer: Aetna Commercial |
$53,207.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,898.00
|
| Rate for Payer: Cash Price |
$34,550.00
|
| Rate for Payer: Cigna Commercial |
$57,353.00
|
| Rate for Payer: First Health Commercial |
$65,645.00
|
| Rate for Payer: Humana Commercial |
$58,735.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,662.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,995.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,730.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,808.00
|
| Rate for Payer: Ohio Health Group HMO |
$51,825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,820.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,983.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,421.00
|
| Rate for Payer: PHCS Commercial |
$66,336.00
|
| Rate for Payer: United Healthcare All Payer |
$60,808.00
|
|
|
DEFIB ELLIPSE CD1411-36C
|
Facility
|
OP
|
$69,100.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,983.00 |
| Max. Negotiated Rate |
$66,336.00 |
| Rate for Payer: Aetna Commercial |
$53,207.00
|
| Rate for Payer: Anthem Medicaid |
$23,763.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,898.00
|
| Rate for Payer: Cash Price |
$34,550.00
|
| Rate for Payer: Cigna Commercial |
$57,353.00
|
| Rate for Payer: First Health Commercial |
$65,645.00
|
| Rate for Payer: Humana Commercial |
$58,735.00
|
| Rate for Payer: Humana KY Medicaid |
$23,763.49
|
| Rate for Payer: Kentucky WC Medicaid |
$24,005.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,662.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,995.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,730.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,240.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,808.00
|
| Rate for Payer: Ohio Health Group HMO |
$51,825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,820.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,983.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,421.00
|
| Rate for Payer: PHCS Commercial |
$66,336.00
|
| Rate for Payer: United Healthcare All Payer |
$60,808.00
|
|
|
DEFIB ELLIPSE CD1411-36C CELL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| 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: 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: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DEFIB ELLIPSE CD1411-36C CELL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DEFIB ELLIPSE DR CD2311-36Q
|
Facility
|
IP
|
$78,640.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,223.20 |
| Max. Negotiated Rate |
$75,494.40 |
| Rate for Payer: Cash Price |
$39,320.00
|
| Rate for Payer: Cigna Commercial |
$65,271.20
|
| Rate for Payer: First Health Commercial |
$74,708.00
|
| Rate for Payer: Humana Commercial |
$66,844.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,484.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,036.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,203.20
|
| Rate for Payer: Ohio Health Group HMO |
$58,980.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,223.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,378.40
|
| Rate for Payer: PHCS Commercial |
$75,494.40
|
| Rate for Payer: United Healthcare All Payer |
$69,203.20
|
| Rate for Payer: Aetna Commercial |
$60,552.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,339.20
|
|
|
DEFIB ELLIPSE DR CD2311-36Q
|
Facility
|
OP
|
$78,640.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,223.20 |
| Max. Negotiated Rate |
$75,494.40 |
| Rate for Payer: Aetna Commercial |
$60,552.80
|
| Rate for Payer: Anthem Medicaid |
$27,044.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,339.20
|
| Rate for Payer: Cash Price |
$39,320.00
|
| Rate for Payer: Cigna Commercial |
$65,271.20
|
| Rate for Payer: First Health Commercial |
$74,708.00
|
| Rate for Payer: Humana Commercial |
$66,844.00
|
| Rate for Payer: Humana KY Medicaid |
$27,044.30
|
| Rate for Payer: Kentucky WC Medicaid |
$27,319.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,484.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,036.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,586.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,203.20
|
| Rate for Payer: Ohio Health Group HMO |
$58,980.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,223.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,378.40
|
| Rate for Payer: PHCS Commercial |
$75,494.40
|
| Rate for Payer: United Healthcare All Payer |
$69,203.20
|
|
|
DEFIB ENERGEN DCRR E142
|
Facility
|
OP
|
$73,600.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,568.00 |
| Max. Negotiated Rate |
$70,656.00 |
| Rate for Payer: Aetna Commercial |
$56,672.00
|
| Rate for Payer: Anthem Medicaid |
$25,311.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,408.00
|
| Rate for Payer: Cash Price |
$36,800.00
|
| Rate for Payer: Cigna Commercial |
$61,088.00
|
| Rate for Payer: First Health Commercial |
$69,920.00
|
| Rate for Payer: Humana Commercial |
$62,560.00
|
| Rate for Payer: Humana KY Medicaid |
$25,311.04
|
| Rate for Payer: Kentucky WC Medicaid |
$25,568.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,352.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,316.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,080.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,818.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,768.00
|
| Rate for Payer: Ohio Health Group HMO |
$55,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,568.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,816.00
|
| Rate for Payer: PHCS Commercial |
$70,656.00
|
| Rate for Payer: United Healthcare All Payer |
$64,768.00
|
|
|
DEFIB ENERGEN DCRR E142
|
Facility
|
IP
|
$73,600.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,568.00 |
| Max. Negotiated Rate |
$70,656.00 |
| Rate for Payer: Aetna Commercial |
$56,672.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,408.00
|
| Rate for Payer: Cash Price |
$36,800.00
|
| Rate for Payer: Cigna Commercial |
$61,088.00
|
| Rate for Payer: First Health Commercial |
$69,920.00
|
| Rate for Payer: Humana Commercial |
$62,560.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,352.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,316.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,080.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,768.00
|
| Rate for Payer: Ohio Health Group HMO |
$55,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,568.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,816.00
|
| Rate for Payer: PHCS Commercial |
$70,656.00
|
| Rate for Payer: United Healthcare All Payer |
$64,768.00
|
|
|
DEFIB ENERGEN DCRR E143
|
Facility
|
OP
|
$73,600.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,568.00 |
| Max. Negotiated Rate |
$70,656.00 |
| Rate for Payer: Aetna Commercial |
$56,672.00
|
| Rate for Payer: Anthem Medicaid |
$25,311.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,408.00
|
| Rate for Payer: Cash Price |
$36,800.00
|
| Rate for Payer: Cigna Commercial |
$61,088.00
|
| Rate for Payer: First Health Commercial |
$69,920.00
|
| Rate for Payer: Humana Commercial |
$62,560.00
|
| Rate for Payer: Humana KY Medicaid |
$25,311.04
|
| Rate for Payer: Kentucky WC Medicaid |
$25,568.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,352.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,316.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,080.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,818.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,768.00
|
| Rate for Payer: Ohio Health Group HMO |
$55,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,568.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,816.00
|
| Rate for Payer: PHCS Commercial |
$70,656.00
|
| Rate for Payer: United Healthcare All Payer |
$64,768.00
|
|
|
DEFIB ENERGEN DCRR E143
|
Facility
|
IP
|
$73,600.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,568.00 |
| Max. Negotiated Rate |
$70,656.00 |
| Rate for Payer: Aetna Commercial |
$56,672.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,408.00
|
| Rate for Payer: Cash Price |
$36,800.00
|
| Rate for Payer: Cigna Commercial |
$61,088.00
|
| Rate for Payer: First Health Commercial |
$69,920.00
|
| Rate for Payer: Humana Commercial |
$62,560.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,352.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,316.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,080.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,768.00
|
| Rate for Payer: Ohio Health Group HMO |
$55,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,568.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,816.00
|
| Rate for Payer: PHCS Commercial |
$70,656.00
|
| Rate for Payer: United Healthcare All Payer |
$64,768.00
|
|
|
DEFIB ENERGEN SCRR E140
|
Facility
|
IP
|
$70,000.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,100.00 |
| Max. Negotiated Rate |
$67,200.00 |
| Rate for Payer: Aetna Commercial |
$53,900.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,600.00
|
| Rate for Payer: Cash Price |
$35,000.00
|
| Rate for Payer: Cigna Commercial |
$58,100.00
|
| Rate for Payer: First Health Commercial |
$66,500.00
|
| Rate for Payer: Humana Commercial |
$59,500.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,660.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,000.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$52,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,100.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,700.00
|
| Rate for Payer: PHCS Commercial |
$67,200.00
|
| Rate for Payer: United Healthcare All Payer |
$61,600.00
|
|
|
DEFIB ENERGEN SCRR E140
|
Facility
|
OP
|
$70,000.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,100.00 |
| Max. Negotiated Rate |
$67,200.00 |
| Rate for Payer: Aetna Commercial |
$53,900.00
|
| Rate for Payer: Anthem Medicaid |
$24,073.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,600.00
|
| Rate for Payer: Cash Price |
$35,000.00
|
| Rate for Payer: Cigna Commercial |
$58,100.00
|
| Rate for Payer: First Health Commercial |
$66,500.00
|
| Rate for Payer: Humana Commercial |
$59,500.00
|
| Rate for Payer: Humana KY Medicaid |
$24,073.00
|
| Rate for Payer: Kentucky WC Medicaid |
$24,318.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,660.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,000.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,556.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$52,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,100.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,700.00
|
| Rate for Payer: PHCS Commercial |
$67,200.00
|
| Rate for Payer: United Healthcare All Payer |
$61,600.00
|
|
|
DEFIB ENERGEN SCRR E141
|
Facility
|
IP
|
$74,770.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,720.10 |
| Max. Negotiated Rate |
$71,779.20 |
| Rate for Payer: Aetna Commercial |
$57,572.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,320.60
|
| Rate for Payer: Cash Price |
$37,385.00
|
| Rate for Payer: Cigna Commercial |
$62,059.10
|
| Rate for Payer: First Health Commercial |
$71,031.50
|
| Rate for Payer: Humana Commercial |
$63,554.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,311.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,180.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,431.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,797.60
|
| Rate for Payer: Ohio Health Group HMO |
$56,077.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,954.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,720.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,178.70
|
| Rate for Payer: PHCS Commercial |
$71,779.20
|
| Rate for Payer: United Healthcare All Payer |
$65,797.60
|
|
|
DEFIB ENERGEN SCRR E141
|
Facility
|
OP
|
$74,770.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,720.10 |
| Max. Negotiated Rate |
$71,779.20 |
| Rate for Payer: Aetna Commercial |
$57,572.90
|
| Rate for Payer: Anthem Medicaid |
$25,713.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,320.60
|
| Rate for Payer: Cash Price |
$37,385.00
|
| Rate for Payer: Cigna Commercial |
$62,059.10
|
| Rate for Payer: First Health Commercial |
$71,031.50
|
| Rate for Payer: Humana Commercial |
$63,554.50
|
| Rate for Payer: Humana KY Medicaid |
$25,713.40
|
| Rate for Payer: Kentucky WC Medicaid |
$25,975.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,311.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,180.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,431.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,229.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,797.60
|
| Rate for Payer: Ohio Health Group HMO |
$56,077.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,954.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,720.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,178.70
|
| Rate for Payer: PHCS Commercial |
$71,779.20
|
| Rate for Payer: United Healthcare All Payer |
$65,797.60
|
|
