|
DEFIBRILLATOR CURRENT DR DCRR
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DEFIBRILLATOR CURRENT DR DCRR
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DEFIBRILLATOR DYNAGEN D023
|
Facility
|
OP
|
$74,680.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,708.40 |
| Max. Negotiated Rate |
$71,692.80 |
| Rate for Payer: Aetna Commercial |
$57,503.60
|
| Rate for Payer: Anthem Medicaid |
$25,682.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,250.40
|
| Rate for Payer: Cash Price |
$37,340.00
|
| Rate for Payer: Cigna Commercial |
$61,984.40
|
| Rate for Payer: First Health Commercial |
$70,946.00
|
| Rate for Payer: Humana Commercial |
$63,478.00
|
| Rate for Payer: Humana KY Medicaid |
$25,682.45
|
| Rate for Payer: Kentucky WC Medicaid |
$25,943.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,237.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,113.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,404.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,197.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,718.40
|
| Rate for Payer: Ohio Health Group HMO |
$56,010.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,708.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,150.80
|
| Rate for Payer: PHCS Commercial |
$71,692.80
|
| Rate for Payer: United Healthcare All Payer |
$65,718.40
|
|
|
DEFIBRILLATOR DYNAGEN D023
|
Facility
|
IP
|
$74,680.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,708.40 |
| Max. Negotiated Rate |
$71,692.80 |
| Rate for Payer: Aetna Commercial |
$57,503.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,250.40
|
| Rate for Payer: Cash Price |
$37,340.00
|
| Rate for Payer: Cigna Commercial |
$61,984.40
|
| Rate for Payer: First Health Commercial |
$70,946.00
|
| Rate for Payer: Humana Commercial |
$63,478.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,237.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,113.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,404.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,718.40
|
| Rate for Payer: Ohio Health Group HMO |
$56,010.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,708.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,150.80
|
| Rate for Payer: PHCS Commercial |
$71,692.80
|
| Rate for Payer: United Healthcare All Payer |
$65,718.40
|
|
|
DEFIBRILLATOR DYNAGEN G150
|
Facility
|
IP
|
$92,320.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,001.60 |
| Max. Negotiated Rate |
$88,627.20 |
| Rate for Payer: Aetna Commercial |
$71,086.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72,009.60
|
| Rate for Payer: Cash Price |
$46,160.00
|
| Rate for Payer: Cigna Commercial |
$76,625.60
|
| Rate for Payer: First Health Commercial |
$87,704.00
|
| Rate for Payer: Humana Commercial |
$78,472.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75,702.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68,132.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,696.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$81,241.60
|
| Rate for Payer: Ohio Health Group HMO |
$69,240.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,464.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,001.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,619.20
|
| Rate for Payer: PHCS Commercial |
$88,627.20
|
| Rate for Payer: United Healthcare All Payer |
$81,241.60
|
|
|
DEFIBRILLATOR DYNAGEN G150
|
Facility
|
OP
|
$92,320.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,001.60 |
| Max. Negotiated Rate |
$88,627.20 |
| Rate for Payer: Aetna Commercial |
$71,086.40
|
| Rate for Payer: Anthem Medicaid |
$31,748.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72,009.60
|
| Rate for Payer: Cash Price |
$46,160.00
|
| Rate for Payer: Cigna Commercial |
$76,625.60
|
| Rate for Payer: First Health Commercial |
$87,704.00
|
| Rate for Payer: Humana Commercial |
$78,472.00
|
| Rate for Payer: Humana KY Medicaid |
$31,748.85
|
| Rate for Payer: Kentucky WC Medicaid |
$32,071.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75,702.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68,132.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,696.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,385.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$81,241.60
|
| Rate for Payer: Ohio Health Group HMO |
$69,240.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,464.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,001.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,619.20
|
| Rate for Payer: PHCS Commercial |
$88,627.20
|
| Rate for Payer: United Healthcare All Payer |
$81,241.60
|
|
|
DEFIBRILLATOR ENERGEN BIV N140
|
Facility
|
OP
|
$95,200.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,376.00 |
| Max. Negotiated Rate |
$91,392.00 |
| Rate for Payer: Aetna Commercial |
$73,304.00
|
| Rate for Payer: Anthem Medicaid |
$32,739.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74,256.00
|
| Rate for Payer: Cash Price |
$47,600.00
|
| Rate for Payer: Cigna Commercial |
$79,016.00
|
| Rate for Payer: First Health Commercial |
$90,440.00
|
| Rate for Payer: Humana Commercial |
$80,920.00
|
| Rate for Payer: Humana KY Medicaid |
$32,739.28
|
| Rate for Payer: Kentucky WC Medicaid |
$33,072.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78,064.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70,257.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,560.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,396.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$83,776.00
|
| Rate for Payer: Ohio Health Group HMO |
$71,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,376.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,512.00
|
| Rate for Payer: PHCS Commercial |
$91,392.00
|
| Rate for Payer: United Healthcare All Payer |
$83,776.00
|
|
|
DEFIBRILLATOR ENERGEN BIV N140
|
Facility
|
IP
|
$95,200.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,376.00 |
| Max. Negotiated Rate |
$91,392.00 |
| Rate for Payer: Aetna Commercial |
$73,304.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74,256.00
|
| Rate for Payer: Cash Price |
$47,600.00
|
| Rate for Payer: Cigna Commercial |
$79,016.00
|
| Rate for Payer: First Health Commercial |
$90,440.00
|
| Rate for Payer: Humana Commercial |
$80,920.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78,064.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70,257.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,560.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$83,776.00
|
| Rate for Payer: Ohio Health Group HMO |
$71,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,376.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,512.00
|
| Rate for Payer: PHCS Commercial |
$91,392.00
|
| Rate for Payer: United Healthcare All Payer |
$83,776.00
|
|
|
DEFIBRILLATOR ENERGEN BIV N141
|
Facility
|
IP
|
$92,320.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,001.60 |
| Max. Negotiated Rate |
$88,627.20 |
| Rate for Payer: Aetna Commercial |
$71,086.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72,009.60
|
| Rate for Payer: Cash Price |
$46,160.00
|
| Rate for Payer: Cigna Commercial |
$76,625.60
|
| Rate for Payer: First Health Commercial |
$87,704.00
|
| Rate for Payer: Humana Commercial |
$78,472.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75,702.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68,132.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,696.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$81,241.60
|
| Rate for Payer: Ohio Health Group HMO |
$69,240.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,464.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,001.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,619.20
|
| Rate for Payer: PHCS Commercial |
$88,627.20
|
| Rate for Payer: United Healthcare All Payer |
$81,241.60
|
|
|
DEFIBRILLATOR ENERGEN BIV N141
|
Facility
|
OP
|
$92,320.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,001.60 |
| Max. Negotiated Rate |
$88,627.20 |
| Rate for Payer: Aetna Commercial |
$71,086.40
|
| Rate for Payer: Anthem Medicaid |
$31,748.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72,009.60
|
| Rate for Payer: Cash Price |
$46,160.00
|
| Rate for Payer: Cigna Commercial |
$76,625.60
|
| Rate for Payer: First Health Commercial |
$87,704.00
|
| Rate for Payer: Humana Commercial |
$78,472.00
|
| Rate for Payer: Humana KY Medicaid |
$31,748.85
|
| Rate for Payer: Kentucky WC Medicaid |
$32,071.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75,702.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68,132.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,696.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,385.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$81,241.60
|
| Rate for Payer: Ohio Health Group HMO |
$69,240.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,464.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,001.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,619.20
|
| Rate for Payer: PHCS Commercial |
$88,627.20
|
| Rate for Payer: United Healthcare All Payer |
$81,241.60
|
|
|
DEFIBRILLATOR EPIC HF II V-355
|
Facility
|
IP
|
$103,300.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$13,429.00 |
| Max. Negotiated Rate |
$99,168.00 |
| Rate for Payer: Aetna Commercial |
$79,541.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80,574.00
|
| Rate for Payer: Cash Price |
$51,650.00
|
| Rate for Payer: Cigna Commercial |
$85,739.00
|
| Rate for Payer: First Health Commercial |
$98,135.00
|
| Rate for Payer: Humana Commercial |
$87,805.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$84,706.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76,235.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,990.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$90,904.00
|
| Rate for Payer: Ohio Health Group HMO |
$77,475.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,429.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32,023.00
|
| Rate for Payer: PHCS Commercial |
$99,168.00
|
| Rate for Payer: United Healthcare All Payer |
$90,904.00
|
|
|
DEFIBRILLATOR EPIC HF II V-355
|
Facility
|
OP
|
$103,300.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$13,429.00 |
| Max. Negotiated Rate |
$99,168.00 |
| Rate for Payer: Aetna Commercial |
$79,541.00
|
| Rate for Payer: Anthem Medicaid |
$35,524.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80,574.00
|
| Rate for Payer: Cash Price |
$51,650.00
|
| Rate for Payer: Cigna Commercial |
$85,739.00
|
| Rate for Payer: First Health Commercial |
$98,135.00
|
| Rate for Payer: Humana Commercial |
$87,805.00
|
| Rate for Payer: Humana KY Medicaid |
$35,524.87
|
| Rate for Payer: Kentucky WC Medicaid |
$35,886.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$84,706.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76,235.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,990.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$36,237.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$90,904.00
|
| Rate for Payer: Ohio Health Group HMO |
$77,475.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,429.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32,023.00
|
| Rate for Payer: PHCS Commercial |
$99,168.00
|
| Rate for Payer: United Healthcare All Payer |
$90,904.00
|
|
|
DEFIBRILLATOR EPIC HF V-337
|
Facility
|
IP
|
$101,500.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$13,195.00 |
| Max. Negotiated Rate |
$97,440.00 |
| Rate for Payer: Aetna Commercial |
$78,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79,170.00
|
| Rate for Payer: Cash Price |
$50,750.00
|
| Rate for Payer: Cigna Commercial |
$84,245.00
|
| Rate for Payer: First Health Commercial |
$96,425.00
|
| Rate for Payer: Humana Commercial |
$86,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74,907.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$89,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$76,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31,465.00
|
| Rate for Payer: PHCS Commercial |
$97,440.00
|
| Rate for Payer: United Healthcare All Payer |
$89,320.00
|
|
|
DEFIBRILLATOR EPIC HF V-337
|
Facility
|
OP
|
$101,500.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$13,195.00 |
| Max. Negotiated Rate |
$97,440.00 |
| Rate for Payer: Aetna Commercial |
$78,155.00
|
| Rate for Payer: Anthem Medicaid |
$34,905.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79,170.00
|
| Rate for Payer: Cash Price |
$50,750.00
|
| Rate for Payer: Cigna Commercial |
$84,245.00
|
| Rate for Payer: First Health Commercial |
$96,425.00
|
| Rate for Payer: Humana Commercial |
$86,275.00
|
| Rate for Payer: Humana KY Medicaid |
$34,905.85
|
| Rate for Payer: Kentucky WC Medicaid |
$35,261.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74,907.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,450.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$35,606.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$89,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$76,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31,465.00
|
| Rate for Payer: PHCS Commercial |
$97,440.00
|
| Rate for Payer: United Healthcare All Payer |
$89,320.00
|
|
|
DEFIBRILLATOR EVERA MRI DDMB1D
|
Facility
|
OP
|
$65,500.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,515.00 |
| Max. Negotiated Rate |
$62,880.00 |
| Rate for Payer: Aetna Commercial |
$50,435.00
|
| Rate for Payer: Anthem Medicaid |
$22,525.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51,090.00
|
| Rate for Payer: Cash Price |
$32,750.00
|
| Rate for Payer: Cigna Commercial |
$54,365.00
|
| Rate for Payer: First Health Commercial |
$62,225.00
|
| Rate for Payer: Humana Commercial |
$55,675.00
|
| Rate for Payer: Humana KY Medicaid |
$22,525.45
|
| Rate for Payer: Kentucky WC Medicaid |
$22,754.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48,339.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,977.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$57,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$49,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,515.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,305.00
|
| Rate for Payer: PHCS Commercial |
$62,880.00
|
| Rate for Payer: United Healthcare All Payer |
$57,640.00
|
|
|
DEFIBRILLATOR EVERA MRI DDMB1D
|
Facility
|
IP
|
$65,500.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,515.00 |
| Max. Negotiated Rate |
$62,880.00 |
| Rate for Payer: Aetna Commercial |
$50,435.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51,090.00
|
| Rate for Payer: Cash Price |
$32,750.00
|
| Rate for Payer: Cigna Commercial |
$54,365.00
|
| Rate for Payer: First Health Commercial |
$62,225.00
|
| Rate for Payer: Humana Commercial |
$55,675.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48,339.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$57,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$49,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,515.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,305.00
|
| Rate for Payer: PHCS Commercial |
$62,880.00
|
| Rate for Payer: United Healthcare All Payer |
$57,640.00
|
|
|
DEFIBRILLATOR EVERA MRI DDMC3D
|
Facility
|
IP
|
$77,380.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,059.40 |
| Max. Negotiated Rate |
$74,284.80 |
| Rate for Payer: Aetna Commercial |
$59,582.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,356.40
|
| Rate for Payer: Cash Price |
$38,690.00
|
| Rate for Payer: Cigna Commercial |
$64,225.40
|
| Rate for Payer: First Health Commercial |
$73,511.00
|
| Rate for Payer: Humana Commercial |
$65,773.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,451.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,106.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,094.40
|
| Rate for Payer: Ohio Health Group HMO |
$58,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,476.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,059.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,987.80
|
| Rate for Payer: PHCS Commercial |
$74,284.80
|
| Rate for Payer: United Healthcare All Payer |
$68,094.40
|
|
|
DEFIBRILLATOR EVERA MRI DDMC3D
|
Facility
|
OP
|
$77,380.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,059.40 |
| Max. Negotiated Rate |
$74,284.80 |
| Rate for Payer: Aetna Commercial |
$59,582.60
|
| Rate for Payer: Anthem Medicaid |
$26,610.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,356.40
|
| Rate for Payer: Cash Price |
$38,690.00
|
| Rate for Payer: Cigna Commercial |
$64,225.40
|
| Rate for Payer: First Health Commercial |
$73,511.00
|
| Rate for Payer: Humana Commercial |
$65,773.00
|
| Rate for Payer: Humana KY Medicaid |
$26,610.98
|
| Rate for Payer: Kentucky WC Medicaid |
$26,881.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,451.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,106.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,144.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,094.40
|
| Rate for Payer: Ohio Health Group HMO |
$58,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,476.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,059.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,987.80
|
| Rate for Payer: PHCS Commercial |
$74,284.80
|
| Rate for Payer: United Healthcare All Payer |
$68,094.40
|
|
|
DEFIBRILLATOR EVERA MRI DDPB3D
|
Facility
|
OP
|
$78,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,153.00 |
| Max. Negotiated Rate |
$74,976.00 |
| Rate for Payer: Aetna Commercial |
$60,137.00
|
| Rate for Payer: Anthem Medicaid |
$26,858.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,918.00
|
| Rate for Payer: Cash Price |
$39,050.00
|
| Rate for Payer: Cigna Commercial |
$64,823.00
|
| Rate for Payer: First Health Commercial |
$74,195.00
|
| Rate for Payer: Humana Commercial |
$66,385.00
|
| Rate for Payer: Humana KY Medicaid |
$26,858.59
|
| Rate for Payer: Kentucky WC Medicaid |
$27,131.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,042.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,637.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,430.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,397.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$58,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,153.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,211.00
|
| Rate for Payer: PHCS Commercial |
$74,976.00
|
| Rate for Payer: United Healthcare All Payer |
$68,728.00
|
|
|
DEFIBRILLATOR EVERA MRI DDPB3D
|
Facility
|
IP
|
$78,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,153.00 |
| Max. Negotiated Rate |
$74,976.00 |
| Rate for Payer: Aetna Commercial |
$60,137.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,918.00
|
| Rate for Payer: Cash Price |
$39,050.00
|
| Rate for Payer: Cigna Commercial |
$64,823.00
|
| Rate for Payer: First Health Commercial |
$74,195.00
|
| Rate for Payer: Humana Commercial |
$66,385.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,042.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,637.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,430.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$58,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,153.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,211.00
|
| Rate for Payer: PHCS Commercial |
$74,976.00
|
| Rate for Payer: United Healthcare All Payer |
$68,728.00
|
|
|
DEFIBRILLATOR EVERA XT DDBB1D1
|
Facility
|
IP
|
$77,380.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,059.40 |
| Max. Negotiated Rate |
$74,284.80 |
| Rate for Payer: Aetna Commercial |
$59,582.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,356.40
|
| Rate for Payer: Cash Price |
$38,690.00
|
| Rate for Payer: Cigna Commercial |
$64,225.40
|
| Rate for Payer: First Health Commercial |
$73,511.00
|
| Rate for Payer: Humana Commercial |
$65,773.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,451.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,106.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,094.40
|
| Rate for Payer: Ohio Health Group HMO |
$58,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,476.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,059.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,987.80
|
| Rate for Payer: PHCS Commercial |
$74,284.80
|
| Rate for Payer: United Healthcare All Payer |
$68,094.40
|
|
|
DEFIBRILLATOR EVERA XT DDBB1D1
|
Facility
|
OP
|
$77,380.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,059.40 |
| Max. Negotiated Rate |
$74,284.80 |
| Rate for Payer: Aetna Commercial |
$59,582.60
|
| Rate for Payer: Anthem Medicaid |
$26,610.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,356.40
|
| Rate for Payer: Cash Price |
$38,690.00
|
| Rate for Payer: Cigna Commercial |
$64,225.40
|
| Rate for Payer: First Health Commercial |
$73,511.00
|
| Rate for Payer: Humana Commercial |
$65,773.00
|
| Rate for Payer: Humana KY Medicaid |
$26,610.98
|
| Rate for Payer: Kentucky WC Medicaid |
$26,881.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,451.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,106.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,144.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,094.40
|
| Rate for Payer: Ohio Health Group HMO |
$58,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,476.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,059.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,987.80
|
| Rate for Payer: PHCS Commercial |
$74,284.80
|
| Rate for Payer: United Healthcare All Payer |
$68,094.40
|
|
|
DEFIBRILLATOR EVERA XT DDBB1D4
|
Facility
|
IP
|
$77,380.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,059.40 |
| Max. Negotiated Rate |
$74,284.80 |
| Rate for Payer: Aetna Commercial |
$59,582.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,356.40
|
| Rate for Payer: Cash Price |
$38,690.00
|
| Rate for Payer: Cigna Commercial |
$64,225.40
|
| Rate for Payer: First Health Commercial |
$73,511.00
|
| Rate for Payer: Humana Commercial |
$65,773.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,451.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,106.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,094.40
|
| Rate for Payer: Ohio Health Group HMO |
$58,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,476.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,059.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,987.80
|
| Rate for Payer: PHCS Commercial |
$74,284.80
|
| Rate for Payer: United Healthcare All Payer |
$68,094.40
|
|
|
DEFIBRILLATOR EVERA XT DDBB1D4
|
Facility
|
OP
|
$77,380.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,059.40 |
| Max. Negotiated Rate |
$74,284.80 |
| Rate for Payer: Aetna Commercial |
$59,582.60
|
| Rate for Payer: Anthem Medicaid |
$26,610.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,356.40
|
| Rate for Payer: Cash Price |
$38,690.00
|
| Rate for Payer: Cigna Commercial |
$64,225.40
|
| Rate for Payer: First Health Commercial |
$73,511.00
|
| Rate for Payer: Humana Commercial |
$65,773.00
|
| Rate for Payer: Humana KY Medicaid |
$26,610.98
|
| Rate for Payer: Kentucky WC Medicaid |
$26,881.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,451.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,106.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,144.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,094.40
|
| Rate for Payer: Ohio Health Group HMO |
$58,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,476.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,059.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,987.80
|
| Rate for Payer: PHCS Commercial |
$74,284.80
|
| Rate for Payer: United Healthcare All Payer |
$68,094.40
|
|
|
DEFIBRILLATOR EVERA XT DVBB1D1
|
Facility
|
OP
|
$78,460.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,199.80 |
| Max. Negotiated Rate |
$75,321.60 |
| Rate for Payer: Aetna Commercial |
$60,414.20
|
| Rate for Payer: Anthem Medicaid |
$26,982.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,198.80
|
| Rate for Payer: Cash Price |
$39,230.00
|
| Rate for Payer: Cigna Commercial |
$65,121.80
|
| Rate for Payer: First Health Commercial |
$74,537.00
|
| Rate for Payer: Humana Commercial |
$66,691.00
|
| Rate for Payer: Humana KY Medicaid |
$26,982.39
|
| Rate for Payer: Kentucky WC Medicaid |
$27,257.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,337.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,903.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,538.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,523.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,044.80
|
| Rate for Payer: Ohio Health Group HMO |
$58,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,199.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,322.60
|
| Rate for Payer: PHCS Commercial |
$75,321.60
|
| Rate for Payer: United Healthcare All Payer |
$69,044.80
|
|
