|
DEFIB PRIZM HE DR DC 1858
|
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 PRIZM HE VR SC 1857
|
Facility
|
IP
|
$79,900.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
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 PRIZM HE VR SC 1857
|
Facility
|
OP
|
$79,900.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
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 PROMOT+ CD3211-36Q
|
Facility
|
OP
|
$106,900.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$13,897.00 |
| Max. Negotiated Rate |
$102,624.00 |
| Rate for Payer: Aetna Commercial |
$82,313.00
|
| Rate for Payer: Anthem Medicaid |
$36,762.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83,382.00
|
| Rate for Payer: Cash Price |
$53,450.00
|
| Rate for Payer: Cigna Commercial |
$88,727.00
|
| Rate for Payer: First Health Commercial |
$101,555.00
|
| Rate for Payer: Humana Commercial |
$90,865.00
|
| Rate for Payer: Humana KY Medicaid |
$36,762.91
|
| Rate for Payer: Kentucky WC Medicaid |
$37,137.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87,658.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78,892.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,070.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$37,500.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$94,072.00
|
| Rate for Payer: Ohio Health Group HMO |
$80,175.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,897.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33,139.00
|
| Rate for Payer: PHCS Commercial |
$102,624.00
|
| Rate for Payer: United Healthcare All Payer |
$94,072.00
|
|
|
DEFIB PROMOT+ CD3211-36Q
|
Facility
|
IP
|
$106,900.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$13,897.00 |
| Max. Negotiated Rate |
$102,624.00 |
| Rate for Payer: Aetna Commercial |
$82,313.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83,382.00
|
| Rate for Payer: Cash Price |
$53,450.00
|
| Rate for Payer: Cigna Commercial |
$88,727.00
|
| Rate for Payer: First Health Commercial |
$101,555.00
|
| Rate for Payer: Humana Commercial |
$90,865.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87,658.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78,892.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,070.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$94,072.00
|
| Rate for Payer: Ohio Health Group HMO |
$80,175.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,897.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33,139.00
|
| Rate for Payer: PHCS Commercial |
$102,624.00
|
| Rate for Payer: United Healthcare All Payer |
$94,072.00
|
|
|
DEFIB PROMOTE+ CD3211-36
|
Facility
|
IP
|
$105,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$13,663.00 |
| Max. Negotiated Rate |
$100,896.00 |
| Rate for Payer: Aetna Commercial |
$80,927.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81,978.00
|
| Rate for Payer: Cash Price |
$52,550.00
|
| Rate for Payer: Cigna Commercial |
$87,233.00
|
| Rate for Payer: First Health Commercial |
$99,845.00
|
| Rate for Payer: Humana Commercial |
$89,335.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86,182.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77,563.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31,530.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$92,488.00
|
| Rate for Payer: Ohio Health Group HMO |
$78,825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,663.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32,581.00
|
| Rate for Payer: PHCS Commercial |
$100,896.00
|
| Rate for Payer: United Healthcare All Payer |
$92,488.00
|
|
|
DEFIB PROMOTE+ CD3211-36
|
Facility
|
OP
|
$105,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$13,663.00 |
| Max. Negotiated Rate |
$100,896.00 |
| Rate for Payer: Aetna Commercial |
$80,927.00
|
| Rate for Payer: Anthem Medicaid |
$36,143.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81,978.00
|
| Rate for Payer: Cash Price |
$52,550.00
|
| Rate for Payer: Cigna Commercial |
$87,233.00
|
| Rate for Payer: First Health Commercial |
$99,845.00
|
| Rate for Payer: Humana Commercial |
$89,335.00
|
| Rate for Payer: Humana KY Medicaid |
$36,143.89
|
| Rate for Payer: Kentucky WC Medicaid |
$36,511.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86,182.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77,563.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31,530.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$36,869.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$92,488.00
|
| Rate for Payer: Ohio Health Group HMO |
$78,825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,663.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32,581.00
|
| Rate for Payer: PHCS Commercial |
$100,896.00
|
| Rate for Payer: United Healthcare All Payer |
$92,488.00
|
|
|
DEFIB PROTECTA DR D334DR
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
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 PROTECTA DR D334DR
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
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 QUAD ASSURA CD3365-40Q
|
Facility
|
IP
|
$40,205.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,226.65 |
| Max. Negotiated Rate |
$38,596.80 |
| Rate for Payer: Aetna Commercial |
$30,957.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,359.90
|
| Rate for Payer: Cash Price |
$20,102.50
|
| Rate for Payer: Cigna Commercial |
$33,370.15
|
| Rate for Payer: First Health Commercial |
$38,194.75
|
| Rate for Payer: Humana Commercial |
$34,174.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,968.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,671.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,061.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,380.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,226.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,463.55
|
| Rate for Payer: PHCS Commercial |
$38,596.80
|
| Rate for Payer: United Healthcare All Payer |
$35,380.40
|
|
|
DEFIB QUAD ASSURA CD3365-40Q
|
Facility
|
OP
|
$40,205.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,226.65 |
| Max. Negotiated Rate |
$38,596.80 |
| Rate for Payer: Aetna Commercial |
$30,957.85
|
| Rate for Payer: Anthem Medicaid |
$13,826.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,359.90
|
| Rate for Payer: Cash Price |
$20,102.50
|
| Rate for Payer: Cigna Commercial |
$33,370.15
|
| Rate for Payer: First Health Commercial |
$38,194.75
|
| Rate for Payer: Humana Commercial |
$34,174.25
|
| Rate for Payer: Humana KY Medicaid |
$13,826.50
|
| Rate for Payer: Kentucky WC Medicaid |
$13,967.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,968.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,671.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,061.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,103.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,380.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,226.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,463.55
|
| Rate for Payer: PHCS Commercial |
$38,596.80
|
| Rate for Payer: United Healthcare All Payer |
$35,380.40
|
|
|
DEFIB QUADRA CD3265-40Q
|
Facility
|
IP
|
$101,500.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$13,195.00 |
| Max. Negotiated Rate |
$97,440.00 |
| Rate for Payer: Aetna Commercial |
$78,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79,170.00
|
| Rate for Payer: Cash Price |
$50,750.00
|
| Rate for Payer: Cigna Commercial |
$84,245.00
|
| Rate for Payer: First Health Commercial |
$96,425.00
|
| Rate for Payer: Humana Commercial |
$86,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74,907.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$89,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$76,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31,465.00
|
| Rate for Payer: PHCS Commercial |
$97,440.00
|
| Rate for Payer: United Healthcare All Payer |
$89,320.00
|
|
|
DEFIB QUADRA CD3265-40Q
|
Facility
|
OP
|
$101,500.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$13,195.00 |
| Max. Negotiated Rate |
$97,440.00 |
| Rate for Payer: Aetna Commercial |
$78,155.00
|
| Rate for Payer: Anthem Medicaid |
$34,905.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79,170.00
|
| Rate for Payer: Cash Price |
$50,750.00
|
| Rate for Payer: Cigna Commercial |
$84,245.00
|
| Rate for Payer: First Health Commercial |
$96,425.00
|
| Rate for Payer: Humana Commercial |
$86,275.00
|
| Rate for Payer: Humana KY Medicaid |
$34,905.85
|
| Rate for Payer: Kentucky WC Medicaid |
$35,261.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74,907.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,450.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$35,606.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$89,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$76,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31,465.00
|
| Rate for Payer: PHCS Commercial |
$97,440.00
|
| Rate for Payer: United Healthcare All Payer |
$89,320.00
|
|
|
DEFIBR ASSURA VR CD1257-40Q
|
Facility
|
IP
|
$78,640.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
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
|
|
|
DEFIBR ASSURA VR CD1257-40Q
|
Facility
|
OP
|
$78,640.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
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
|
|
|
DEFIBR ASSURA VR CD1357-40Q
|
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
|
|
|
DEFIBR ASSURA VR CD1357-40Q
|
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
|
|
|
DEFIBRILLATOR AMPLIA MRI DTMB1
|
Facility
|
OP
|
$78,100.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
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
|
|
|
DEFIBRILLATOR AMPLIA MRI DTMB1
|
Facility
|
IP
|
$78,100.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
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
|
|
|
DEFIBRILLATOR CONCERTO C154DWK
|
Facility
|
IP
|
$121,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$15,769.00 |
| Max. Negotiated Rate |
$116,448.00 |
| Rate for Payer: Aetna Commercial |
$93,401.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94,614.00
|
| Rate for Payer: Cash Price |
$60,650.00
|
| Rate for Payer: Cigna Commercial |
$100,679.00
|
| Rate for Payer: First Health Commercial |
$115,235.00
|
| Rate for Payer: Humana Commercial |
$103,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99,466.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89,519.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36,390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$106,744.00
|
| Rate for Payer: Ohio Health Group HMO |
$90,975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,769.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37,603.00
|
| Rate for Payer: PHCS Commercial |
$116,448.00
|
| Rate for Payer: United Healthcare All Payer |
$106,744.00
|
|
|
DEFIBRILLATOR CONCERTO C154DWK
|
Facility
|
OP
|
$121,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$15,769.00 |
| Max. Negotiated Rate |
$116,448.00 |
| Rate for Payer: First Health Commercial |
$115,235.00
|
| Rate for Payer: Humana Commercial |
$103,105.00
|
| Rate for Payer: Humana KY Medicaid |
$41,715.07
|
| Rate for Payer: Kentucky WC Medicaid |
$42,139.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99,466.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89,519.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36,390.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$42,552.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$106,744.00
|
| Rate for Payer: Ohio Health Group HMO |
$90,975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,769.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37,603.00
|
| Rate for Payer: PHCS Commercial |
$116,448.00
|
| Rate for Payer: United Healthcare All Payer |
$106,744.00
|
| Rate for Payer: Aetna Commercial |
$93,401.00
|
| Rate for Payer: Anthem Medicaid |
$41,715.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94,614.00
|
| Rate for Payer: Cash Price |
$60,650.00
|
| Rate for Payer: Cigna Commercial |
$100,679.00
|
|
|
DEFIBRILLATOR CRT-D D224TRK
|
Facility
|
OP
|
$99,700.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,961.00 |
| Max. Negotiated Rate |
$95,712.00 |
| Rate for Payer: Aetna Commercial |
$76,769.00
|
| Rate for Payer: Anthem Medicaid |
$34,286.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77,766.00
|
| Rate for Payer: Cash Price |
$49,850.00
|
| Rate for Payer: Cigna Commercial |
$82,751.00
|
| Rate for Payer: First Health Commercial |
$94,715.00
|
| Rate for Payer: Humana Commercial |
$84,745.00
|
| Rate for Payer: Humana KY Medicaid |
$34,286.83
|
| Rate for Payer: Kentucky WC Medicaid |
$34,635.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81,754.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73,578.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,910.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,974.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$87,736.00
|
| Rate for Payer: Ohio Health Group HMO |
$74,775.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,961.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30,907.00
|
| Rate for Payer: PHCS Commercial |
$95,712.00
|
| Rate for Payer: United Healthcare All Payer |
$87,736.00
|
|
|
DEFIBRILLATOR CRT-D D224TRK
|
Facility
|
IP
|
$99,700.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,961.00 |
| Max. Negotiated Rate |
$95,712.00 |
| Rate for Payer: Aetna Commercial |
$76,769.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77,766.00
|
| Rate for Payer: Cash Price |
$49,850.00
|
| Rate for Payer: Cigna Commercial |
$82,751.00
|
| Rate for Payer: First Health Commercial |
$94,715.00
|
| Rate for Payer: Humana Commercial |
$84,745.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81,754.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73,578.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,910.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$87,736.00
|
| Rate for Payer: Ohio Health Group HMO |
$74,775.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,961.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30,907.00
|
| Rate for Payer: PHCS Commercial |
$95,712.00
|
| Rate for Payer: United Healthcare All Payer |
$87,736.00
|
|
|
DEFIBRILLATOR CRT-D DTBB1D1
|
Facility
|
IP
|
$87,460.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,369.80 |
| Max. Negotiated Rate |
$83,961.60 |
| Rate for Payer: Aetna Commercial |
$67,344.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68,218.80
|
| Rate for Payer: Cash Price |
$43,730.00
|
| Rate for Payer: Cigna Commercial |
$72,591.80
|
| Rate for Payer: First Health Commercial |
$83,087.00
|
| Rate for Payer: Humana Commercial |
$74,341.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71,717.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64,545.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,238.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,964.80
|
| Rate for Payer: Ohio Health Group HMO |
$65,595.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,369.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,112.60
|
| Rate for Payer: PHCS Commercial |
$83,961.60
|
| Rate for Payer: United Healthcare All Payer |
$76,964.80
|
|
|
DEFIBRILLATOR CRT-D DTBB1D1
|
Facility
|
OP
|
$87,460.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,369.80 |
| Max. Negotiated Rate |
$83,961.60 |
| Rate for Payer: Aetna Commercial |
$67,344.20
|
| Rate for Payer: Anthem Medicaid |
$30,077.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68,218.80
|
| Rate for Payer: Cash Price |
$43,730.00
|
| Rate for Payer: Cigna Commercial |
$72,591.80
|
| Rate for Payer: First Health Commercial |
$83,087.00
|
| Rate for Payer: Humana Commercial |
$74,341.00
|
| Rate for Payer: Humana KY Medicaid |
$30,077.49
|
| Rate for Payer: Kentucky WC Medicaid |
$30,383.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71,717.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64,545.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,238.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,680.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,964.80
|
| Rate for Payer: Ohio Health Group HMO |
$65,595.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,369.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,112.60
|
| Rate for Payer: PHCS Commercial |
$83,961.60
|
| Rate for Payer: United Healthcare All Payer |
$76,964.80
|
|
