|
DEFIB SC MAXIMO VR 7232CX
|
Facility
|
IP
|
$74,500.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,685.00 |
| Max. Negotiated Rate |
$71,520.00 |
| Rate for Payer: Aetna Commercial |
$57,365.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,110.00
|
| Rate for Payer: Cash Price |
$37,250.00
|
| Rate for Payer: Cigna Commercial |
$61,835.00
|
| Rate for Payer: First Health Commercial |
$70,775.00
|
| Rate for Payer: Humana Commercial |
$63,325.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,090.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,981.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,350.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,560.00
|
| Rate for Payer: Ohio Health Group HMO |
$55,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,685.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,095.00
|
| Rate for Payer: PHCS Commercial |
$71,520.00
|
| Rate for Payer: United Healthcare All Payer |
$65,560.00
|
|
|
DEFIB SC MAXIMO VR 7232CX
|
Facility
|
OP
|
$74,500.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,685.00 |
| Max. Negotiated Rate |
$71,520.00 |
| Rate for Payer: Aetna Commercial |
$57,365.00
|
| Rate for Payer: Anthem Medicaid |
$25,620.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,110.00
|
| Rate for Payer: Cash Price |
$37,250.00
|
| Rate for Payer: Cigna Commercial |
$61,835.00
|
| Rate for Payer: First Health Commercial |
$70,775.00
|
| Rate for Payer: Humana Commercial |
$63,325.00
|
| Rate for Payer: Humana KY Medicaid |
$25,620.55
|
| Rate for Payer: Kentucky WC Medicaid |
$25,881.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,090.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,981.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,350.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,134.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,560.00
|
| Rate for Payer: Ohio Health Group HMO |
$55,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,685.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,095.00
|
| Rate for Payer: PHCS Commercial |
$71,520.00
|
| Rate for Payer: United Healthcare All Payer |
$65,560.00
|
|
|
DEFIB SC VIRTUOSO VR D154VW
|
Facility
|
OP
|
$98,260.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,773.80 |
| Max. Negotiated Rate |
$94,329.60 |
| Rate for Payer: Aetna Commercial |
$75,660.20
|
| Rate for Payer: Anthem Medicaid |
$33,791.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,642.80
|
| Rate for Payer: Cash Price |
$49,130.00
|
| Rate for Payer: Cigna Commercial |
$81,555.80
|
| Rate for Payer: First Health Commercial |
$93,347.00
|
| Rate for Payer: Humana Commercial |
$83,521.00
|
| Rate for Payer: Humana KY Medicaid |
$33,791.61
|
| Rate for Payer: Kentucky WC Medicaid |
$34,135.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,573.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,515.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,478.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,469.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,468.80
|
| Rate for Payer: Ohio Health Group HMO |
$73,695.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,652.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,773.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30,460.60
|
| Rate for Payer: PHCS Commercial |
$94,329.60
|
| Rate for Payer: United Healthcare All Payer |
$86,468.80
|
|
|
DEFIB SC VIRTUOSO VR D154VW
|
Facility
|
IP
|
$98,260.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,773.80 |
| Max. Negotiated Rate |
$94,329.60 |
| Rate for Payer: Aetna Commercial |
$75,660.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,642.80
|
| Rate for Payer: Cash Price |
$49,130.00
|
| Rate for Payer: Cigna Commercial |
$81,555.80
|
| Rate for Payer: First Health Commercial |
$93,347.00
|
| Rate for Payer: Humana Commercial |
$83,521.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,573.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,515.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,478.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,468.80
|
| Rate for Payer: Ohio Health Group HMO |
$73,695.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,652.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,773.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30,460.60
|
| Rate for Payer: PHCS Commercial |
$94,329.60
|
| Rate for Payer: United Healthcare All Payer |
$86,468.80
|
|
|
DEFIB TELIGEN SCRR E102
|
Facility
|
OP
|
$82,960.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,784.80 |
| Max. Negotiated Rate |
$79,641.60 |
| Rate for Payer: Aetna Commercial |
$63,879.20
|
| Rate for Payer: Anthem Medicaid |
$28,529.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,708.80
|
| Rate for Payer: Cash Price |
$41,480.00
|
| Rate for Payer: Cigna Commercial |
$68,856.80
|
| Rate for Payer: First Health Commercial |
$78,812.00
|
| Rate for Payer: Humana Commercial |
$70,516.00
|
| Rate for Payer: Humana KY Medicaid |
$28,529.94
|
| Rate for Payer: Kentucky WC Medicaid |
$28,820.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,027.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,224.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,888.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,102.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,004.80
|
| Rate for Payer: Ohio Health Group HMO |
$62,220.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,592.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,784.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,717.60
|
| Rate for Payer: PHCS Commercial |
$79,641.60
|
| Rate for Payer: United Healthcare All Payer |
$73,004.80
|
|
|
DEFIB TELIGEN SCRR E102
|
Facility
|
IP
|
$82,960.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,784.80 |
| Max. Negotiated Rate |
$79,641.60 |
| Rate for Payer: Aetna Commercial |
$63,879.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,708.80
|
| Rate for Payer: Cash Price |
$41,480.00
|
| Rate for Payer: Cigna Commercial |
$68,856.80
|
| Rate for Payer: First Health Commercial |
$78,812.00
|
| Rate for Payer: Humana Commercial |
$70,516.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,027.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,224.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,888.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,004.80
|
| Rate for Payer: Ohio Health Group HMO |
$62,220.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,592.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,784.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,717.60
|
| Rate for Payer: PHCS Commercial |
$79,641.60
|
| Rate for Payer: United Healthcare All Payer |
$73,004.80
|
|
|
DEFIB UNIFYASSURA CD3357-40C
|
Facility
|
IP
|
$40,205.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
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 UNIFYASSURA CD3357-40C
|
Facility
|
OP
|
$40,205.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
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 UNIFYASSURA CD3357-40Q
|
Facility
|
OP
|
$40,205.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
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 UNIFYASSURA CD3357-40Q
|
Facility
|
IP
|
$40,205.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
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 VITALITY 2 DR DC T165
|
Facility
|
IP
|
$78,460.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,199.80 |
| Max. Negotiated Rate |
$75,321.60 |
| Rate for Payer: Aetna Commercial |
$60,414.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,198.80
|
| Rate for Payer: Cash Price |
$39,230.00
|
| Rate for Payer: Cigna Commercial |
$65,121.80
|
| Rate for Payer: First Health Commercial |
$74,537.00
|
| Rate for Payer: Humana Commercial |
$66,691.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,337.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,903.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,538.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,044.80
|
| Rate for Payer: Ohio Health Group HMO |
$58,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,199.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,322.60
|
| Rate for Payer: PHCS Commercial |
$75,321.60
|
| Rate for Payer: United Healthcare All Payer |
$69,044.80
|
|
|
DEFIB VITALITY 2 DR DC T165
|
Facility
|
OP
|
$78,460.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,199.80 |
| Max. Negotiated Rate |
$75,321.60 |
| Rate for Payer: Aetna Commercial |
$60,414.20
|
| Rate for Payer: Anthem Medicaid |
$26,982.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,198.80
|
| Rate for Payer: Cash Price |
$39,230.00
|
| Rate for Payer: Cigna Commercial |
$65,121.80
|
| Rate for Payer: First Health Commercial |
$74,537.00
|
| Rate for Payer: Humana Commercial |
$66,691.00
|
| Rate for Payer: Humana KY Medicaid |
$26,982.39
|
| Rate for Payer: Kentucky WC Medicaid |
$27,257.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,337.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,903.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,538.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,523.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,044.80
|
| Rate for Payer: Ohio Health Group HMO |
$58,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,199.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,322.60
|
| Rate for Payer: PHCS Commercial |
$75,321.60
|
| Rate for Payer: United Healthcare All Payer |
$69,044.80
|
|
|
DEFIB VITALITY 2 EL DC T167
|
Facility
|
OP
|
$81,700.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,621.00 |
| Max. Negotiated Rate |
$78,432.00 |
| Rate for Payer: Aetna Commercial |
$62,909.00
|
| Rate for Payer: Anthem Medicaid |
$28,096.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,726.00
|
| Rate for Payer: Cash Price |
$40,850.00
|
| Rate for Payer: Cigna Commercial |
$67,811.00
|
| Rate for Payer: First Health Commercial |
$77,615.00
|
| Rate for Payer: Humana Commercial |
$69,445.00
|
| Rate for Payer: Humana KY Medicaid |
$28,096.63
|
| Rate for Payer: Kentucky WC Medicaid |
$28,382.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,994.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,294.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,510.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,660.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,896.00
|
| Rate for Payer: Ohio Health Group HMO |
$61,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,621.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,327.00
|
| Rate for Payer: PHCS Commercial |
$78,432.00
|
| Rate for Payer: United Healthcare All Payer |
$71,896.00
|
|
|
DEFIB VITALITY 2 EL DC T167
|
Facility
|
IP
|
$81,700.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,621.00 |
| Max. Negotiated Rate |
$78,432.00 |
| Rate for Payer: Aetna Commercial |
$62,909.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,726.00
|
| Rate for Payer: Cash Price |
$40,850.00
|
| Rate for Payer: Cigna Commercial |
$67,811.00
|
| Rate for Payer: First Health Commercial |
$77,615.00
|
| Rate for Payer: Humana Commercial |
$69,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,994.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,294.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,896.00
|
| Rate for Payer: Ohio Health Group HMO |
$61,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,621.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,327.00
|
| Rate for Payer: PHCS Commercial |
$78,432.00
|
| Rate for Payer: United Healthcare All Payer |
$71,896.00
|
|
|
DEFIB VITALITY 2 EL VR SC T177
|
Facility
|
OP
|
$81,700.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,621.00 |
| Max. Negotiated Rate |
$78,432.00 |
| Rate for Payer: Aetna Commercial |
$62,909.00
|
| Rate for Payer: Anthem Medicaid |
$28,096.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,726.00
|
| Rate for Payer: Cash Price |
$40,850.00
|
| Rate for Payer: Cigna Commercial |
$67,811.00
|
| Rate for Payer: First Health Commercial |
$77,615.00
|
| Rate for Payer: Humana Commercial |
$69,445.00
|
| Rate for Payer: Humana KY Medicaid |
$28,096.63
|
| Rate for Payer: Kentucky WC Medicaid |
$28,382.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,994.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,294.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,510.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,660.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,896.00
|
| Rate for Payer: Ohio Health Group HMO |
$61,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,621.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,327.00
|
| Rate for Payer: PHCS Commercial |
$78,432.00
|
| Rate for Payer: United Healthcare All Payer |
$71,896.00
|
|
|
DEFIB VITALITY 2 EL VR SC T177
|
Facility
|
IP
|
$81,700.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,621.00 |
| Max. Negotiated Rate |
$78,432.00 |
| Rate for Payer: Aetna Commercial |
$62,909.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,726.00
|
| Rate for Payer: Cash Price |
$40,850.00
|
| Rate for Payer: Cigna Commercial |
$67,811.00
|
| Rate for Payer: First Health Commercial |
$77,615.00
|
| Rate for Payer: Humana Commercial |
$69,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,994.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,294.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,896.00
|
| Rate for Payer: Ohio Health Group HMO |
$61,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,621.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,327.00
|
| Rate for Payer: PHCS Commercial |
$78,432.00
|
| Rate for Payer: United Healthcare All Payer |
$71,896.00
|
|
|
DEFIB VITALITY 2 VR SC T175
|
Facility
|
IP
|
$78,460.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,199.80 |
| Max. Negotiated Rate |
$75,321.60 |
| Rate for Payer: Aetna Commercial |
$60,414.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,198.80
|
| Rate for Payer: Cash Price |
$39,230.00
|
| Rate for Payer: Cigna Commercial |
$65,121.80
|
| Rate for Payer: First Health Commercial |
$74,537.00
|
| Rate for Payer: Humana Commercial |
$66,691.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,337.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,903.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,538.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,044.80
|
| Rate for Payer: Ohio Health Group HMO |
$58,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,199.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,322.60
|
| Rate for Payer: PHCS Commercial |
$75,321.60
|
| Rate for Payer: United Healthcare All Payer |
$69,044.80
|
|
|
DEFIB VITALITY 2 VR SC T175
|
Facility
|
OP
|
$78,460.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,199.80 |
| Max. Negotiated Rate |
$75,321.60 |
| Rate for Payer: Aetna Commercial |
$60,414.20
|
| Rate for Payer: Anthem Medicaid |
$26,982.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,198.80
|
| Rate for Payer: Cash Price |
$39,230.00
|
| Rate for Payer: Cigna Commercial |
$65,121.80
|
| Rate for Payer: First Health Commercial |
$74,537.00
|
| Rate for Payer: Humana Commercial |
$66,691.00
|
| Rate for Payer: Humana KY Medicaid |
$26,982.39
|
| Rate for Payer: Kentucky WC Medicaid |
$27,257.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,337.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,903.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,538.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,523.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,044.80
|
| Rate for Payer: Ohio Health Group HMO |
$58,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,199.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,322.60
|
| Rate for Payer: PHCS Commercial |
$75,321.60
|
| Rate for Payer: United Healthcare All Payer |
$69,044.80
|
|
|
DEFIB VITALITY AVT DC A135
|
Facility
|
IP
|
$76,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,919.00 |
| Max. Negotiated Rate |
$73,248.00 |
| Rate for Payer: Aetna Commercial |
$58,751.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,514.00
|
| Rate for Payer: Cash Price |
$38,150.00
|
| Rate for Payer: Cigna Commercial |
$63,329.00
|
| Rate for Payer: First Health Commercial |
$72,485.00
|
| Rate for Payer: Humana Commercial |
$64,855.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,566.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,309.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,890.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,919.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,653.00
|
| Rate for Payer: PHCS Commercial |
$73,248.00
|
| Rate for Payer: United Healthcare All Payer |
$67,144.00
|
|
|
DEFIB VITALITY AVT DC A135
|
Facility
|
OP
|
$76,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,919.00 |
| Max. Negotiated Rate |
$73,248.00 |
| Rate for Payer: Aetna Commercial |
$58,751.00
|
| Rate for Payer: Anthem Medicaid |
$26,239.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,514.00
|
| Rate for Payer: Cash Price |
$38,150.00
|
| Rate for Payer: Cigna Commercial |
$63,329.00
|
| Rate for Payer: First Health Commercial |
$72,485.00
|
| Rate for Payer: Humana Commercial |
$64,855.00
|
| Rate for Payer: Humana KY Medicaid |
$26,239.57
|
| Rate for Payer: Kentucky WC Medicaid |
$26,506.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,566.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,309.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,890.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,766.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,919.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,653.00
|
| Rate for Payer: PHCS Commercial |
$73,248.00
|
| Rate for Payer: United Healthcare All Payer |
$67,144.00
|
|
|
DEFIB VITALITY AVT DC A155
|
Facility
|
IP
|
$76,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,919.00 |
| Max. Negotiated Rate |
$73,248.00 |
| Rate for Payer: Aetna Commercial |
$58,751.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,514.00
|
| Rate for Payer: Cash Price |
$38,150.00
|
| Rate for Payer: Cigna Commercial |
$63,329.00
|
| Rate for Payer: First Health Commercial |
$72,485.00
|
| Rate for Payer: Humana Commercial |
$64,855.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,566.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,309.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,890.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,919.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,653.00
|
| Rate for Payer: PHCS Commercial |
$73,248.00
|
| Rate for Payer: United Healthcare All Payer |
$67,144.00
|
|
|
DEFIB VITALITY AVT DC A155
|
Facility
|
OP
|
$76,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,919.00 |
| Max. Negotiated Rate |
$73,248.00 |
| Rate for Payer: Aetna Commercial |
$58,751.00
|
| Rate for Payer: Anthem Medicaid |
$26,239.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,514.00
|
| Rate for Payer: Cash Price |
$38,150.00
|
| Rate for Payer: Cigna Commercial |
$63,329.00
|
| Rate for Payer: First Health Commercial |
$72,485.00
|
| Rate for Payer: Humana Commercial |
$64,855.00
|
| Rate for Payer: Humana KY Medicaid |
$26,239.57
|
| Rate for Payer: Kentucky WC Medicaid |
$26,506.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,566.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,309.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,890.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,766.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,919.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,653.00
|
| Rate for Payer: PHCS Commercial |
$73,248.00
|
| Rate for Payer: United Healthcare All Payer |
$67,144.00
|
|
|
DEFIB VITALITY DS DR DC T125
|
Facility
|
IP
|
$76,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,919.00 |
| Max. Negotiated Rate |
$73,248.00 |
| Rate for Payer: Aetna Commercial |
$58,751.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,514.00
|
| Rate for Payer: Cash Price |
$38,150.00
|
| Rate for Payer: Cigna Commercial |
$63,329.00
|
| Rate for Payer: First Health Commercial |
$72,485.00
|
| Rate for Payer: Humana Commercial |
$64,855.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,566.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,309.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,890.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,919.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,653.00
|
| Rate for Payer: PHCS Commercial |
$73,248.00
|
| Rate for Payer: United Healthcare All Payer |
$67,144.00
|
|
|
DEFIB VITALITY DS DR DC T125
|
Facility
|
OP
|
$76,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,919.00 |
| Max. Negotiated Rate |
$73,248.00 |
| Rate for Payer: 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
|
| Rate for Payer: Aetna Commercial |
$58,751.00
|
|
|
DEFIB VITALITY DS VR SC T135
|
Facility
|
IP
|
$72,700.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,451.00 |
| Max. Negotiated Rate |
$69,792.00 |
| Rate for Payer: Aetna Commercial |
$55,979.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,706.00
|
| Rate for Payer: Cash Price |
$36,350.00
|
| Rate for Payer: Cigna Commercial |
$60,341.00
|
| Rate for Payer: First Health Commercial |
$69,065.00
|
| Rate for Payer: Humana Commercial |
$61,795.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,652.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$54,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,537.00
|
| Rate for Payer: PHCS Commercial |
$69,792.00
|
| Rate for Payer: United Healthcare All Payer |
$63,976.00
|
|
