|
DEFIBRILLATOR VISIA VR DVAB1D4
|
Facility
|
OP
|
$68,640.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$20,592.00 |
| Max. Negotiated Rate |
$65,894.40 |
| Rate for Payer: Aetna Commercial |
$52,852.80
|
| Rate for Payer: Anthem Medicaid |
$23,605.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,539.20
|
| Rate for Payer: Cash Price |
$34,320.00
|
| Rate for Payer: Cigna Commercial |
$56,971.20
|
| Rate for Payer: First Health Commercial |
$65,208.00
|
| Rate for Payer: Humana Commercial |
$58,344.00
|
| Rate for Payer: Humana KY Medicaid |
$23,605.30
|
| Rate for Payer: Kentucky WC Medicaid |
$23,845.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,284.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,656.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,078.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,403.20
|
| Rate for Payer: Ohio Health Group HMO |
$51,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,912.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,716.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,361.60
|
| Rate for Payer: PHCS Commercial |
$65,894.40
|
| Rate for Payer: United Healthcare All Payer |
$60,403.20
|
|
|
DEFIBRILLATOR VISIA VR DVFB1D1
|
Facility
|
IP
|
$72,440.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$21,732.00 |
| Max. Negotiated Rate |
$69,542.40 |
| Rate for Payer: Aetna Commercial |
$55,778.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,503.20
|
| Rate for Payer: Cash Price |
$36,220.00
|
| Rate for Payer: Cigna Commercial |
$60,125.20
|
| Rate for Payer: First Health Commercial |
$68,818.00
|
| Rate for Payer: Humana Commercial |
$61,574.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,400.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,460.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,732.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,747.20
|
| Rate for Payer: Ohio Health Group HMO |
$54,330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,952.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,022.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,983.60
|
| Rate for Payer: PHCS Commercial |
$69,542.40
|
| Rate for Payer: United Healthcare All Payer |
$63,747.20
|
|
|
DEFIBRILLATOR VISIA VR DVFB1D1
|
Facility
|
OP
|
$72,440.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$21,732.00 |
| Max. Negotiated Rate |
$69,542.40 |
| Rate for Payer: Aetna Commercial |
$55,778.80
|
| Rate for Payer: Anthem Medicaid |
$24,912.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,503.20
|
| Rate for Payer: Cash Price |
$36,220.00
|
| Rate for Payer: Cigna Commercial |
$60,125.20
|
| Rate for Payer: First Health Commercial |
$68,818.00
|
| Rate for Payer: Humana Commercial |
$61,574.00
|
| Rate for Payer: Humana KY Medicaid |
$24,912.12
|
| Rate for Payer: Kentucky WC Medicaid |
$25,165.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,400.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,460.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,732.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,411.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,747.20
|
| Rate for Payer: Ohio Health Group HMO |
$54,330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,952.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,022.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,983.60
|
| Rate for Payer: PHCS Commercial |
$69,542.40
|
| Rate for Payer: United Healthcare All Payer |
$63,747.20
|
|
|
DEFIBRILLATR CRT-D DTBA1D1
|
Facility
|
IP
|
$90,680.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$27,204.00 |
| Max. Negotiated Rate |
$87,052.80 |
| Rate for Payer: Aetna Commercial |
$69,823.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,730.40
|
| Rate for Payer: Cash Price |
$45,340.00
|
| Rate for Payer: Cigna Commercial |
$75,264.40
|
| Rate for Payer: First Health Commercial |
$86,146.00
|
| Rate for Payer: Humana Commercial |
$77,078.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,357.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,921.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,204.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,798.40
|
| Rate for Payer: Ohio Health Group HMO |
$68,010.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72,544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78,891.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62,569.20
|
| Rate for Payer: PHCS Commercial |
$87,052.80
|
| Rate for Payer: United Healthcare All Payer |
$79,798.40
|
|
|
DEFIBRILLATR CRT-D DTBA1D1
|
Facility
|
OP
|
$90,680.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$27,204.00 |
| Max. Negotiated Rate |
$87,052.80 |
| Rate for Payer: Aetna Commercial |
$69,823.60
|
| Rate for Payer: Anthem Medicaid |
$31,184.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,730.40
|
| Rate for Payer: Cash Price |
$45,340.00
|
| Rate for Payer: Cigna Commercial |
$75,264.40
|
| Rate for Payer: First Health Commercial |
$86,146.00
|
| Rate for Payer: Humana Commercial |
$77,078.00
|
| Rate for Payer: Humana KY Medicaid |
$31,184.85
|
| Rate for Payer: Kentucky WC Medicaid |
$31,502.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,357.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,921.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,204.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,810.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,798.40
|
| Rate for Payer: Ohio Health Group HMO |
$68,010.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72,544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78,891.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62,569.20
|
| Rate for Payer: PHCS Commercial |
$87,052.80
|
| Rate for Payer: United Healthcare All Payer |
$79,798.40
|
|
|
DEFIBRILLATR CRT-D DTBA1D4
|
Facility
|
IP
|
$90,680.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$27,204.00 |
| Max. Negotiated Rate |
$87,052.80 |
| Rate for Payer: Aetna Commercial |
$69,823.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,730.40
|
| Rate for Payer: Cash Price |
$45,340.00
|
| Rate for Payer: Cigna Commercial |
$75,264.40
|
| Rate for Payer: First Health Commercial |
$86,146.00
|
| Rate for Payer: Humana Commercial |
$77,078.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,357.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,921.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,204.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,798.40
|
| Rate for Payer: Ohio Health Group HMO |
$68,010.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72,544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78,891.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62,569.20
|
| Rate for Payer: PHCS Commercial |
$87,052.80
|
| Rate for Payer: United Healthcare All Payer |
$79,798.40
|
|
|
DEFIBRILLATR CRT-D DTBA1D4
|
Facility
|
OP
|
$90,680.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$27,204.00 |
| Max. Negotiated Rate |
$87,052.80 |
| Rate for Payer: Aetna Commercial |
$69,823.60
|
| Rate for Payer: Anthem Medicaid |
$31,184.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,730.40
|
| Rate for Payer: Cash Price |
$45,340.00
|
| Rate for Payer: Cigna Commercial |
$75,264.40
|
| Rate for Payer: First Health Commercial |
$86,146.00
|
| Rate for Payer: Humana Commercial |
$77,078.00
|
| Rate for Payer: Humana KY Medicaid |
$31,184.85
|
| Rate for Payer: Kentucky WC Medicaid |
$31,502.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,357.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,921.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,204.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,810.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,798.40
|
| Rate for Payer: Ohio Health Group HMO |
$68,010.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72,544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78,891.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62,569.20
|
| Rate for Payer: PHCS Commercial |
$87,052.80
|
| Rate for Payer: United Healthcare All Payer |
$79,798.40
|
|
|
DEFIB SC ATLAS VR V-193C
|
Facility
|
OP
|
$38,750.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,625.00 |
| Max. Negotiated Rate |
$37,200.00 |
| Rate for Payer: Aetna Commercial |
$29,837.50
|
| Rate for Payer: Anthem Medicaid |
$13,326.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,225.00
|
| Rate for Payer: Cash Price |
$19,375.00
|
| Rate for Payer: Cigna Commercial |
$32,162.50
|
| Rate for Payer: First Health Commercial |
$36,812.50
|
| Rate for Payer: Humana Commercial |
$32,937.50
|
| Rate for Payer: Humana KY Medicaid |
$13,326.12
|
| Rate for Payer: Kentucky WC Medicaid |
$13,461.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,775.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,597.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,625.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,593.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$29,062.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,712.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,737.50
|
| Rate for Payer: PHCS Commercial |
$37,200.00
|
| Rate for Payer: United Healthcare All Payer |
$34,100.00
|
|
|
DEFIB SC ATLAS VR V-193C
|
Facility
|
IP
|
$38,750.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,625.00 |
| Max. Negotiated Rate |
$37,200.00 |
| Rate for Payer: Aetna Commercial |
$29,837.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,225.00
|
| Rate for Payer: Cash Price |
$19,375.00
|
| Rate for Payer: Cigna Commercial |
$32,162.50
|
| Rate for Payer: First Health Commercial |
$36,812.50
|
| Rate for Payer: Humana Commercial |
$32,937.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,775.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,597.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,625.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$29,062.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,712.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,737.50
|
| Rate for Payer: PHCS Commercial |
$37,200.00
|
| Rate for Payer: United Healthcare All Payer |
$34,100.00
|
|
|
DEFIB SC CURRENT RF VR 1207-30
|
Facility
|
OP
|
$82,700.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,810.00 |
| Max. Negotiated Rate |
$79,392.00 |
| Rate for Payer: Aetna Commercial |
$63,679.00
|
| Rate for Payer: Anthem Medicaid |
$28,440.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,506.00
|
| Rate for Payer: Cash Price |
$41,350.00
|
| Rate for Payer: Cigna Commercial |
$68,641.00
|
| Rate for Payer: First Health Commercial |
$78,565.00
|
| Rate for Payer: Humana Commercial |
$70,295.00
|
| Rate for Payer: Humana KY Medicaid |
$28,440.53
|
| Rate for Payer: Kentucky WC Medicaid |
$28,729.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,814.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,032.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,011.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,776.00
|
| Rate for Payer: Ohio Health Group HMO |
$62,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,949.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,063.00
|
| Rate for Payer: PHCS Commercial |
$79,392.00
|
| Rate for Payer: United Healthcare All Payer |
$72,776.00
|
|
|
DEFIB SC CURRENT RF VR 1207-30
|
Facility
|
IP
|
$82,700.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,810.00 |
| Max. Negotiated Rate |
$79,392.00 |
| Rate for Payer: Aetna Commercial |
$63,679.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,506.00
|
| Rate for Payer: Cash Price |
$41,350.00
|
| Rate for Payer: Cigna Commercial |
$68,641.00
|
| Rate for Payer: First Health Commercial |
$78,565.00
|
| Rate for Payer: Humana Commercial |
$70,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,814.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,032.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,776.00
|
| Rate for Payer: Ohio Health Group HMO |
$62,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,949.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,063.00
|
| Rate for Payer: PHCS Commercial |
$79,392.00
|
| Rate for Payer: United Healthcare All Payer |
$72,776.00
|
|
|
DEFIB SC CURRENT RF VR 1207-36
|
Facility
|
OP
|
$82,700.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,810.00 |
| Max. Negotiated Rate |
$79,392.00 |
| Rate for Payer: Aetna Commercial |
$63,679.00
|
| Rate for Payer: Anthem Medicaid |
$28,440.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,506.00
|
| Rate for Payer: Cash Price |
$41,350.00
|
| Rate for Payer: Cigna Commercial |
$68,641.00
|
| Rate for Payer: First Health Commercial |
$78,565.00
|
| Rate for Payer: Humana Commercial |
$70,295.00
|
| Rate for Payer: Humana KY Medicaid |
$28,440.53
|
| Rate for Payer: Kentucky WC Medicaid |
$28,729.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,814.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,032.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,011.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,776.00
|
| Rate for Payer: Ohio Health Group HMO |
$62,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,949.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,063.00
|
| Rate for Payer: PHCS Commercial |
$79,392.00
|
| Rate for Payer: United Healthcare All Payer |
$72,776.00
|
|
|
DEFIB SC CURRENT RF VR 1207-36
|
Facility
|
IP
|
$82,700.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,810.00 |
| Max. Negotiated Rate |
$79,392.00 |
| Rate for Payer: Aetna Commercial |
$63,679.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,506.00
|
| Rate for Payer: Cash Price |
$41,350.00
|
| Rate for Payer: Cigna Commercial |
$68,641.00
|
| Rate for Payer: First Health Commercial |
$78,565.00
|
| Rate for Payer: Humana Commercial |
$70,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,814.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,032.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,776.00
|
| Rate for Payer: Ohio Health Group HMO |
$62,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,949.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,063.00
|
| Rate for Payer: PHCS Commercial |
$79,392.00
|
| Rate for Payer: United Healthcare All Payer |
$72,776.00
|
|
|
DEFIB SC CURRENT VR 1107-30
|
Facility
|
IP
|
$154,900.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$46,470.00 |
| Max. Negotiated Rate |
$148,704.00 |
| Rate for Payer: Aetna Commercial |
$119,273.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$120,822.00
|
| Rate for Payer: Cash Price |
$77,450.00
|
| Rate for Payer: Cigna Commercial |
$128,567.00
|
| Rate for Payer: First Health Commercial |
$147,155.00
|
| Rate for Payer: Humana Commercial |
$131,665.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127,018.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114,316.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46,470.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$136,312.00
|
| Rate for Payer: Ohio Health Group HMO |
$116,175.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$123,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$134,763.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106,881.00
|
| Rate for Payer: PHCS Commercial |
$148,704.00
|
| Rate for Payer: United Healthcare All Payer |
$136,312.00
|
|
|
DEFIB SC CURRENT VR 1107-30
|
Facility
|
OP
|
$154,900.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$46,470.00 |
| Max. Negotiated Rate |
$148,704.00 |
| Rate for Payer: Aetna Commercial |
$119,273.00
|
| Rate for Payer: Anthem Medicaid |
$53,270.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$120,822.00
|
| Rate for Payer: Cash Price |
$77,450.00
|
| Rate for Payer: Cigna Commercial |
$128,567.00
|
| Rate for Payer: First Health Commercial |
$147,155.00
|
| Rate for Payer: Humana Commercial |
$131,665.00
|
| Rate for Payer: Humana KY Medicaid |
$53,270.11
|
| Rate for Payer: Kentucky WC Medicaid |
$53,812.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127,018.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114,316.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46,470.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$54,338.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$136,312.00
|
| Rate for Payer: Ohio Health Group HMO |
$116,175.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$123,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$134,763.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106,881.00
|
| Rate for Payer: PHCS Commercial |
$148,704.00
|
| Rate for Payer: United Healthcare All Payer |
$136,312.00
|
|
|
DEFIB SC CURRENT VR 1107-36
|
Facility
|
OP
|
$167,250.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$50,175.00 |
| Max. Negotiated Rate |
$160,560.00 |
| Rate for Payer: Aetna Commercial |
$128,782.50
|
| Rate for Payer: Anthem Medicaid |
$57,517.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130,455.00
|
| Rate for Payer: Cash Price |
$83,625.00
|
| Rate for Payer: Cigna Commercial |
$138,817.50
|
| Rate for Payer: First Health Commercial |
$158,887.50
|
| Rate for Payer: Humana Commercial |
$142,162.50
|
| Rate for Payer: Humana KY Medicaid |
$57,517.28
|
| Rate for Payer: Kentucky WC Medicaid |
$58,102.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$137,145.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123,430.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50,175.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$58,671.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$147,180.00
|
| Rate for Payer: Ohio Health Group HMO |
$125,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145,507.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115,402.50
|
| Rate for Payer: PHCS Commercial |
$160,560.00
|
| Rate for Payer: United Healthcare All Payer |
$147,180.00
|
|
|
DEFIB SC CURRENT VR 1107-36
|
Facility
|
IP
|
$167,250.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$50,175.00 |
| Max. Negotiated Rate |
$160,560.00 |
| Rate for Payer: Aetna Commercial |
$128,782.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130,455.00
|
| Rate for Payer: Cash Price |
$83,625.00
|
| Rate for Payer: Cigna Commercial |
$138,817.50
|
| Rate for Payer: First Health Commercial |
$158,887.50
|
| Rate for Payer: Humana Commercial |
$142,162.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$137,145.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123,430.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50,175.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$147,180.00
|
| Rate for Payer: Ohio Health Group HMO |
$125,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145,507.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115,402.50
|
| Rate for Payer: PHCS Commercial |
$160,560.00
|
| Rate for Payer: United Healthcare All Payer |
$147,180.00
|
|
|
DEFIB SC EPIC+ VR V-196
|
Facility
|
IP
|
$78,900.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
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 SC EPIC+ VR V-196
|
Facility
|
OP
|
$78,900.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
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 SC MAXIMO VR 7232CX
|
Facility
|
IP
|
$77,000.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,100.00 |
| Max. Negotiated Rate |
$73,920.00 |
| Rate for Payer: Aetna Commercial |
$59,290.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,060.00
|
| Rate for Payer: Cash Price |
$38,500.00
|
| Rate for Payer: Cigna Commercial |
$63,910.00
|
| Rate for Payer: First Health Commercial |
$73,150.00
|
| Rate for Payer: Humana Commercial |
$65,450.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,140.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,826.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,100.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,990.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,130.00
|
| Rate for Payer: PHCS Commercial |
$73,920.00
|
| Rate for Payer: United Healthcare All Payer |
$67,760.00
|
|
|
DEFIB SC MAXIMO VR 7232CX
|
Facility
|
OP
|
$77,000.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,100.00 |
| Max. Negotiated Rate |
$73,920.00 |
| Rate for Payer: Aetna Commercial |
$59,290.00
|
| Rate for Payer: Anthem Medicaid |
$26,480.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,060.00
|
| Rate for Payer: Cash Price |
$38,500.00
|
| Rate for Payer: Cigna Commercial |
$63,910.00
|
| Rate for Payer: First Health Commercial |
$73,150.00
|
| Rate for Payer: Humana Commercial |
$65,450.00
|
| Rate for Payer: Humana KY Medicaid |
$26,480.30
|
| Rate for Payer: Kentucky WC Medicaid |
$26,749.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,140.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,826.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,100.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,011.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,990.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,130.00
|
| Rate for Payer: PHCS Commercial |
$73,920.00
|
| Rate for Payer: United Healthcare All Payer |
$67,760.00
|
|
|
DEFIB SC VIRTUOSO VR D154VW
|
Facility
|
OP
|
$102,080.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$30,624.00 |
| Max. Negotiated Rate |
$97,996.80 |
| Rate for Payer: Aetna Commercial |
$78,601.60
|
| Rate for Payer: Anthem Medicaid |
$35,105.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79,622.40
|
| Rate for Payer: Cash Price |
$51,040.00
|
| Rate for Payer: Cigna Commercial |
$84,726.40
|
| Rate for Payer: First Health Commercial |
$96,976.00
|
| Rate for Payer: Humana Commercial |
$86,768.00
|
| Rate for Payer: Humana KY Medicaid |
$35,105.31
|
| Rate for Payer: Kentucky WC Medicaid |
$35,462.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83,705.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75,335.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,624.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$35,809.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$89,830.40
|
| Rate for Payer: Ohio Health Group HMO |
$76,560.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81,664.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88,809.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70,435.20
|
| Rate for Payer: PHCS Commercial |
$97,996.80
|
| Rate for Payer: United Healthcare All Payer |
$89,830.40
|
|
|
DEFIB SC VIRTUOSO VR D154VW
|
Facility
|
IP
|
$102,080.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$30,624.00 |
| Max. Negotiated Rate |
$97,996.80 |
| Rate for Payer: Aetna Commercial |
$78,601.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79,622.40
|
| Rate for Payer: Cash Price |
$51,040.00
|
| Rate for Payer: Cigna Commercial |
$84,726.40
|
| Rate for Payer: First Health Commercial |
$96,976.00
|
| Rate for Payer: Humana Commercial |
$86,768.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83,705.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75,335.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,624.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$89,830.40
|
| Rate for Payer: Ohio Health Group HMO |
$76,560.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81,664.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88,809.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70,435.20
|
| Rate for Payer: PHCS Commercial |
$97,996.80
|
| Rate for Payer: United Healthcare All Payer |
$89,830.40
|
|
|
DEFIB TELIGEN SCRR E102
|
Facility
|
OP
|
$85,930.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$25,779.00 |
| Max. Negotiated Rate |
$82,492.80 |
| Rate for Payer: Aetna Commercial |
$66,166.10
|
| Rate for Payer: Anthem Medicaid |
$29,551.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,025.40
|
| Rate for Payer: Cash Price |
$42,965.00
|
| Rate for Payer: Cigna Commercial |
$71,321.90
|
| Rate for Payer: First Health Commercial |
$81,633.50
|
| Rate for Payer: Humana Commercial |
$73,040.50
|
| Rate for Payer: Humana KY Medicaid |
$29,551.33
|
| Rate for Payer: Kentucky WC Medicaid |
$29,852.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,462.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,416.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,779.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,144.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$75,618.40
|
| Rate for Payer: Ohio Health Group HMO |
$64,447.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68,744.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74,759.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,291.70
|
| Rate for Payer: PHCS Commercial |
$82,492.80
|
| Rate for Payer: United Healthcare All Payer |
$75,618.40
|
|
|
DEFIB TELIGEN SCRR E102
|
Facility
|
IP
|
$85,930.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$25,779.00 |
| Max. Negotiated Rate |
$82,492.80 |
| Rate for Payer: Aetna Commercial |
$66,166.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,025.40
|
| Rate for Payer: Cash Price |
$42,965.00
|
| Rate for Payer: Cigna Commercial |
$71,321.90
|
| Rate for Payer: First Health Commercial |
$81,633.50
|
| Rate for Payer: Humana Commercial |
$73,040.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,462.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,416.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,779.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$75,618.40
|
| Rate for Payer: Ohio Health Group HMO |
$64,447.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68,744.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74,759.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,291.70
|
| Rate for Payer: PHCS Commercial |
$82,492.80
|
| Rate for Payer: United Healthcare All Payer |
$75,618.40
|
|
