|
DEFIB DC CURRENT DR 2107-30
|
Facility
|
IP
|
$181,500.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$54,450.00 |
| Max. Negotiated Rate |
$174,240.00 |
| Rate for Payer: Aetna Commercial |
$139,755.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141,570.00
|
| Rate for Payer: Cash Price |
$90,750.00
|
| Rate for Payer: Cigna Commercial |
$150,645.00
|
| Rate for Payer: First Health Commercial |
$172,425.00
|
| Rate for Payer: Humana Commercial |
$154,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148,830.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133,947.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54,450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$159,720.00
|
| Rate for Payer: Ohio Health Group HMO |
$136,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157,905.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125,235.00
|
| Rate for Payer: PHCS Commercial |
$174,240.00
|
| Rate for Payer: United Healthcare All Payer |
$159,720.00
|
|
|
DEFIB DC CURRENT DR 2107-30
|
Facility
|
OP
|
$181,500.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$54,450.00 |
| Max. Negotiated Rate |
$174,240.00 |
| Rate for Payer: Aetna Commercial |
$139,755.00
|
| Rate for Payer: Anthem Medicaid |
$62,417.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141,570.00
|
| Rate for Payer: Cash Price |
$90,750.00
|
| Rate for Payer: Cigna Commercial |
$150,645.00
|
| Rate for Payer: First Health Commercial |
$172,425.00
|
| Rate for Payer: Humana Commercial |
$154,275.00
|
| Rate for Payer: Humana KY Medicaid |
$62,417.85
|
| Rate for Payer: Kentucky WC Medicaid |
$63,053.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148,830.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133,947.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54,450.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$63,670.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$159,720.00
|
| Rate for Payer: Ohio Health Group HMO |
$136,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157,905.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125,235.00
|
| Rate for Payer: PHCS Commercial |
$174,240.00
|
| Rate for Payer: United Healthcare All Payer |
$159,720.00
|
|
|
DEFIB DC CURRENT DR 2107-36
|
Facility
|
OP
|
$190,050.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$57,015.00 |
| Max. Negotiated Rate |
$182,448.00 |
| Rate for Payer: Aetna Commercial |
$146,338.50
|
| Rate for Payer: Anthem Medicaid |
$65,358.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148,239.00
|
| Rate for Payer: Cash Price |
$95,025.00
|
| Rate for Payer: Cigna Commercial |
$157,741.50
|
| Rate for Payer: First Health Commercial |
$180,547.50
|
| Rate for Payer: Humana Commercial |
$161,542.50
|
| Rate for Payer: Humana KY Medicaid |
$65,358.19
|
| Rate for Payer: Kentucky WC Medicaid |
$66,023.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$155,841.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140,256.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57,015.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$66,669.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$167,244.00
|
| Rate for Payer: Ohio Health Group HMO |
$142,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165,343.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131,134.50
|
| Rate for Payer: PHCS Commercial |
$182,448.00
|
| Rate for Payer: United Healthcare All Payer |
$167,244.00
|
|
|
DEFIB DC CURRENT DR 2107-36
|
Facility
|
IP
|
$190,050.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$57,015.00 |
| Max. Negotiated Rate |
$182,448.00 |
| Rate for Payer: Aetna Commercial |
$146,338.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148,239.00
|
| Rate for Payer: Cash Price |
$95,025.00
|
| Rate for Payer: Cigna Commercial |
$157,741.50
|
| Rate for Payer: First Health Commercial |
$180,547.50
|
| Rate for Payer: Humana Commercial |
$161,542.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$155,841.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140,256.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57,015.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$167,244.00
|
| Rate for Payer: Ohio Health Group HMO |
$142,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165,343.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131,134.50
|
| Rate for Payer: PHCS Commercial |
$182,448.00
|
| Rate for Payer: United Healthcare All Payer |
$167,244.00
|
|
|
DEFIB DC CURRENT RF DR 2207-30
|
Facility
|
OP
|
$90,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$27,090.00 |
| Max. Negotiated Rate |
$86,688.00 |
| Rate for Payer: Aetna Commercial |
$69,531.00
|
| Rate for Payer: Anthem Medicaid |
$31,054.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,434.00
|
| Rate for Payer: Cash Price |
$45,150.00
|
| Rate for Payer: Cigna Commercial |
$74,949.00
|
| Rate for Payer: First Health Commercial |
$85,785.00
|
| Rate for Payer: Humana Commercial |
$76,755.00
|
| Rate for Payer: Humana KY Medicaid |
$31,054.17
|
| Rate for Payer: Kentucky WC Medicaid |
$31,370.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,046.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,641.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,090.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,677.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$67,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78,561.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62,307.00
|
| Rate for Payer: PHCS Commercial |
$86,688.00
|
| Rate for Payer: United Healthcare All Payer |
$79,464.00
|
|
|
DEFIB DC CURRENT RF DR 2207-30
|
Facility
|
IP
|
$90,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$27,090.00 |
| Max. Negotiated Rate |
$86,688.00 |
| Rate for Payer: Aetna Commercial |
$69,531.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,434.00
|
| Rate for Payer: Cash Price |
$45,150.00
|
| Rate for Payer: Cigna Commercial |
$74,949.00
|
| Rate for Payer: First Health Commercial |
$85,785.00
|
| Rate for Payer: Humana Commercial |
$76,755.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,046.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,641.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,090.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$67,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78,561.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62,307.00
|
| Rate for Payer: PHCS Commercial |
$86,688.00
|
| Rate for Payer: United Healthcare All Payer |
$79,464.00
|
|
|
DEFIB DC CURRENT RF DR 2207-36
|
Facility
|
OP
|
$84,600.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$25,380.00 |
| Max. Negotiated Rate |
$81,216.00 |
| Rate for Payer: Aetna Commercial |
$65,142.00
|
| Rate for Payer: Anthem Medicaid |
$29,093.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,988.00
|
| Rate for Payer: Cash Price |
$42,300.00
|
| Rate for Payer: Cigna Commercial |
$70,218.00
|
| Rate for Payer: First Health Commercial |
$80,370.00
|
| Rate for Payer: Humana Commercial |
$71,910.00
|
| Rate for Payer: Humana KY Medicaid |
$29,093.94
|
| Rate for Payer: Kentucky WC Medicaid |
$29,390.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69,372.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62,434.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,380.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,677.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$74,448.00
|
| Rate for Payer: Ohio Health Group HMO |
$63,450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73,602.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58,374.00
|
| Rate for Payer: PHCS Commercial |
$81,216.00
|
| Rate for Payer: United Healthcare All Payer |
$74,448.00
|
|
|
DEFIB DC CURRENT RF DR 2207-36
|
Facility
|
IP
|
$84,600.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$25,380.00 |
| Max. Negotiated Rate |
$81,216.00 |
| Rate for Payer: Aetna Commercial |
$65,142.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,988.00
|
| Rate for Payer: Cash Price |
$42,300.00
|
| Rate for Payer: Cigna Commercial |
$70,218.00
|
| Rate for Payer: First Health Commercial |
$80,370.00
|
| Rate for Payer: Humana Commercial |
$71,910.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69,372.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62,434.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,380.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$74,448.00
|
| Rate for Payer: Ohio Health Group HMO |
$63,450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73,602.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58,374.00
|
| Rate for Payer: PHCS Commercial |
$81,216.00
|
| Rate for Payer: United Healthcare All Payer |
$74,448.00
|
|
|
DEFIB DC EPIC DR V-233
|
Facility
|
OP
|
$78,900.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,670.00 |
| Max. Negotiated Rate |
$75,744.00 |
| Rate for Payer: Aetna Commercial |
$60,753.00
|
| Rate for Payer: Anthem Medicaid |
$27,133.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,542.00
|
| Rate for Payer: Cash Price |
$39,450.00
|
| Rate for Payer: Cigna Commercial |
$65,487.00
|
| Rate for Payer: First Health Commercial |
$74,955.00
|
| Rate for Payer: Humana Commercial |
$67,065.00
|
| Rate for Payer: Humana KY Medicaid |
$27,133.71
|
| Rate for Payer: Kentucky WC Medicaid |
$27,409.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,698.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,228.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,670.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,678.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,432.00
|
| Rate for Payer: Ohio Health Group HMO |
$59,175.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,643.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,441.00
|
| Rate for Payer: PHCS Commercial |
$75,744.00
|
| Rate for Payer: United Healthcare All Payer |
$69,432.00
|
|
|
DEFIB DC EPIC DR V-233
|
Facility
|
IP
|
$78,900.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,670.00 |
| Max. Negotiated Rate |
$75,744.00 |
| Rate for Payer: Aetna Commercial |
$60,753.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,542.00
|
| Rate for Payer: Cash Price |
$39,450.00
|
| Rate for Payer: Cigna Commercial |
$65,487.00
|
| Rate for Payer: First Health Commercial |
$74,955.00
|
| Rate for Payer: Humana Commercial |
$67,065.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,698.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,228.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,670.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,432.00
|
| Rate for Payer: Ohio Health Group HMO |
$59,175.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,643.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,441.00
|
| Rate for Payer: PHCS Commercial |
$75,744.00
|
| Rate for Payer: United Healthcare All Payer |
$69,432.00
|
|
|
DEFIB DC EPIC+ DR V-239
|
Facility
|
IP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,240.00 |
| Max. Negotiated Rate |
$77,568.00 |
| Rate for Payer: Aetna Commercial |
$62,216.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,024.00
|
| Rate for Payer: Cash Price |
$40,400.00
|
| Rate for Payer: Cigna Commercial |
$67,064.00
|
| Rate for Payer: First Health Commercial |
$76,760.00
|
| Rate for Payer: Humana Commercial |
$68,680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,256.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,630.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,104.00
|
| Rate for Payer: Ohio Health Group HMO |
$60,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,296.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,752.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
|
DEFIB DC EPIC+ DR V-239
|
Facility
|
OP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,240.00 |
| Max. Negotiated Rate |
$77,568.00 |
| Rate for Payer: Aetna Commercial |
$62,216.00
|
| Rate for Payer: Anthem Medicaid |
$27,787.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,024.00
|
| Rate for Payer: Cash Price |
$40,400.00
|
| Rate for Payer: Cigna Commercial |
$67,064.00
|
| Rate for Payer: First Health Commercial |
$76,760.00
|
| Rate for Payer: Humana Commercial |
$68,680.00
|
| Rate for Payer: Humana KY Medicaid |
$27,787.12
|
| Rate for Payer: Kentucky WC Medicaid |
$28,069.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,256.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,630.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,344.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,104.00
|
| Rate for Payer: Ohio Health Group HMO |
$60,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,296.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,752.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
|
DEFIB DC EPIC II DR V-253
|
Facility
|
IP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,240.00 |
| Max. Negotiated Rate |
$77,568.00 |
| Rate for Payer: Aetna Commercial |
$62,216.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,024.00
|
| Rate for Payer: Cash Price |
$40,400.00
|
| Rate for Payer: Cigna Commercial |
$67,064.00
|
| Rate for Payer: First Health Commercial |
$76,760.00
|
| Rate for Payer: Humana Commercial |
$68,680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,256.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,630.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,104.00
|
| Rate for Payer: Ohio Health Group HMO |
$60,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,296.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,752.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
|
DEFIB DC EPIC II DR V-253
|
Facility
|
OP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,240.00 |
| Max. Negotiated Rate |
$77,568.00 |
| Rate for Payer: Aetna Commercial |
$62,216.00
|
| Rate for Payer: Anthem Medicaid |
$27,787.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,024.00
|
| Rate for Payer: Cash Price |
$40,400.00
|
| Rate for Payer: Cigna Commercial |
$67,064.00
|
| Rate for Payer: First Health Commercial |
$76,760.00
|
| Rate for Payer: Humana Commercial |
$68,680.00
|
| Rate for Payer: Humana KY Medicaid |
$27,787.12
|
| Rate for Payer: Kentucky WC Medicaid |
$28,069.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,256.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,630.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,344.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,104.00
|
| Rate for Payer: Ohio Health Group HMO |
$60,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,296.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,752.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
|
DEFIB DC EPIC II+ DR V-258
|
Facility
|
IP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,240.00 |
| Max. Negotiated Rate |
$77,568.00 |
| Rate for Payer: Aetna Commercial |
$62,216.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,024.00
|
| Rate for Payer: Cash Price |
$40,400.00
|
| Rate for Payer: Cigna Commercial |
$67,064.00
|
| Rate for Payer: First Health Commercial |
$76,760.00
|
| Rate for Payer: Humana Commercial |
$68,680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,256.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,630.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,104.00
|
| Rate for Payer: Ohio Health Group HMO |
$60,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,296.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,752.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
|
DEFIB DC EPIC II+ DR V-258
|
Facility
|
OP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,240.00 |
| Max. Negotiated Rate |
$77,568.00 |
| Rate for Payer: Aetna Commercial |
$62,216.00
|
| Rate for Payer: Anthem Medicaid |
$27,787.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,024.00
|
| Rate for Payer: Cash Price |
$40,400.00
|
| Rate for Payer: Cigna Commercial |
$67,064.00
|
| Rate for Payer: First Health Commercial |
$76,760.00
|
| Rate for Payer: Humana Commercial |
$68,680.00
|
| Rate for Payer: Humana KY Medicaid |
$27,787.12
|
| Rate for Payer: Kentucky WC Medicaid |
$28,069.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,256.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,630.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,344.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,104.00
|
| Rate for Payer: Ohio Health Group HMO |
$60,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,296.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,752.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
|
DEFIB DC INTRINSIC 7288
|
Facility
|
IP
|
$98,280.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$29,484.00 |
| Max. Negotiated Rate |
$94,348.80 |
| Rate for Payer: Aetna Commercial |
$75,675.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,658.40
|
| Rate for Payer: Cash Price |
$49,140.00
|
| Rate for Payer: Cigna Commercial |
$81,572.40
|
| Rate for Payer: First Health Commercial |
$93,366.00
|
| Rate for Payer: Humana Commercial |
$83,538.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,589.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,530.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,484.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,486.40
|
| Rate for Payer: Ohio Health Group HMO |
$73,710.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78,624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85,503.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67,813.20
|
| Rate for Payer: PHCS Commercial |
$94,348.80
|
| Rate for Payer: United Healthcare All Payer |
$86,486.40
|
|
|
DEFIB DC INTRINSIC 7288
|
Facility
|
OP
|
$98,280.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$29,484.00 |
| Max. Negotiated Rate |
$94,348.80 |
| Rate for Payer: Aetna Commercial |
$75,675.60
|
| Rate for Payer: Anthem Medicaid |
$33,798.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,658.40
|
| Rate for Payer: Cash Price |
$49,140.00
|
| Rate for Payer: Cigna Commercial |
$81,572.40
|
| Rate for Payer: First Health Commercial |
$93,366.00
|
| Rate for Payer: Humana Commercial |
$83,538.00
|
| Rate for Payer: Humana KY Medicaid |
$33,798.49
|
| Rate for Payer: Kentucky WC Medicaid |
$34,142.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,589.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,530.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,484.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,476.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,486.40
|
| Rate for Payer: Ohio Health Group HMO |
$73,710.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78,624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85,503.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67,813.20
|
| Rate for Payer: PHCS Commercial |
$94,348.80
|
| Rate for Payer: United Healthcare All Payer |
$86,486.40
|
|
|
DEFIB DC VIRTUOSO DR D154AW
|
Facility
|
OP
|
$111,960.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$33,588.00 |
| Max. Negotiated Rate |
$107,481.60 |
| Rate for Payer: Aetna Commercial |
$86,209.20
|
| Rate for Payer: Anthem Medicaid |
$38,503.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87,328.80
|
| Rate for Payer: Cash Price |
$55,980.00
|
| Rate for Payer: Cigna Commercial |
$92,926.80
|
| Rate for Payer: First Health Commercial |
$106,362.00
|
| Rate for Payer: Humana Commercial |
$95,166.00
|
| Rate for Payer: Humana KY Medicaid |
$38,503.04
|
| Rate for Payer: Kentucky WC Medicaid |
$38,894.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91,807.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82,626.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33,588.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$39,275.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$98,524.80
|
| Rate for Payer: Ohio Health Group HMO |
$83,970.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89,568.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97,405.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77,252.40
|
| Rate for Payer: PHCS Commercial |
$107,481.60
|
| Rate for Payer: United Healthcare All Payer |
$98,524.80
|
|
|
DEFIB DC VIRTUOSO DR D154AW
|
Facility
|
IP
|
$111,960.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$33,588.00 |
| Max. Negotiated Rate |
$107,481.60 |
| Rate for Payer: Aetna Commercial |
$86,209.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87,328.80
|
| Rate for Payer: Cash Price |
$55,980.00
|
| Rate for Payer: Cigna Commercial |
$92,926.80
|
| Rate for Payer: First Health Commercial |
$106,362.00
|
| Rate for Payer: Humana Commercial |
$95,166.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91,807.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82,626.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33,588.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$98,524.80
|
| Rate for Payer: Ohio Health Group HMO |
$83,970.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89,568.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97,405.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77,252.40
|
| Rate for Payer: PHCS Commercial |
$107,481.60
|
| Rate for Payer: United Healthcare All Payer |
$98,524.80
|
|
|
DEFIB ELIP DCRR CD2411-36C CEL
|
Facility
|
IP
|
$75,860.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,758.00 |
| Max. Negotiated Rate |
$72,825.60 |
| Rate for Payer: Aetna Commercial |
$58,412.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,170.80
|
| Rate for Payer: Cash Price |
$37,930.00
|
| Rate for Payer: Cigna Commercial |
$62,963.80
|
| Rate for Payer: First Health Commercial |
$72,067.00
|
| Rate for Payer: Humana Commercial |
$64,481.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,205.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,984.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,758.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,756.80
|
| Rate for Payer: Ohio Health Group HMO |
$56,895.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,688.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,998.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,343.40
|
| Rate for Payer: PHCS Commercial |
$72,825.60
|
| Rate for Payer: United Healthcare All Payer |
$66,756.80
|
|
|
DEFIB ELIP DCRR CD2411-36C CEL
|
Facility
|
OP
|
$75,860.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,758.00 |
| Max. Negotiated Rate |
$72,825.60 |
| Rate for Payer: Aetna Commercial |
$58,412.20
|
| Rate for Payer: Anthem Medicaid |
$26,088.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,170.80
|
| Rate for Payer: Cash Price |
$37,930.00
|
| Rate for Payer: Cigna Commercial |
$62,963.80
|
| Rate for Payer: First Health Commercial |
$72,067.00
|
| Rate for Payer: Humana Commercial |
$64,481.00
|
| Rate for Payer: Humana KY Medicaid |
$26,088.25
|
| Rate for Payer: Kentucky WC Medicaid |
$26,353.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,205.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,984.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,758.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,611.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,756.80
|
| Rate for Payer: Ohio Health Group HMO |
$56,895.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,688.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,998.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,343.40
|
| Rate for Payer: PHCS Commercial |
$72,825.60
|
| Rate for Payer: United Healthcare All Payer |
$66,756.80
|
|
|
DEFIB ELIP DCRR CD2411-36Q CEL
|
Facility
|
OP
|
$75,860.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,758.00 |
| Max. Negotiated Rate |
$72,825.60 |
| Rate for Payer: Aetna Commercial |
$58,412.20
|
| Rate for Payer: Anthem Medicaid |
$26,088.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,170.80
|
| Rate for Payer: Cash Price |
$37,930.00
|
| Rate for Payer: Cigna Commercial |
$62,963.80
|
| Rate for Payer: First Health Commercial |
$72,067.00
|
| Rate for Payer: Humana Commercial |
$64,481.00
|
| Rate for Payer: Humana KY Medicaid |
$26,088.25
|
| Rate for Payer: Kentucky WC Medicaid |
$26,353.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,205.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,984.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,758.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,611.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,756.80
|
| Rate for Payer: Ohio Health Group HMO |
$56,895.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,688.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,998.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,343.40
|
| Rate for Payer: PHCS Commercial |
$72,825.60
|
| Rate for Payer: United Healthcare All Payer |
$66,756.80
|
|
|
DEFIB ELIP DCRR CD2411-36Q CEL
|
Facility
|
IP
|
$75,860.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,758.00 |
| Max. Negotiated Rate |
$72,825.60 |
| Rate for Payer: Aetna Commercial |
$58,412.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,170.80
|
| Rate for Payer: Cash Price |
$37,930.00
|
| Rate for Payer: Cigna Commercial |
$62,963.80
|
| Rate for Payer: First Health Commercial |
$72,067.00
|
| Rate for Payer: Humana Commercial |
$64,481.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,205.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,984.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,758.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,756.80
|
| Rate for Payer: Ohio Health Group HMO |
$56,895.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,688.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,998.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,343.40
|
| Rate for Payer: PHCS Commercial |
$72,825.60
|
| Rate for Payer: United Healthcare All Payer |
$66,756.80
|
|
|
DEFIB ELIPSE DCRR CD2411-36C
|
Facility
|
OP
|
$75,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,530.00 |
| Max. Negotiated Rate |
$72,096.00 |
| Rate for Payer: Aetna Commercial |
$57,827.00
|
| Rate for Payer: Anthem Medicaid |
$25,826.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,578.00
|
| Rate for Payer: Cash Price |
$37,550.00
|
| Rate for Payer: Cigna Commercial |
$62,333.00
|
| Rate for Payer: First Health Commercial |
$71,345.00
|
| Rate for Payer: Humana Commercial |
$63,835.00
|
| Rate for Payer: Humana KY Medicaid |
$25,826.89
|
| Rate for Payer: Kentucky WC Medicaid |
$26,089.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,582.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,423.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,530.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,345.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,088.00
|
| Rate for Payer: Ohio Health Group HMO |
$56,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,337.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,819.00
|
| Rate for Payer: PHCS Commercial |
$72,096.00
|
| Rate for Payer: United Healthcare All Payer |
$66,088.00
|
|
