|
DEFIBRILLATOR UNIFY CD3257-40Q
|
Facility
|
OP
|
$97,540.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,680.20 |
| Max. Negotiated Rate |
$93,638.40 |
| Rate for Payer: Aetna Commercial |
$75,105.80
|
| Rate for Payer: Anthem Medicaid |
$33,544.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,081.20
|
| Rate for Payer: Cash Price |
$48,770.00
|
| Rate for Payer: Cigna Commercial |
$80,958.20
|
| Rate for Payer: First Health Commercial |
$92,663.00
|
| Rate for Payer: Humana Commercial |
$82,909.00
|
| Rate for Payer: Humana KY Medicaid |
$33,544.01
|
| Rate for Payer: Kentucky WC Medicaid |
$33,885.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79,982.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71,984.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,262.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,217.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$85,835.20
|
| Rate for Payer: Ohio Health Group HMO |
$73,155.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,508.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,680.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30,237.40
|
| Rate for Payer: PHCS Commercial |
$93,638.40
|
| Rate for Payer: United Healthcare All Payer |
$85,835.20
|
|
|
DEFIBRILLATOR VISIA MRI DVFB1D
|
Facility
|
OP
|
$36,701.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,771.13 |
| Max. Negotiated Rate |
$35,232.96 |
| Rate for Payer: Aetna Commercial |
$28,259.77
|
| Rate for Payer: Anthem Medicaid |
$12,621.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,626.78
|
| Rate for Payer: Cash Price |
$18,350.50
|
| Rate for Payer: Cigna Commercial |
$30,461.83
|
| Rate for Payer: First Health Commercial |
$34,865.95
|
| Rate for Payer: Humana Commercial |
$31,195.85
|
| Rate for Payer: Humana KY Medicaid |
$12,621.47
|
| Rate for Payer: Kentucky WC Medicaid |
$12,749.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,094.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,085.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,010.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,874.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,296.88
|
| Rate for Payer: Ohio Health Group HMO |
$27,525.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,340.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,771.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,377.31
|
| Rate for Payer: PHCS Commercial |
$35,232.96
|
| Rate for Payer: United Healthcare All Payer |
$32,296.88
|
|
|
DEFIBRILLATOR VISIA MRI DVFB1D
|
Facility
|
IP
|
$36,701.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,771.13 |
| Max. Negotiated Rate |
$35,232.96 |
| Rate for Payer: Aetna Commercial |
$28,259.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,626.78
|
| Rate for Payer: Cash Price |
$18,350.50
|
| Rate for Payer: Cigna Commercial |
$30,461.83
|
| Rate for Payer: First Health Commercial |
$34,865.95
|
| Rate for Payer: Humana Commercial |
$31,195.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,094.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,085.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,010.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,296.88
|
| Rate for Payer: Ohio Health Group HMO |
$27,525.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,340.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,771.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,377.31
|
| Rate for Payer: PHCS Commercial |
$35,232.96
|
| Rate for Payer: United Healthcare All Payer |
$32,296.88
|
|
|
DEFIBRILLATOR VISIA VR DTMB1D1
|
Facility
|
OP
|
$94,660.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,305.80 |
| Max. Negotiated Rate |
$90,873.60 |
| Rate for Payer: Aetna Commercial |
$72,888.20
|
| Rate for Payer: Anthem Medicaid |
$32,553.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,834.80
|
| Rate for Payer: Cash Price |
$47,330.00
|
| Rate for Payer: Cigna Commercial |
$78,567.80
|
| Rate for Payer: First Health Commercial |
$89,927.00
|
| Rate for Payer: Humana Commercial |
$80,461.00
|
| Rate for Payer: Humana KY Medicaid |
$32,553.57
|
| Rate for Payer: Kentucky WC Medicaid |
$32,884.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,621.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,859.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,398.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,206.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$83,300.80
|
| Rate for Payer: Ohio Health Group HMO |
$70,995.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,932.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,305.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,344.60
|
| Rate for Payer: PHCS Commercial |
$90,873.60
|
| Rate for Payer: United Healthcare All Payer |
$83,300.80
|
|
|
DEFIBRILLATOR VISIA VR DTMB1D1
|
Facility
|
IP
|
$94,660.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
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
|
|
|
DEFIBRILLATOR VISIA VR DVAB1D4
|
Facility
|
OP
|
$66,580.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,655.40 |
| Max. Negotiated Rate |
$63,916.80 |
| Rate for Payer: Aetna Commercial |
$51,266.60
|
| Rate for Payer: Anthem Medicaid |
$22,896.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51,932.40
|
| Rate for Payer: Cash Price |
$33,290.00
|
| Rate for Payer: Cigna Commercial |
$55,261.40
|
| Rate for Payer: First Health Commercial |
$63,251.00
|
| Rate for Payer: Humana Commercial |
$56,593.00
|
| Rate for Payer: Humana KY Medicaid |
$22,896.86
|
| Rate for Payer: Kentucky WC Medicaid |
$23,129.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54,595.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49,136.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,974.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,356.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$58,590.40
|
| Rate for Payer: Ohio Health Group HMO |
$49,935.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,655.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,639.80
|
| Rate for Payer: PHCS Commercial |
$63,916.80
|
| Rate for Payer: United Healthcare All Payer |
$58,590.40
|
|
|
DEFIBRILLATOR VISIA VR DVAB1D4
|
Facility
|
IP
|
$66,580.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,655.40 |
| Max. Negotiated Rate |
$63,916.80 |
| Rate for Payer: Aetna Commercial |
$51,266.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51,932.40
|
| Rate for Payer: Cash Price |
$33,290.00
|
| Rate for Payer: Cigna Commercial |
$55,261.40
|
| Rate for Payer: First Health Commercial |
$63,251.00
|
| Rate for Payer: Humana Commercial |
$56,593.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54,595.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49,136.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,974.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$58,590.40
|
| Rate for Payer: Ohio Health Group HMO |
$49,935.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,655.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,639.80
|
| Rate for Payer: PHCS Commercial |
$63,916.80
|
| Rate for Payer: United Healthcare All Payer |
$58,590.40
|
|
|
DEFIBRILLATOR VISIA VR DVFB1D1
|
Facility
|
IP
|
$70,180.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,123.40 |
| Max. Negotiated Rate |
$67,372.80 |
| Rate for Payer: Aetna Commercial |
$54,038.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,740.40
|
| Rate for Payer: Cash Price |
$35,090.00
|
| Rate for Payer: Cigna Commercial |
$58,249.40
|
| Rate for Payer: First Health Commercial |
$66,671.00
|
| Rate for Payer: Humana Commercial |
$59,653.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,547.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,792.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,054.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,758.40
|
| Rate for Payer: Ohio Health Group HMO |
$52,635.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,123.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,755.80
|
| Rate for Payer: PHCS Commercial |
$67,372.80
|
| Rate for Payer: United Healthcare All Payer |
$61,758.40
|
|
|
DEFIBRILLATOR VISIA VR DVFB1D1
|
Facility
|
OP
|
$70,180.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,123.40 |
| Max. Negotiated Rate |
$67,372.80 |
| Rate for Payer: Aetna Commercial |
$54,038.60
|
| Rate for Payer: Anthem Medicaid |
$24,134.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,740.40
|
| Rate for Payer: Cash Price |
$35,090.00
|
| Rate for Payer: Cigna Commercial |
$58,249.40
|
| Rate for Payer: First Health Commercial |
$66,671.00
|
| Rate for Payer: Humana Commercial |
$59,653.00
|
| Rate for Payer: Humana KY Medicaid |
$24,134.90
|
| Rate for Payer: Kentucky WC Medicaid |
$24,380.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,547.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,792.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,054.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,619.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,758.40
|
| Rate for Payer: Ohio Health Group HMO |
$52,635.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,123.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,755.80
|
| Rate for Payer: PHCS Commercial |
$67,372.80
|
| Rate for Payer: United Healthcare All Payer |
$61,758.40
|
|
|
DEFIBRILLATR CRT-D DTBA1D1
|
Facility
|
IP
|
$87,460.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
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
|
|
|
DEFIBRILLATR CRT-D DTBA1D1
|
Facility
|
OP
|
$87,460.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
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
|
|
|
DEFIBRILLATR CRT-D DTBA1D4
|
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
|
|
|
DEFIBRILLATR CRT-D DTBA1D4
|
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
|
|
|
DEFIB SC ATLAS VR V-193C
|
Facility
|
IP
|
$37,650.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,894.50 |
| Max. Negotiated Rate |
$36,144.00 |
| 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
|
| Rate for Payer: Aetna Commercial |
$28,990.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,367.00
|
|
|
DEFIB SC ATLAS VR V-193C
|
Facility
|
OP
|
$37,650.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
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 SC CURRENT RF VR 1207-30
|
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 SC CURRENT RF VR 1207-30
|
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 SC CURRENT RF VR 1207-36
|
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 SC CURRENT RF VR 1207-36
|
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 SC CURRENT VR 1107-30
|
Facility
|
IP
|
$148,300.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$19,279.00 |
| Max. Negotiated Rate |
$142,368.00 |
| Rate for Payer: Aetna Commercial |
$114,191.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$115,674.00
|
| Rate for Payer: Cash Price |
$74,150.00
|
| Rate for Payer: Cigna Commercial |
$123,089.00
|
| Rate for Payer: First Health Commercial |
$140,885.00
|
| Rate for Payer: Humana Commercial |
$126,055.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$121,606.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109,445.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44,490.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$130,504.00
|
| Rate for Payer: Ohio Health Group HMO |
$111,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,279.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45,973.00
|
| Rate for Payer: PHCS Commercial |
$142,368.00
|
| Rate for Payer: United Healthcare All Payer |
$130,504.00
|
|
|
DEFIB SC CURRENT VR 1107-30
|
Facility
|
OP
|
$148,300.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$19,279.00 |
| Max. Negotiated Rate |
$142,368.00 |
| Rate for Payer: Aetna Commercial |
$114,191.00
|
| Rate for Payer: Anthem Medicaid |
$51,000.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$115,674.00
|
| Rate for Payer: Cash Price |
$74,150.00
|
| Rate for Payer: Cigna Commercial |
$123,089.00
|
| Rate for Payer: First Health Commercial |
$140,885.00
|
| Rate for Payer: Humana Commercial |
$126,055.00
|
| Rate for Payer: Humana KY Medicaid |
$51,000.37
|
| Rate for Payer: Kentucky WC Medicaid |
$51,519.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$121,606.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109,445.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44,490.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$52,023.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$130,504.00
|
| Rate for Payer: Ohio Health Group HMO |
$111,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,279.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45,973.00
|
| Rate for Payer: PHCS Commercial |
$142,368.00
|
| Rate for Payer: United Healthcare All Payer |
$130,504.00
|
|
|
DEFIB SC CURRENT VR 1107-36
|
Facility
|
IP
|
$160,000.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$20,800.00 |
| Max. Negotiated Rate |
$153,600.00 |
| Rate for Payer: Aetna Commercial |
$123,200.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124,800.00
|
| Rate for Payer: Cash Price |
$80,000.00
|
| Rate for Payer: Cigna Commercial |
$132,800.00
|
| Rate for Payer: First Health Commercial |
$152,000.00
|
| Rate for Payer: Humana Commercial |
$136,000.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131,200.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118,080.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48,000.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140,800.00
|
| Rate for Payer: Ohio Health Group HMO |
$120,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,800.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,600.00
|
| Rate for Payer: PHCS Commercial |
$153,600.00
|
| Rate for Payer: United Healthcare All Payer |
$140,800.00
|
|
|
DEFIB SC CURRENT VR 1107-36
|
Facility
|
OP
|
$160,000.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$20,800.00 |
| Max. Negotiated Rate |
$153,600.00 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$124,800.00
|
| Rate for Payer: Cash Price |
$80,000.00
|
| Rate for Payer: Cigna Commercial |
$132,800.00
|
| Rate for Payer: First Health Commercial |
$152,000.00
|
| Rate for Payer: Humana Commercial |
$136,000.00
|
| Rate for Payer: Humana KY Medicaid |
$55,024.00
|
| Rate for Payer: Kentucky WC Medicaid |
$55,584.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131,200.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118,080.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48,000.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$56,128.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140,800.00
|
| Rate for Payer: Ohio Health Group HMO |
$120,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,800.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,600.00
|
| Rate for Payer: PHCS Commercial |
$153,600.00
|
| Rate for Payer: United Healthcare All Payer |
$140,800.00
|
| Rate for Payer: Aetna Commercial |
$123,200.00
|
| Rate for Payer: Anthem Medicaid |
$55,024.00
|
|
|
DEFIB SC EPIC+ VR V-196
|
Facility
|
IP
|
$76,300.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,919.00 |
| Max. Negotiated Rate |
$73,248.00 |
| Rate for Payer: Aetna Commercial |
$58,751.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,514.00
|
| Rate for Payer: Cash Price |
$38,150.00
|
| Rate for Payer: Cigna Commercial |
$63,329.00
|
| Rate for Payer: First Health Commercial |
$72,485.00
|
| Rate for Payer: Humana Commercial |
$64,855.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,566.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,309.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,890.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,919.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,653.00
|
| Rate for Payer: PHCS Commercial |
$73,248.00
|
| Rate for Payer: United Healthcare All Payer |
$67,144.00
|
|
|
DEFIB SC EPIC+ VR V-196
|
Facility
|
OP
|
$76,300.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,919.00 |
| Max. Negotiated Rate |
$73,248.00 |
| Rate for Payer: Aetna Commercial |
$58,751.00
|
| Rate for Payer: Anthem Medicaid |
$26,239.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,514.00
|
| Rate for Payer: Cash Price |
$38,150.00
|
| Rate for Payer: Cigna Commercial |
$63,329.00
|
| Rate for Payer: First Health Commercial |
$72,485.00
|
| Rate for Payer: Humana Commercial |
$64,855.00
|
| Rate for Payer: Humana KY Medicaid |
$26,239.57
|
| Rate for Payer: Kentucky WC Medicaid |
$26,506.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,566.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,309.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,890.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,766.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,919.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,653.00
|
| Rate for Payer: PHCS Commercial |
$73,248.00
|
| Rate for Payer: United Healthcare All Payer |
$67,144.00
|
|
