|
DEFIBRILLATOR PROTECTA D314DRG
|
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: United Healthcare All Payer |
$68,728.00
|
| 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
|
|
|
DEFIBRILLATOR PROTECTA D314DRG
|
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 PROTECTA D314DRM
|
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 PROTECTA D314DRM
|
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 PROTECTA D314TRG
|
Facility
|
OP
|
$97,900.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,727.00 |
| Max. Negotiated Rate |
$93,984.00 |
| Rate for Payer: Aetna Commercial |
$75,383.00
|
| Rate for Payer: Anthem Medicaid |
$33,667.81
|
| 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: Humana KY Medicaid |
$33,667.81
|
| Rate for Payer: Kentucky WC Medicaid |
$34,010.46
|
| 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: Molina Healthcare Medicaid |
$34,343.32
|
| 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 |
$19,580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,727.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30,349.00
|
| Rate for Payer: PHCS Commercial |
$93,984.00
|
| Rate for Payer: United Healthcare All Payer |
$86,152.00
|
|
|
DEFIBRILLATOR PROTECTA D314TRG
|
Facility
|
IP
|
$97,900.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,727.00 |
| 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 |
$19,580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,727.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30,349.00
|
| Rate for Payer: PHCS Commercial |
$93,984.00
|
| Rate for Payer: United Healthcare All Payer |
$86,152.00
|
|
|
DEFIBRILLATOR PROTECTA D314VRG
|
Facility
|
IP
|
$76,660.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,965.80 |
| Max. Negotiated Rate |
$73,593.60 |
| Rate for Payer: Aetna Commercial |
$59,028.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,794.80
|
| Rate for Payer: Cash Price |
$38,330.00
|
| Rate for Payer: Cigna Commercial |
$63,627.80
|
| Rate for Payer: First Health Commercial |
$72,827.00
|
| Rate for Payer: Humana Commercial |
$65,161.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,861.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,575.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,998.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,460.80
|
| Rate for Payer: Ohio Health Group HMO |
$57,495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,332.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,965.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,764.60
|
| Rate for Payer: PHCS Commercial |
$73,593.60
|
| Rate for Payer: United Healthcare All Payer |
$67,460.80
|
|
|
DEFIBRILLATOR PROTECTA D314VRG
|
Facility
|
OP
|
$76,660.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,965.80 |
| Max. Negotiated Rate |
$73,593.60 |
| Rate for Payer: Aetna Commercial |
$59,028.20
|
| Rate for Payer: Anthem Medicaid |
$26,363.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,794.80
|
| Rate for Payer: Cash Price |
$38,330.00
|
| Rate for Payer: Cigna Commercial |
$63,627.80
|
| Rate for Payer: First Health Commercial |
$72,827.00
|
| Rate for Payer: Humana Commercial |
$65,161.00
|
| Rate for Payer: Humana KY Medicaid |
$26,363.37
|
| Rate for Payer: Kentucky WC Medicaid |
$26,631.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,861.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,575.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,998.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,892.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,460.80
|
| Rate for Payer: Ohio Health Group HMO |
$57,495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,332.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,965.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,764.60
|
| Rate for Payer: PHCS Commercial |
$73,593.60
|
| Rate for Payer: United Healthcare All Payer |
$67,460.80
|
|
|
DEFIBRILLATOR PROTECTA D344TRM
|
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 PROTECTA D344TRM
|
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 QUADRA CD3265-40
|
Facility
|
IP
|
$101,500.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
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 QUADRA CD3265-40
|
Facility
|
OP
|
$101,500.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
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 RF PROMOTE
|
Facility
|
OP
|
$105,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$13,663.00 |
| Max. Negotiated Rate |
$100,896.00 |
| Rate for Payer: Aetna Commercial |
$80,927.00
|
| Rate for Payer: Anthem Medicaid |
$36,143.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81,978.00
|
| Rate for Payer: Cash Price |
$52,550.00
|
| Rate for Payer: Cigna Commercial |
$87,233.00
|
| Rate for Payer: First Health Commercial |
$99,845.00
|
| Rate for Payer: Humana Commercial |
$89,335.00
|
| Rate for Payer: Humana KY Medicaid |
$36,143.89
|
| Rate for Payer: Kentucky WC Medicaid |
$36,511.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86,182.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77,563.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31,530.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$36,869.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$92,488.00
|
| Rate for Payer: Ohio Health Group HMO |
$78,825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,663.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32,581.00
|
| Rate for Payer: PHCS Commercial |
$100,896.00
|
| Rate for Payer: United Healthcare All Payer |
$92,488.00
|
|
|
DEFIBRILLATOR RF PROMOTE
|
Facility
|
IP
|
$105,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$13,663.00 |
| Max. Negotiated Rate |
$100,896.00 |
| Rate for Payer: Aetna Commercial |
$80,927.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81,978.00
|
| Rate for Payer: Cash Price |
$52,550.00
|
| Rate for Payer: Cigna Commercial |
$87,233.00
|
| Rate for Payer: First Health Commercial |
$99,845.00
|
| Rate for Payer: Humana Commercial |
$89,335.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86,182.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77,563.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31,530.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$92,488.00
|
| Rate for Payer: Ohio Health Group HMO |
$78,825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,663.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32,581.00
|
| Rate for Payer: PHCS Commercial |
$100,896.00
|
| Rate for Payer: United Healthcare All Payer |
$92,488.00
|
|
|
DEFIBRILLATOR SECURA D224DRG
|
Facility
|
OP
|
$110,320.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$14,341.60 |
| Max. Negotiated Rate |
$105,907.20 |
| Rate for Payer: Aetna Commercial |
$84,946.40
|
| Rate for Payer: Anthem Medicaid |
$37,939.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86,049.60
|
| Rate for Payer: Cash Price |
$55,160.00
|
| Rate for Payer: Cigna Commercial |
$91,565.60
|
| Rate for Payer: First Health Commercial |
$104,804.00
|
| Rate for Payer: Humana Commercial |
$93,772.00
|
| Rate for Payer: Humana KY Medicaid |
$37,939.05
|
| Rate for Payer: Kentucky WC Medicaid |
$38,325.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$90,462.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$81,416.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33,096.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$38,700.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$97,081.60
|
| Rate for Payer: Ohio Health Group HMO |
$82,740.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,341.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34,199.20
|
| Rate for Payer: PHCS Commercial |
$105,907.20
|
| Rate for Payer: United Healthcare All Payer |
$97,081.60
|
|
|
DEFIBRILLATOR SECURA D224DRG
|
Facility
|
IP
|
$110,320.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$14,341.60 |
| Max. Negotiated Rate |
$105,907.20 |
| Rate for Payer: Aetna Commercial |
$84,946.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86,049.60
|
| Rate for Payer: Cash Price |
$55,160.00
|
| Rate for Payer: Cigna Commercial |
$91,565.60
|
| Rate for Payer: First Health Commercial |
$104,804.00
|
| Rate for Payer: Humana Commercial |
$93,772.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$90,462.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$81,416.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33,096.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$97,081.60
|
| Rate for Payer: Ohio Health Group HMO |
$82,740.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,341.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34,199.20
|
| Rate for Payer: PHCS Commercial |
$105,907.20
|
| Rate for Payer: United Healthcare All Payer |
$97,081.60
|
|
|
DEFIBRILLATOR TELIGEN 100 E110
|
Facility
|
OP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,504.00 |
| Max. Negotiated Rate |
$77,568.00 |
| Rate for Payer: Aetna Commercial |
$62,216.00
|
| Rate for Payer: Anthem Medicaid |
$27,787.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,024.00
|
| Rate for Payer: Cash Price |
$40,400.00
|
| Rate for Payer: Cigna Commercial |
$67,064.00
|
| Rate for Payer: First Health Commercial |
$76,760.00
|
| Rate for Payer: Humana Commercial |
$68,680.00
|
| Rate for Payer: Humana KY Medicaid |
$27,787.12
|
| Rate for Payer: Kentucky WC Medicaid |
$28,069.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,256.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,630.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,344.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,104.00
|
| Rate for Payer: Ohio Health Group HMO |
$60,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,504.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,048.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
|
DEFIBRILLATOR TELIGEN 100 E110
|
Facility
|
IP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,504.00 |
| Max. Negotiated Rate |
$77,568.00 |
| Rate for Payer: Aetna Commercial |
$62,216.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,024.00
|
| Rate for Payer: Cash Price |
$40,400.00
|
| Rate for Payer: Cigna Commercial |
$67,064.00
|
| Rate for Payer: First Health Commercial |
$76,760.00
|
| Rate for Payer: Humana Commercial |
$68,680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,256.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,630.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,104.00
|
| Rate for Payer: Ohio Health Group HMO |
$60,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,504.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,048.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
|
DEFIBRILLATOR UNIFY CD3231-40
|
Facility
|
OP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Humana KY Medicaid |
$32,429.77
|
| Rate for Payer: Kentucky WC Medicaid |
$32,759.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem Medicaid |
$32,429.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
|
|
DEFIBRILLATOR UNIFY CD3231-40
|
Facility
|
IP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
DEFIBRILLATOR UNIFY CD3231-40Q
|
Facility
|
OP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem Medicaid |
$32,429.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Humana KY Medicaid |
$32,429.77
|
| Rate for Payer: Kentucky WC Medicaid |
$32,759.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
DEFIBRILLATOR UNIFY CD3231-40Q
|
Facility
|
IP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
DEFIBRILLATOR UNIFY CD3257-40
|
Facility
|
IP
|
$97,540.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,680.20 |
| Max. Negotiated Rate |
$93,638.40 |
| Rate for Payer: Aetna Commercial |
$75,105.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,081.20
|
| Rate for Payer: Cash Price |
$48,770.00
|
| Rate for Payer: Cigna Commercial |
$80,958.20
|
| Rate for Payer: First Health Commercial |
$92,663.00
|
| Rate for Payer: Humana Commercial |
$82,909.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79,982.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71,984.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$85,835.20
|
| Rate for Payer: Ohio Health Group HMO |
$73,155.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,508.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,680.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30,237.40
|
| Rate for Payer: PHCS Commercial |
$93,638.40
|
| Rate for Payer: United Healthcare All Payer |
$85,835.20
|
|
|
DEFIBRILLATOR UNIFY CD3257-40
|
Facility
|
OP
|
$97,540.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,680.20 |
| Max. Negotiated Rate |
$93,638.40 |
| Rate for Payer: Aetna Commercial |
$75,105.80
|
| Rate for Payer: Anthem Medicaid |
$33,544.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,081.20
|
| Rate for Payer: Cash Price |
$48,770.00
|
| Rate for Payer: Cigna Commercial |
$80,958.20
|
| Rate for Payer: First Health Commercial |
$92,663.00
|
| Rate for Payer: Humana Commercial |
$82,909.00
|
| Rate for Payer: Humana KY Medicaid |
$33,544.01
|
| Rate for Payer: Kentucky WC Medicaid |
$33,885.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79,982.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71,984.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,262.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,217.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$85,835.20
|
| Rate for Payer: Ohio Health Group HMO |
$73,155.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,508.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,680.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30,237.40
|
| Rate for Payer: PHCS Commercial |
$93,638.40
|
| Rate for Payer: United Healthcare All Payer |
$85,835.20
|
|
|
DEFIBRILLATOR UNIFY CD3257-40Q
|
Facility
|
IP
|
$97,540.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,680.20 |
| Max. Negotiated Rate |
$93,638.40 |
| Rate for Payer: Aetna Commercial |
$75,105.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,081.20
|
| Rate for Payer: Cash Price |
$48,770.00
|
| Rate for Payer: Cigna Commercial |
$80,958.20
|
| Rate for Payer: First Health Commercial |
$92,663.00
|
| Rate for Payer: Humana Commercial |
$82,909.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79,982.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71,984.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$85,835.20
|
| Rate for Payer: Ohio Health Group HMO |
$73,155.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,508.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,680.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30,237.40
|
| Rate for Payer: PHCS Commercial |
$93,638.40
|
| Rate for Payer: United Healthcare All Payer |
$85,835.20
|
|
