|
DEFIB ELIPSE DCRR CD2411-36C
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
DEFIB ELIPSE DCRR CD2411-36Q
|
Facility
|
IP
|
$77,220.40
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,166.12 |
| Max. Negotiated Rate |
$74,131.58 |
| Rate for Payer: Aetna Commercial |
$59,459.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,231.91
|
| Rate for Payer: Cash Price |
$38,610.20
|
| Rate for Payer: Cigna Commercial |
$64,092.93
|
| Rate for Payer: First Health Commercial |
$73,359.38
|
| Rate for Payer: Humana Commercial |
$65,637.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,320.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,988.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,166.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,953.95
|
| Rate for Payer: Ohio Health Group HMO |
$57,915.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,776.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,181.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,282.08
|
| Rate for Payer: PHCS Commercial |
$74,131.58
|
| Rate for Payer: United Healthcare All Payer |
$67,953.95
|
|
|
DEFIB ELIPSE DCRR CD2411-36Q
|
Facility
|
OP
|
$77,220.40
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,166.12 |
| Max. Negotiated Rate |
$74,131.58 |
| Rate for Payer: Aetna Commercial |
$59,459.71
|
| Rate for Payer: Anthem Medicaid |
$26,556.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,231.91
|
| Rate for Payer: Cash Price |
$38,610.20
|
| Rate for Payer: Cigna Commercial |
$64,092.93
|
| Rate for Payer: First Health Commercial |
$73,359.38
|
| Rate for Payer: Humana Commercial |
$65,637.34
|
| Rate for Payer: Humana KY Medicaid |
$26,556.10
|
| Rate for Payer: Kentucky WC Medicaid |
$26,826.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,320.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,988.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,166.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,088.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,953.95
|
| Rate for Payer: Ohio Health Group HMO |
$57,915.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,776.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,181.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,282.08
|
| Rate for Payer: PHCS Commercial |
$74,131.58
|
| Rate for Payer: United Healthcare All Payer |
$67,953.95
|
|
|
DEFIB ELLIPSE CD1411-36C
|
Facility
|
IP
|
$71,300.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$21,390.00 |
| Max. Negotiated Rate |
$68,448.00 |
| Rate for Payer: Aetna Commercial |
$54,901.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,614.00
|
| Rate for Payer: Cash Price |
$35,650.00
|
| Rate for Payer: Cigna Commercial |
$59,179.00
|
| Rate for Payer: First Health Commercial |
$67,735.00
|
| Rate for Payer: Humana Commercial |
$60,605.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,466.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,619.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,744.00
|
| Rate for Payer: Ohio Health Group HMO |
$53,475.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,031.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,197.00
|
| Rate for Payer: PHCS Commercial |
$68,448.00
|
| Rate for Payer: United Healthcare All Payer |
$62,744.00
|
|
|
DEFIB ELLIPSE CD1411-36C
|
Facility
|
OP
|
$71,300.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$21,390.00 |
| Max. Negotiated Rate |
$68,448.00 |
| Rate for Payer: Aetna Commercial |
$54,901.00
|
| Rate for Payer: Anthem Medicaid |
$24,520.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,614.00
|
| Rate for Payer: Cash Price |
$35,650.00
|
| Rate for Payer: Cigna Commercial |
$59,179.00
|
| Rate for Payer: First Health Commercial |
$67,735.00
|
| Rate for Payer: Humana Commercial |
$60,605.00
|
| Rate for Payer: Humana KY Medicaid |
$24,520.07
|
| Rate for Payer: Kentucky WC Medicaid |
$24,769.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,466.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,619.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,390.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,012.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,744.00
|
| Rate for Payer: Ohio Health Group HMO |
$53,475.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,031.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,197.00
|
| Rate for Payer: PHCS Commercial |
$68,448.00
|
| Rate for Payer: United Healthcare All Payer |
$62,744.00
|
|
|
DEFIB ELLIPSE CD1411-36C CELL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DEFIB ELLIPSE CD1411-36C CELL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DEFIB ELLIPSE DR CD2311-36Q
|
Facility
|
OP
|
$81,370.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,411.00 |
| Max. Negotiated Rate |
$78,115.20 |
| Rate for Payer: Aetna Commercial |
$62,654.90
|
| Rate for Payer: Anthem Medicaid |
$27,983.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,468.60
|
| Rate for Payer: Cash Price |
$40,685.00
|
| Rate for Payer: Cigna Commercial |
$67,537.10
|
| Rate for Payer: First Health Commercial |
$77,301.50
|
| Rate for Payer: Humana Commercial |
$69,164.50
|
| Rate for Payer: Humana KY Medicaid |
$27,983.14
|
| Rate for Payer: Kentucky WC Medicaid |
$28,267.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,723.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,051.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,411.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,544.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,605.60
|
| Rate for Payer: Ohio Health Group HMO |
$61,027.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,096.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,791.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,145.30
|
| Rate for Payer: PHCS Commercial |
$78,115.20
|
| Rate for Payer: United Healthcare All Payer |
$71,605.60
|
|
|
DEFIB ELLIPSE DR CD2311-36Q
|
Facility
|
IP
|
$81,370.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,411.00 |
| Max. Negotiated Rate |
$78,115.20 |
| Rate for Payer: Aetna Commercial |
$62,654.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,468.60
|
| Rate for Payer: Cash Price |
$40,685.00
|
| Rate for Payer: Cigna Commercial |
$67,537.10
|
| Rate for Payer: First Health Commercial |
$77,301.50
|
| Rate for Payer: Humana Commercial |
$69,164.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,723.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,051.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,411.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,605.60
|
| Rate for Payer: Ohio Health Group HMO |
$61,027.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,096.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,791.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,145.30
|
| Rate for Payer: PHCS Commercial |
$78,115.20
|
| Rate for Payer: United Healthcare All Payer |
$71,605.60
|
|
|
DEFIB ENERGEN DCRR E142
|
Facility
|
OP
|
$76,050.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,815.00 |
| Max. Negotiated Rate |
$73,008.00 |
| Rate for Payer: Aetna Commercial |
$58,558.50
|
| Rate for Payer: Anthem Medicaid |
$26,153.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,319.00
|
| Rate for Payer: Cash Price |
$38,025.00
|
| Rate for Payer: Cigna Commercial |
$63,121.50
|
| Rate for Payer: First Health Commercial |
$72,247.50
|
| Rate for Payer: Humana Commercial |
$64,642.50
|
| Rate for Payer: Humana KY Medicaid |
$26,153.60
|
| Rate for Payer: Kentucky WC Medicaid |
$26,419.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,361.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,124.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,815.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,678.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,924.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,037.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,163.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,474.50
|
| Rate for Payer: PHCS Commercial |
$73,008.00
|
| Rate for Payer: United Healthcare All Payer |
$66,924.00
|
|
|
DEFIB ENERGEN DCRR E142
|
Facility
|
IP
|
$76,050.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,815.00 |
| Max. Negotiated Rate |
$73,008.00 |
| Rate for Payer: Aetna Commercial |
$58,558.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,319.00
|
| Rate for Payer: Cash Price |
$38,025.00
|
| Rate for Payer: Cigna Commercial |
$63,121.50
|
| Rate for Payer: First Health Commercial |
$72,247.50
|
| Rate for Payer: Humana Commercial |
$64,642.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,361.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,124.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,815.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,924.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,037.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,163.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,474.50
|
| Rate for Payer: PHCS Commercial |
$73,008.00
|
| Rate for Payer: United Healthcare All Payer |
$66,924.00
|
|
|
DEFIB ENERGEN DCRR E143
|
Facility
|
OP
|
$76,050.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,815.00 |
| Max. Negotiated Rate |
$73,008.00 |
| Rate for Payer: Aetna Commercial |
$58,558.50
|
| Rate for Payer: Anthem Medicaid |
$26,153.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,319.00
|
| Rate for Payer: Cash Price |
$38,025.00
|
| Rate for Payer: Cigna Commercial |
$63,121.50
|
| Rate for Payer: First Health Commercial |
$72,247.50
|
| Rate for Payer: Humana Commercial |
$64,642.50
|
| Rate for Payer: Humana KY Medicaid |
$26,153.60
|
| Rate for Payer: Kentucky WC Medicaid |
$26,419.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,361.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,124.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,815.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,678.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,924.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,037.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,163.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,474.50
|
| Rate for Payer: PHCS Commercial |
$73,008.00
|
| Rate for Payer: United Healthcare All Payer |
$66,924.00
|
|
|
DEFIB ENERGEN DCRR E143
|
Facility
|
IP
|
$76,050.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,815.00 |
| Max. Negotiated Rate |
$73,008.00 |
| Rate for Payer: Aetna Commercial |
$58,558.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,319.00
|
| Rate for Payer: Cash Price |
$38,025.00
|
| Rate for Payer: Cigna Commercial |
$63,121.50
|
| Rate for Payer: First Health Commercial |
$72,247.50
|
| Rate for Payer: Humana Commercial |
$64,642.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,361.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,124.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,815.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,924.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,037.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,163.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,474.50
|
| Rate for Payer: PHCS Commercial |
$73,008.00
|
| Rate for Payer: United Healthcare All Payer |
$66,924.00
|
|
|
DEFIB ENERGEN SCRR E140
|
Facility
|
OP
|
$72,250.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$21,675.00 |
| Max. Negotiated Rate |
$69,360.00 |
| Rate for Payer: Aetna Commercial |
$55,632.50
|
| Rate for Payer: Anthem Medicaid |
$24,846.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,355.00
|
| Rate for Payer: Cash Price |
$36,125.00
|
| Rate for Payer: Cigna Commercial |
$59,967.50
|
| Rate for Payer: First Health Commercial |
$68,637.50
|
| Rate for Payer: Humana Commercial |
$61,412.50
|
| Rate for Payer: Humana KY Medicaid |
$24,846.78
|
| Rate for Payer: Kentucky WC Medicaid |
$25,099.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,245.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,320.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,675.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,345.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,580.00
|
| Rate for Payer: Ohio Health Group HMO |
$54,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,857.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,852.50
|
| Rate for Payer: PHCS Commercial |
$69,360.00
|
| Rate for Payer: United Healthcare All Payer |
$63,580.00
|
|
|
DEFIB ENERGEN SCRR E140
|
Facility
|
IP
|
$72,250.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$21,675.00 |
| Max. Negotiated Rate |
$69,360.00 |
| Rate for Payer: Aetna Commercial |
$55,632.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,355.00
|
| Rate for Payer: Cash Price |
$36,125.00
|
| Rate for Payer: Cigna Commercial |
$59,967.50
|
| Rate for Payer: First Health Commercial |
$68,637.50
|
| Rate for Payer: Humana Commercial |
$61,412.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,245.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,320.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,675.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,580.00
|
| Rate for Payer: Ohio Health Group HMO |
$54,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,857.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,852.50
|
| Rate for Payer: PHCS Commercial |
$69,360.00
|
| Rate for Payer: United Healthcare All Payer |
$63,580.00
|
|
|
DEFIB ENERGEN SCRR E141
|
Facility
|
IP
|
$77,285.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,185.50 |
| Max. Negotiated Rate |
$74,193.60 |
| Rate for Payer: Aetna Commercial |
$59,509.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,282.30
|
| Rate for Payer: Cash Price |
$38,642.50
|
| Rate for Payer: Cigna Commercial |
$64,146.55
|
| Rate for Payer: First Health Commercial |
$73,420.75
|
| Rate for Payer: Humana Commercial |
$65,692.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,373.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,036.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,185.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,010.80
|
| Rate for Payer: Ohio Health Group HMO |
$57,963.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,828.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,237.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,326.65
|
| Rate for Payer: PHCS Commercial |
$74,193.60
|
| Rate for Payer: United Healthcare All Payer |
$68,010.80
|
|
|
DEFIB ENERGEN SCRR E141
|
Facility
|
OP
|
$77,285.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,185.50 |
| Max. Negotiated Rate |
$74,193.60 |
| Rate for Payer: Aetna Commercial |
$59,509.45
|
| Rate for Payer: Anthem Medicaid |
$26,578.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,282.30
|
| Rate for Payer: Cash Price |
$38,642.50
|
| Rate for Payer: Cigna Commercial |
$64,146.55
|
| Rate for Payer: First Health Commercial |
$73,420.75
|
| Rate for Payer: Humana Commercial |
$65,692.25
|
| Rate for Payer: Humana KY Medicaid |
$26,578.31
|
| Rate for Payer: Kentucky WC Medicaid |
$26,848.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,373.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,036.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,185.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,111.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,010.80
|
| Rate for Payer: Ohio Health Group HMO |
$57,963.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,828.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,237.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,326.65
|
| Rate for Payer: PHCS Commercial |
$74,193.60
|
| Rate for Payer: United Healthcare All Payer |
$68,010.80
|
|
|
DEFIB EVERA MRI DVMB1D4
|
Facility
|
IP
|
$74,340.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,302.00 |
| Max. Negotiated Rate |
$71,366.40 |
| Rate for Payer: Aetna Commercial |
$57,241.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,985.20
|
| Rate for Payer: Cash Price |
$37,170.00
|
| Rate for Payer: Cigna Commercial |
$61,702.20
|
| Rate for Payer: First Health Commercial |
$70,623.00
|
| Rate for Payer: Humana Commercial |
$63,189.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,958.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,862.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,302.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,419.20
|
| Rate for Payer: Ohio Health Group HMO |
$55,755.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59,472.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64,675.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,294.60
|
| Rate for Payer: PHCS Commercial |
$71,366.40
|
| Rate for Payer: United Healthcare All Payer |
$65,419.20
|
|
|
DEFIB EVERA MRI DVMB1D4
|
Facility
|
OP
|
$74,340.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,302.00 |
| Max. Negotiated Rate |
$71,366.40 |
| Rate for Payer: Aetna Commercial |
$57,241.80
|
| Rate for Payer: Anthem Medicaid |
$25,565.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,985.20
|
| Rate for Payer: Cash Price |
$37,170.00
|
| Rate for Payer: Cigna Commercial |
$61,702.20
|
| Rate for Payer: First Health Commercial |
$70,623.00
|
| Rate for Payer: Humana Commercial |
$63,189.00
|
| Rate for Payer: Humana KY Medicaid |
$25,565.53
|
| Rate for Payer: Kentucky WC Medicaid |
$25,825.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,958.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,862.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,302.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,078.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,419.20
|
| Rate for Payer: Ohio Health Group HMO |
$55,755.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59,472.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64,675.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,294.60
|
| Rate for Payer: PHCS Commercial |
$71,366.40
|
| Rate for Payer: United Healthcare All Payer |
$65,419.20
|
|
|
DEFIB EVERA MRI XT DR SYS
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DEFIB EVERA MRI XT DR SYS
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DEFIB F0RTIFY CD2231-40Q
|
Facility
|
IP
|
$74,340.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,302.00 |
| Max. Negotiated Rate |
$71,366.40 |
| Rate for Payer: Aetna Commercial |
$57,241.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,985.20
|
| Rate for Payer: Cash Price |
$37,170.00
|
| Rate for Payer: Cigna Commercial |
$61,702.20
|
| Rate for Payer: First Health Commercial |
$70,623.00
|
| Rate for Payer: Humana Commercial |
$63,189.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,958.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,862.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,302.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,419.20
|
| Rate for Payer: Ohio Health Group HMO |
$55,755.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59,472.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64,675.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,294.60
|
| Rate for Payer: PHCS Commercial |
$71,366.40
|
| Rate for Payer: United Healthcare All Payer |
$65,419.20
|
|
|
DEFIB F0RTIFY CD2231-40Q
|
Facility
|
OP
|
$74,340.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,302.00 |
| Max. Negotiated Rate |
$71,366.40 |
| Rate for Payer: Aetna Commercial |
$57,241.80
|
| Rate for Payer: Anthem Medicaid |
$25,565.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,985.20
|
| Rate for Payer: Cash Price |
$37,170.00
|
| Rate for Payer: Cigna Commercial |
$61,702.20
|
| Rate for Payer: First Health Commercial |
$70,623.00
|
| Rate for Payer: Humana Commercial |
$63,189.00
|
| Rate for Payer: Humana KY Medicaid |
$25,565.53
|
| Rate for Payer: Kentucky WC Medicaid |
$25,825.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,958.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,862.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,302.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,078.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,419.20
|
| Rate for Payer: Ohio Health Group HMO |
$55,755.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59,472.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64,675.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,294.60
|
| Rate for Payer: PHCS Commercial |
$71,366.40
|
| Rate for Payer: United Healthcare All Payer |
$65,419.20
|
|
|
DEFIB F0RTIFY CD2257-40Q
|
Facility
|
OP
|
$81,370.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,411.00 |
| Max. Negotiated Rate |
$78,115.20 |
| Rate for Payer: Aetna Commercial |
$62,654.90
|
| Rate for Payer: Anthem Medicaid |
$27,983.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,468.60
|
| Rate for Payer: Cash Price |
$40,685.00
|
| Rate for Payer: Cigna Commercial |
$67,537.10
|
| Rate for Payer: First Health Commercial |
$77,301.50
|
| Rate for Payer: Humana Commercial |
$69,164.50
|
| Rate for Payer: Humana KY Medicaid |
$27,983.14
|
| Rate for Payer: Kentucky WC Medicaid |
$28,267.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,723.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,051.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,411.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,544.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,605.60
|
| Rate for Payer: Ohio Health Group HMO |
$61,027.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,096.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,791.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,145.30
|
| Rate for Payer: PHCS Commercial |
$78,115.20
|
| Rate for Payer: United Healthcare All Payer |
$71,605.60
|
|
|
DEFIB F0RTIFY CD2257-40Q
|
Facility
|
IP
|
$81,370.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,411.00 |
| Max. Negotiated Rate |
$78,115.20 |
| Rate for Payer: Aetna Commercial |
$62,654.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,468.60
|
| Rate for Payer: Cash Price |
$40,685.00
|
| Rate for Payer: Cigna Commercial |
$67,537.10
|
| Rate for Payer: First Health Commercial |
$77,301.50
|
| Rate for Payer: Humana Commercial |
$69,164.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,723.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,051.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,411.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,605.60
|
| Rate for Payer: Ohio Health Group HMO |
$61,027.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,096.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,791.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,145.30
|
| Rate for Payer: PHCS Commercial |
$78,115.20
|
| Rate for Payer: United Healthcare All Payer |
$71,605.60
|
|
