|
DEFIB UNIFYASSURA CD3357-40C
|
Facility
|
IP
|
$41,375.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,412.50 |
| Max. Negotiated Rate |
$39,720.00 |
| Rate for Payer: Aetna Commercial |
$31,858.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,272.50
|
| Rate for Payer: Cash Price |
$20,687.50
|
| Rate for Payer: Cigna Commercial |
$34,341.25
|
| Rate for Payer: First Health Commercial |
$39,306.25
|
| Rate for Payer: Humana Commercial |
$35,168.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,927.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,534.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,412.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$31,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,996.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,548.75
|
| Rate for Payer: PHCS Commercial |
$39,720.00
|
| Rate for Payer: United Healthcare All Payer |
$36,410.00
|
|
|
DEFIB UNIFYASSURA CD3357-40C
|
Facility
|
OP
|
$41,375.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,412.50 |
| Max. Negotiated Rate |
$39,720.00 |
| Rate for Payer: Aetna Commercial |
$31,858.75
|
| Rate for Payer: Anthem Medicaid |
$14,228.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,272.50
|
| Rate for Payer: Cash Price |
$20,687.50
|
| Rate for Payer: Cigna Commercial |
$34,341.25
|
| Rate for Payer: First Health Commercial |
$39,306.25
|
| Rate for Payer: Humana Commercial |
$35,168.75
|
| Rate for Payer: Humana KY Medicaid |
$14,228.86
|
| Rate for Payer: Kentucky WC Medicaid |
$14,373.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,927.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,534.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,412.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,514.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$31,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,996.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,548.75
|
| Rate for Payer: PHCS Commercial |
$39,720.00
|
| Rate for Payer: United Healthcare All Payer |
$36,410.00
|
|
|
DEFIB UNIFYASSURA CD3357-40Q
|
Facility
|
OP
|
$41,375.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,412.50 |
| Max. Negotiated Rate |
$39,720.00 |
| Rate for Payer: Aetna Commercial |
$31,858.75
|
| Rate for Payer: Anthem Medicaid |
$14,228.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,272.50
|
| Rate for Payer: Cash Price |
$20,687.50
|
| Rate for Payer: Cigna Commercial |
$34,341.25
|
| Rate for Payer: First Health Commercial |
$39,306.25
|
| Rate for Payer: Humana Commercial |
$35,168.75
|
| Rate for Payer: Humana KY Medicaid |
$14,228.86
|
| Rate for Payer: Kentucky WC Medicaid |
$14,373.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,927.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,534.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,412.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,514.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$31,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,996.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,548.75
|
| Rate for Payer: PHCS Commercial |
$39,720.00
|
| Rate for Payer: United Healthcare All Payer |
$36,410.00
|
|
|
DEFIB UNIFYASSURA CD3357-40Q
|
Facility
|
IP
|
$41,375.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,412.50 |
| Max. Negotiated Rate |
$39,720.00 |
| Rate for Payer: Aetna Commercial |
$31,858.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,272.50
|
| Rate for Payer: Cash Price |
$20,687.50
|
| Rate for Payer: Cigna Commercial |
$34,341.25
|
| Rate for Payer: First Health Commercial |
$39,306.25
|
| Rate for Payer: Humana Commercial |
$35,168.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,927.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,534.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,412.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$31,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,996.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,548.75
|
| Rate for Payer: PHCS Commercial |
$39,720.00
|
| Rate for Payer: United Healthcare All Payer |
$36,410.00
|
|
|
DEFIB VITALITY 2 DR DC T165
|
Facility
|
OP
|
$81,180.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,354.00 |
| Max. Negotiated Rate |
$77,932.80 |
| Rate for Payer: Aetna Commercial |
$62,508.60
|
| Rate for Payer: Anthem Medicaid |
$27,917.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,320.40
|
| Rate for Payer: Cash Price |
$40,590.00
|
| Rate for Payer: Cigna Commercial |
$67,379.40
|
| Rate for Payer: First Health Commercial |
$77,121.00
|
| Rate for Payer: Humana Commercial |
$69,003.00
|
| Rate for Payer: Humana KY Medicaid |
$27,917.80
|
| Rate for Payer: Kentucky WC Medicaid |
$28,201.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,567.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,910.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,354.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,477.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,438.40
|
| Rate for Payer: Ohio Health Group HMO |
$60,885.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,626.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,014.20
|
| Rate for Payer: PHCS Commercial |
$77,932.80
|
| Rate for Payer: United Healthcare All Payer |
$71,438.40
|
|
|
DEFIB VITALITY 2 DR DC T165
|
Facility
|
IP
|
$81,180.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,354.00 |
| Max. Negotiated Rate |
$77,932.80 |
| Rate for Payer: Aetna Commercial |
$62,508.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,320.40
|
| Rate for Payer: Cash Price |
$40,590.00
|
| Rate for Payer: Cigna Commercial |
$67,379.40
|
| Rate for Payer: First Health Commercial |
$77,121.00
|
| Rate for Payer: Humana Commercial |
$69,003.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,567.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,910.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,354.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,438.40
|
| Rate for Payer: Ohio Health Group HMO |
$60,885.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,626.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,014.20
|
| Rate for Payer: PHCS Commercial |
$77,932.80
|
| Rate for Payer: United Healthcare All Payer |
$71,438.40
|
|
|
DEFIB VITALITY 2 EL DC T167
|
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 VITALITY 2 EL DC T167
|
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 VITALITY 2 EL VR SC T177
|
Facility
|
IP
|
$84,600.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
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 VITALITY 2 EL VR SC T177
|
Facility
|
OP
|
$84,600.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
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 VITALITY 2 VR SC T175
|
Facility
|
IP
|
$81,180.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,354.00 |
| Max. Negotiated Rate |
$77,932.80 |
| Rate for Payer: Aetna Commercial |
$62,508.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,320.40
|
| Rate for Payer: Cash Price |
$40,590.00
|
| Rate for Payer: Cigna Commercial |
$67,379.40
|
| Rate for Payer: First Health Commercial |
$77,121.00
|
| Rate for Payer: Humana Commercial |
$69,003.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,567.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,910.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,354.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,438.40
|
| Rate for Payer: Ohio Health Group HMO |
$60,885.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,626.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,014.20
|
| Rate for Payer: PHCS Commercial |
$77,932.80
|
| Rate for Payer: United Healthcare All Payer |
$71,438.40
|
|
|
DEFIB VITALITY 2 VR SC T175
|
Facility
|
OP
|
$81,180.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,354.00 |
| Max. Negotiated Rate |
$77,932.80 |
| Rate for Payer: Aetna Commercial |
$62,508.60
|
| Rate for Payer: Anthem Medicaid |
$27,917.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,320.40
|
| Rate for Payer: Cash Price |
$40,590.00
|
| Rate for Payer: Cigna Commercial |
$67,379.40
|
| Rate for Payer: First Health Commercial |
$77,121.00
|
| Rate for Payer: Humana Commercial |
$69,003.00
|
| Rate for Payer: Humana KY Medicaid |
$27,917.80
|
| Rate for Payer: Kentucky WC Medicaid |
$28,201.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,567.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,910.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,354.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,477.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,438.40
|
| Rate for Payer: Ohio Health Group HMO |
$60,885.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,626.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,014.20
|
| Rate for Payer: PHCS Commercial |
$77,932.80
|
| Rate for Payer: United Healthcare All Payer |
$71,438.40
|
|
|
DEFIB VITALITY AVT DC A135
|
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 VITALITY AVT DC A135
|
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 VITALITY AVT DC A155
|
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 VITALITY AVT DC A155
|
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 VITALITY DS DR DC T125
|
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 VITALITY DS DR DC T125
|
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 VITALITY DS VR SC T135
|
Facility
|
OP
|
$75,100.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
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
|
|
|
DEFIB VITALITY DS VR SC T135
|
Facility
|
IP
|
$75,100.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
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 VITALITY EL DC T127
|
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 VITALITY EL DC T127
|
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 VITALITY HE DC T180
|
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 VITALITY HE DC T180
|
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 VIVA QUAD XT CRT-D DF1
|
Facility
|
IP
|
$97,900.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$29,370.00 |
| Max. Negotiated Rate |
$93,984.00 |
| Rate for Payer: Aetna Commercial |
$75,383.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,362.00
|
| Rate for Payer: Cash Price |
$48,950.00
|
| Rate for Payer: Cigna Commercial |
$81,257.00
|
| Rate for Payer: First Health Commercial |
$93,005.00
|
| Rate for Payer: Humana Commercial |
$83,215.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,278.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,250.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,370.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,152.00
|
| Rate for Payer: Ohio Health Group HMO |
$73,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85,173.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67,551.00
|
| Rate for Payer: PHCS Commercial |
$93,984.00
|
| Rate for Payer: United Healthcare All Payer |
$86,152.00
|
|
