|
DEFIB EVERA MRI DVMB1D4
|
Facility
|
IP
|
$71,980.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,357.40 |
| Max. Negotiated Rate |
$69,100.80 |
| Rate for Payer: Aetna Commercial |
$55,424.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,144.40
|
| Rate for Payer: Cash Price |
$35,990.00
|
| Rate for Payer: Cigna Commercial |
$59,743.40
|
| Rate for Payer: First Health Commercial |
$68,381.00
|
| Rate for Payer: Humana Commercial |
$61,183.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,023.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,121.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,594.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,342.40
|
| Rate for Payer: Ohio Health Group HMO |
$53,985.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,357.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,313.80
|
| Rate for Payer: PHCS Commercial |
$69,100.80
|
| Rate for Payer: United Healthcare All Payer |
$63,342.40
|
|
|
DEFIB EVERA MRI DVMB1D4
|
Facility
|
OP
|
$71,980.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,357.40 |
| Max. Negotiated Rate |
$69,100.80 |
| Rate for Payer: Aetna Commercial |
$55,424.60
|
| Rate for Payer: Anthem Medicaid |
$24,753.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,144.40
|
| Rate for Payer: Cash Price |
$35,990.00
|
| Rate for Payer: Cigna Commercial |
$59,743.40
|
| Rate for Payer: First Health Commercial |
$68,381.00
|
| Rate for Payer: Humana Commercial |
$61,183.00
|
| Rate for Payer: Humana KY Medicaid |
$24,753.92
|
| Rate for Payer: Kentucky WC Medicaid |
$25,005.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,023.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,121.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,594.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,250.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,342.40
|
| Rate for Payer: Ohio Health Group HMO |
$53,985.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,357.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,313.80
|
| Rate for Payer: PHCS Commercial |
$69,100.80
|
| Rate for Payer: United Healthcare All Payer |
$63,342.40
|
|
|
DEFIB EVERA MRI XT DR SYS
|
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 EVERA MRI XT DR SYS
|
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 F0RTIFY CD2231-40Q
|
Facility
|
OP
|
$71,980.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,357.40 |
| Max. Negotiated Rate |
$69,100.80 |
| Rate for Payer: Anthem Medicaid |
$24,753.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,144.40
|
| Rate for Payer: Cash Price |
$35,990.00
|
| Rate for Payer: Cigna Commercial |
$59,743.40
|
| Rate for Payer: First Health Commercial |
$68,381.00
|
| Rate for Payer: Humana Commercial |
$61,183.00
|
| Rate for Payer: Humana KY Medicaid |
$24,753.92
|
| Rate for Payer: Kentucky WC Medicaid |
$25,005.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,023.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,121.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,594.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,250.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,342.40
|
| Rate for Payer: Ohio Health Group HMO |
$53,985.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,357.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,313.80
|
| Rate for Payer: PHCS Commercial |
$69,100.80
|
| Rate for Payer: United Healthcare All Payer |
$63,342.40
|
| Rate for Payer: Aetna Commercial |
$55,424.60
|
|
|
DEFIB F0RTIFY CD2231-40Q
|
Facility
|
IP
|
$71,980.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,357.40 |
| Max. Negotiated Rate |
$69,100.80 |
| Rate for Payer: Aetna Commercial |
$55,424.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,144.40
|
| Rate for Payer: Cash Price |
$35,990.00
|
| Rate for Payer: Cigna Commercial |
$59,743.40
|
| Rate for Payer: First Health Commercial |
$68,381.00
|
| Rate for Payer: Humana Commercial |
$61,183.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,023.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,121.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,594.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,342.40
|
| Rate for Payer: Ohio Health Group HMO |
$53,985.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,357.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,313.80
|
| Rate for Payer: PHCS Commercial |
$69,100.80
|
| Rate for Payer: United Healthcare All Payer |
$63,342.40
|
|
|
DEFIB F0RTIFY CD2257-40Q
|
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: Aetna Commercial |
$60,552.80
|
| 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: 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
|
|
|
DEFIB F0RTIFY CD2257-40Q
|
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 FORTFYASRA DR CD2357-40C
|
Facility
|
IP
|
$37,650.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,894.50 |
| Max. Negotiated Rate |
$36,144.00 |
| Rate for Payer: Aetna Commercial |
$28,990.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,367.00
|
| Rate for Payer: Cash Price |
$18,825.00
|
| Rate for Payer: Cigna Commercial |
$31,249.50
|
| Rate for Payer: First Health Commercial |
$35,767.50
|
| Rate for Payer: Humana Commercial |
$32,002.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,873.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,785.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,295.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,132.00
|
| Rate for Payer: Ohio Health Group HMO |
$28,237.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,530.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,894.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,671.50
|
| Rate for Payer: PHCS Commercial |
$36,144.00
|
| Rate for Payer: United Healthcare All Payer |
$33,132.00
|
|
|
DEFIB FORTFYASRA DR CD2357-40C
|
Facility
|
OP
|
$37,650.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,894.50 |
| Max. Negotiated Rate |
$36,144.00 |
| Rate for Payer: Aetna Commercial |
$28,990.50
|
| Rate for Payer: Anthem Medicaid |
$12,947.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,367.00
|
| Rate for Payer: Cash Price |
$18,825.00
|
| Rate for Payer: Cigna Commercial |
$31,249.50
|
| Rate for Payer: First Health Commercial |
$35,767.50
|
| Rate for Payer: Humana Commercial |
$32,002.50
|
| Rate for Payer: Humana KY Medicaid |
$12,947.84
|
| Rate for Payer: Kentucky WC Medicaid |
$13,079.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,873.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,785.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,295.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,207.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,132.00
|
| Rate for Payer: Ohio Health Group HMO |
$28,237.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,530.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,894.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,671.50
|
| Rate for Payer: PHCS Commercial |
$36,144.00
|
| Rate for Payer: United Healthcare All Payer |
$33,132.00
|
|
|
DEFIB FORTFY ASSUR VR CD1357-4
|
Facility
|
OP
|
$31,080.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,040.40 |
| Max. Negotiated Rate |
$29,836.80 |
| Rate for Payer: Aetna Commercial |
$23,931.60
|
| Rate for Payer: Anthem Medicaid |
$10,688.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,242.40
|
| Rate for Payer: Cash Price |
$15,540.00
|
| Rate for Payer: Cigna Commercial |
$25,796.40
|
| Rate for Payer: First Health Commercial |
$29,526.00
|
| Rate for Payer: Humana Commercial |
$26,418.00
|
| Rate for Payer: Humana KY Medicaid |
$10,688.41
|
| Rate for Payer: Kentucky WC Medicaid |
$10,797.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,485.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,937.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,324.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,902.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,350.40
|
| Rate for Payer: Ohio Health Group HMO |
$23,310.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,040.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,634.80
|
| Rate for Payer: PHCS Commercial |
$29,836.80
|
| Rate for Payer: United Healthcare All Payer |
$27,350.40
|
|
|
DEFIB FORTFY ASSUR VR CD1357-4
|
Facility
|
IP
|
$31,080.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,040.40 |
| Max. Negotiated Rate |
$29,836.80 |
| Rate for Payer: Aetna Commercial |
$23,931.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,242.40
|
| Rate for Payer: Cash Price |
$15,540.00
|
| Rate for Payer: Cigna Commercial |
$25,796.40
|
| Rate for Payer: First Health Commercial |
$29,526.00
|
| Rate for Payer: Humana Commercial |
$26,418.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,485.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,937.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,324.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,350.40
|
| Rate for Payer: Ohio Health Group HMO |
$23,310.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,040.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,634.80
|
| Rate for Payer: PHCS Commercial |
$29,836.80
|
| Rate for Payer: United Healthcare All Payer |
$27,350.40
|
|
|
DEFIB FORTIFYASSRA DR CD2357-4
|
Facility
|
IP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
DEFIB FORTIFYASSRA DR CD2357-4
|
Facility
|
OP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem Medicaid |
$11,064.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Humana KY Medicaid |
$11,064.98
|
| Rate for Payer: Kentucky WC Medicaid |
$11,177.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,286.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
DEFIB FORTIFY CD1231-40Q
|
Facility
|
IP
|
$80,530.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,468.90 |
| Max. Negotiated Rate |
$77,308.80 |
| Rate for Payer: Aetna Commercial |
$62,008.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,813.40
|
| Rate for Payer: Cash Price |
$40,265.00
|
| Rate for Payer: Cigna Commercial |
$66,839.90
|
| Rate for Payer: First Health Commercial |
$76,503.50
|
| Rate for Payer: Humana Commercial |
$68,450.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,034.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,431.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,159.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,866.40
|
| Rate for Payer: Ohio Health Group HMO |
$60,397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,106.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,468.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,964.30
|
| Rate for Payer: PHCS Commercial |
$77,308.80
|
| Rate for Payer: United Healthcare All Payer |
$70,866.40
|
|
|
DEFIB FORTIFY CD1231-40Q
|
Facility
|
OP
|
$80,530.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,468.90 |
| Max. Negotiated Rate |
$77,308.80 |
| Rate for Payer: Aetna Commercial |
$62,008.10
|
| Rate for Payer: Anthem Medicaid |
$27,694.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,813.40
|
| Rate for Payer: Cash Price |
$40,265.00
|
| Rate for Payer: Cigna Commercial |
$66,839.90
|
| Rate for Payer: First Health Commercial |
$76,503.50
|
| Rate for Payer: Humana Commercial |
$68,450.50
|
| Rate for Payer: Humana KY Medicaid |
$27,694.27
|
| Rate for Payer: Kentucky WC Medicaid |
$27,976.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,034.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,431.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,159.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,249.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,866.40
|
| Rate for Payer: Ohio Health Group HMO |
$60,397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,106.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,468.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,964.30
|
| Rate for Payer: PHCS Commercial |
$77,308.80
|
| Rate for Payer: United Healthcare All Payer |
$70,866.40
|
|
|
DEFIB FRTFYASSR DR CD2357-40Q
|
Facility
|
IP
|
$37,650.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,894.50 |
| Max. Negotiated Rate |
$36,144.00 |
| Rate for Payer: Aetna Commercial |
$28,990.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,367.00
|
| Rate for Payer: Cash Price |
$18,825.00
|
| Rate for Payer: Cigna Commercial |
$31,249.50
|
| Rate for Payer: First Health Commercial |
$35,767.50
|
| Rate for Payer: Humana Commercial |
$32,002.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,873.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,785.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,295.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,132.00
|
| Rate for Payer: Ohio Health Group HMO |
$28,237.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,530.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,894.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,671.50
|
| Rate for Payer: PHCS Commercial |
$36,144.00
|
| Rate for Payer: United Healthcare All Payer |
$33,132.00
|
|
|
DEFIB FRTFYASSR DR CD2357-40Q
|
Facility
|
OP
|
$37,650.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,894.50 |
| Max. Negotiated Rate |
$36,144.00 |
| Rate for Payer: Aetna Commercial |
$28,990.50
|
| Rate for Payer: Anthem Medicaid |
$12,947.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,367.00
|
| Rate for Payer: Cash Price |
$18,825.00
|
| Rate for Payer: Cigna Commercial |
$31,249.50
|
| Rate for Payer: First Health Commercial |
$35,767.50
|
| Rate for Payer: Humana Commercial |
$32,002.50
|
| Rate for Payer: Humana KY Medicaid |
$12,947.84
|
| Rate for Payer: Kentucky WC Medicaid |
$13,079.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,873.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,785.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,295.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,207.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,132.00
|
| Rate for Payer: Ohio Health Group HMO |
$28,237.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,530.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,894.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,671.50
|
| Rate for Payer: PHCS Commercial |
$36,144.00
|
| Rate for Payer: United Healthcare All Payer |
$33,132.00
|
|
|
DEFIB ILESTO 7 DR-T
|
Facility
|
OP
|
$79,900.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,387.00 |
| Max. Negotiated Rate |
$76,704.00 |
| Rate for Payer: Aetna Commercial |
$61,523.00
|
| Rate for Payer: Anthem Medicaid |
$27,477.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,322.00
|
| Rate for Payer: Cash Price |
$39,950.00
|
| Rate for Payer: Cigna Commercial |
$66,317.00
|
| Rate for Payer: First Health Commercial |
$75,905.00
|
| Rate for Payer: Humana Commercial |
$67,915.00
|
| Rate for Payer: Humana KY Medicaid |
$27,477.61
|
| Rate for Payer: Kentucky WC Medicaid |
$27,757.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,518.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,966.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,970.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,028.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,312.00
|
| Rate for Payer: Ohio Health Group HMO |
$59,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,387.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,769.00
|
| Rate for Payer: PHCS Commercial |
$76,704.00
|
| Rate for Payer: United Healthcare All Payer |
$70,312.00
|
|
|
DEFIB ILESTO 7 DR-T
|
Facility
|
IP
|
$79,900.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,387.00 |
| Max. Negotiated Rate |
$76,704.00 |
| Rate for Payer: Aetna Commercial |
$61,523.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,322.00
|
| Rate for Payer: Cash Price |
$39,950.00
|
| Rate for Payer: Cigna Commercial |
$66,317.00
|
| Rate for Payer: First Health Commercial |
$75,905.00
|
| Rate for Payer: Humana Commercial |
$67,915.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,518.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,966.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,970.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,312.00
|
| Rate for Payer: Ohio Health Group HMO |
$59,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,387.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,769.00
|
| Rate for Payer: PHCS Commercial |
$76,704.00
|
| Rate for Payer: United Healthcare All Payer |
$70,312.00
|
|
|
DEFIB ILESTO 7 HF-T
|
Facility
|
OP
|
$90,700.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,791.00 |
| Max. Negotiated Rate |
$87,072.00 |
| Rate for Payer: Aetna Commercial |
$69,839.00
|
| Rate for Payer: Anthem Medicaid |
$31,191.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,746.00
|
| Rate for Payer: Cash Price |
$45,350.00
|
| Rate for Payer: Cigna Commercial |
$75,281.00
|
| Rate for Payer: First Health Commercial |
$86,165.00
|
| Rate for Payer: Humana Commercial |
$77,095.00
|
| Rate for Payer: Humana KY Medicaid |
$31,191.73
|
| Rate for Payer: Kentucky WC Medicaid |
$31,509.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,374.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,936.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,210.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,817.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$68,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,791.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,117.00
|
| Rate for Payer: PHCS Commercial |
$87,072.00
|
| Rate for Payer: United Healthcare All Payer |
$79,816.00
|
|
|
DEFIB ILESTO 7 HF-T
|
Facility
|
IP
|
$90,700.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,791.00 |
| Max. Negotiated Rate |
$87,072.00 |
| Rate for Payer: Aetna Commercial |
$69,839.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,746.00
|
| Rate for Payer: Cash Price |
$45,350.00
|
| Rate for Payer: Cigna Commercial |
$75,281.00
|
| Rate for Payer: First Health Commercial |
$86,165.00
|
| Rate for Payer: Humana Commercial |
$77,095.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,374.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,936.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,210.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$68,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,791.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,117.00
|
| Rate for Payer: PHCS Commercial |
$87,072.00
|
| Rate for Payer: United Healthcare All Payer |
$79,816.00
|
|
|
DEFIB INOGEN EL ICD VR D140
|
Facility
|
IP
|
$71,080.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,240.40 |
| Max. Negotiated Rate |
$68,236.80 |
| Rate for Payer: Aetna Commercial |
$54,731.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,442.40
|
| Rate for Payer: Cash Price |
$35,540.00
|
| Rate for Payer: Cigna Commercial |
$58,996.40
|
| Rate for Payer: First Health Commercial |
$67,526.00
|
| Rate for Payer: Humana Commercial |
$60,418.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,285.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,457.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,324.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,550.40
|
| Rate for Payer: Ohio Health Group HMO |
$53,310.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,240.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,034.80
|
| Rate for Payer: PHCS Commercial |
$68,236.80
|
| Rate for Payer: United Healthcare All Payer |
$62,550.40
|
|
|
DEFIB INOGEN EL ICD VR D140
|
Facility
|
OP
|
$71,080.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,240.40 |
| Max. Negotiated Rate |
$68,236.80 |
| Rate for Payer: Cigna Commercial |
$58,996.40
|
| Rate for Payer: First Health Commercial |
$67,526.00
|
| Rate for Payer: Humana Commercial |
$60,418.00
|
| Rate for Payer: Humana KY Medicaid |
$24,444.41
|
| Rate for Payer: Kentucky WC Medicaid |
$24,693.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,285.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,457.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,324.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,934.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,550.40
|
| Rate for Payer: Ohio Health Group HMO |
$53,310.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,240.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,034.80
|
| Rate for Payer: PHCS Commercial |
$68,236.80
|
| Rate for Payer: United Healthcare All Payer |
$62,550.40
|
| Rate for Payer: Aetna Commercial |
$54,731.60
|
| Rate for Payer: Anthem Medicaid |
$24,444.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,442.40
|
| Rate for Payer: Cash Price |
$35,540.00
|
|
|
DEFIB LEAD OPTSUR 58CM LDA210Q
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
