|
DEFIB PROTECTA DR D334DR
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DEFIB QUAD ASSURA CD3365-40Q
|
Facility
|
IP
|
$41,375.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
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 QUAD ASSURA CD3365-40Q
|
Facility
|
OP
|
$41,375.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
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 QUADRA CD3265-40Q
|
Facility
|
IP
|
$105,500.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$31,650.00 |
| Max. Negotiated Rate |
$101,280.00 |
| Rate for Payer: Aetna Commercial |
$81,235.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$82,290.00
|
| Rate for Payer: Cash Price |
$52,750.00
|
| Rate for Payer: Cigna Commercial |
$87,565.00
|
| Rate for Payer: First Health Commercial |
$100,225.00
|
| Rate for Payer: Humana Commercial |
$89,675.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86,510.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77,859.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$92,840.00
|
| Rate for Payer: Ohio Health Group HMO |
$79,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91,785.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72,795.00
|
| Rate for Payer: PHCS Commercial |
$101,280.00
|
| Rate for Payer: United Healthcare All Payer |
$92,840.00
|
|
|
DEFIB QUADRA CD3265-40Q
|
Facility
|
OP
|
$105,500.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$31,650.00 |
| Max. Negotiated Rate |
$101,280.00 |
| Rate for Payer: Aetna Commercial |
$81,235.00
|
| Rate for Payer: Anthem Medicaid |
$36,281.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$82,290.00
|
| Rate for Payer: Cash Price |
$52,750.00
|
| Rate for Payer: Cigna Commercial |
$87,565.00
|
| Rate for Payer: First Health Commercial |
$100,225.00
|
| Rate for Payer: Humana Commercial |
$89,675.00
|
| Rate for Payer: Humana KY Medicaid |
$36,281.45
|
| Rate for Payer: Kentucky WC Medicaid |
$36,650.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86,510.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77,859.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$37,009.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$92,840.00
|
| Rate for Payer: Ohio Health Group HMO |
$79,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91,785.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72,795.00
|
| Rate for Payer: PHCS Commercial |
$101,280.00
|
| Rate for Payer: United Healthcare All Payer |
$92,840.00
|
|
|
DEFIBR ASSURA VR CD1257-40Q
|
Facility
|
OP
|
$81,370.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,411.00 |
| Max. Negotiated Rate |
$78,115.20 |
| Rate for Payer: Aetna Commercial |
$62,654.90
|
| Rate for Payer: Anthem Medicaid |
$27,983.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,468.60
|
| Rate for Payer: Cash Price |
$40,685.00
|
| Rate for Payer: Cigna Commercial |
$67,537.10
|
| Rate for Payer: First Health Commercial |
$77,301.50
|
| Rate for Payer: Humana Commercial |
$69,164.50
|
| Rate for Payer: Humana KY Medicaid |
$27,983.14
|
| Rate for Payer: Kentucky WC Medicaid |
$28,267.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,723.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,051.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,411.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,544.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,605.60
|
| Rate for Payer: Ohio Health Group HMO |
$61,027.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,096.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,791.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,145.30
|
| Rate for Payer: PHCS Commercial |
$78,115.20
|
| Rate for Payer: United Healthcare All Payer |
$71,605.60
|
|
|
DEFIBR ASSURA VR CD1257-40Q
|
Facility
|
IP
|
$81,370.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,411.00 |
| Max. Negotiated Rate |
$78,115.20 |
| Rate for Payer: Aetna Commercial |
$62,654.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,468.60
|
| Rate for Payer: Cash Price |
$40,685.00
|
| Rate for Payer: Cigna Commercial |
$67,537.10
|
| Rate for Payer: First Health Commercial |
$77,301.50
|
| Rate for Payer: Humana Commercial |
$69,164.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,723.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,051.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,411.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,605.60
|
| Rate for Payer: Ohio Health Group HMO |
$61,027.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,096.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,791.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,145.30
|
| Rate for Payer: PHCS Commercial |
$78,115.20
|
| Rate for Payer: United Healthcare All Payer |
$71,605.60
|
|
|
DEFIBR ASSURA VR CD1357-40Q
|
Facility
|
OP
|
$26,562.50
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,968.75 |
| Max. Negotiated Rate |
$25,500.00 |
| Rate for Payer: Aetna Commercial |
$20,453.12
|
| Rate for Payer: Anthem Medicaid |
$9,134.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,718.75
|
| Rate for Payer: Cash Price |
$13,281.25
|
| Rate for Payer: Cigna Commercial |
$22,046.88
|
| Rate for Payer: First Health Commercial |
$25,234.38
|
| Rate for Payer: Humana Commercial |
$22,578.12
|
| Rate for Payer: Humana KY Medicaid |
$9,134.84
|
| Rate for Payer: Kentucky WC Medicaid |
$9,227.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,781.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,603.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,968.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,318.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,375.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,921.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,109.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,328.12
|
| Rate for Payer: PHCS Commercial |
$25,500.00
|
| Rate for Payer: United Healthcare All Payer |
$23,375.00
|
|
|
DEFIBR ASSURA VR CD1357-40Q
|
Facility
|
IP
|
$26,562.50
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,968.75 |
| Max. Negotiated Rate |
$25,500.00 |
| Rate for Payer: Aetna Commercial |
$20,453.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,718.75
|
| Rate for Payer: Cash Price |
$13,281.25
|
| Rate for Payer: Cigna Commercial |
$22,046.88
|
| Rate for Payer: First Health Commercial |
$25,234.38
|
| Rate for Payer: Humana Commercial |
$22,578.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,781.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,603.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,968.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,375.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,921.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,109.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,328.12
|
| Rate for Payer: PHCS Commercial |
$25,500.00
|
| Rate for Payer: United Healthcare All Payer |
$23,375.00
|
|
|
DEFIBRILLATOR AMPLIA MRI DTMB1
|
Facility
|
IP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,240.00 |
| 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 |
$64,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,296.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,752.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
|
DEFIBRILLATOR AMPLIA MRI DTMB1
|
Facility
|
OP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,240.00 |
| 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 |
$64,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,296.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,752.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
|
DEFIBRILLATOR CONCERTO C154DWK
|
Facility
|
OP
|
$126,400.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$37,920.00 |
| Max. Negotiated Rate |
$121,344.00 |
| Rate for Payer: Aetna Commercial |
$97,328.00
|
| Rate for Payer: Anthem Medicaid |
$43,468.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98,592.00
|
| Rate for Payer: Cash Price |
$63,200.00
|
| Rate for Payer: Cigna Commercial |
$104,912.00
|
| Rate for Payer: First Health Commercial |
$120,080.00
|
| Rate for Payer: Humana Commercial |
$107,440.00
|
| Rate for Payer: Humana KY Medicaid |
$43,468.96
|
| Rate for Payer: Kentucky WC Medicaid |
$43,911.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103,648.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93,283.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37,920.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$44,341.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$111,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$94,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109,968.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87,216.00
|
| Rate for Payer: PHCS Commercial |
$121,344.00
|
| Rate for Payer: United Healthcare All Payer |
$111,232.00
|
|
|
DEFIBRILLATOR CONCERTO C154DWK
|
Facility
|
IP
|
$126,400.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$37,920.00 |
| Max. Negotiated Rate |
$121,344.00 |
| Rate for Payer: Aetna Commercial |
$97,328.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98,592.00
|
| Rate for Payer: Cash Price |
$63,200.00
|
| Rate for Payer: Cigna Commercial |
$104,912.00
|
| Rate for Payer: First Health Commercial |
$120,080.00
|
| Rate for Payer: Humana Commercial |
$107,440.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103,648.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93,283.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37,920.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$111,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$94,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109,968.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87,216.00
|
| Rate for Payer: PHCS Commercial |
$121,344.00
|
| Rate for Payer: United Healthcare All Payer |
$111,232.00
|
|
|
DEFIBRILLATOR CRT-D D224TRK
|
Facility
|
OP
|
$103,600.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$31,080.00 |
| Max. Negotiated Rate |
$99,456.00 |
| Rate for Payer: Aetna Commercial |
$79,772.00
|
| Rate for Payer: Anthem Medicaid |
$35,628.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80,808.00
|
| Rate for Payer: Cash Price |
$51,800.00
|
| Rate for Payer: Cigna Commercial |
$85,988.00
|
| Rate for Payer: First Health Commercial |
$98,420.00
|
| Rate for Payer: Humana Commercial |
$88,060.00
|
| Rate for Payer: Humana KY Medicaid |
$35,628.04
|
| Rate for Payer: Kentucky WC Medicaid |
$35,990.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$84,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76,456.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31,080.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$36,342.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$91,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$77,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90,132.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71,484.00
|
| Rate for Payer: PHCS Commercial |
$99,456.00
|
| Rate for Payer: United Healthcare All Payer |
$91,168.00
|
|
|
DEFIBRILLATOR CRT-D D224TRK
|
Facility
|
IP
|
$103,600.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$31,080.00 |
| Max. Negotiated Rate |
$99,456.00 |
| Rate for Payer: Aetna Commercial |
$79,772.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80,808.00
|
| Rate for Payer: Cash Price |
$51,800.00
|
| Rate for Payer: Cigna Commercial |
$85,988.00
|
| Rate for Payer: First Health Commercial |
$98,420.00
|
| Rate for Payer: Humana Commercial |
$88,060.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$84,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76,456.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31,080.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$91,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$77,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90,132.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71,484.00
|
| Rate for Payer: PHCS Commercial |
$99,456.00
|
| Rate for Payer: United Healthcare All Payer |
$91,168.00
|
|
|
DEFIBRILLATOR CRT-D DTBB1D1
|
Facility
|
IP
|
$90,680.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$27,204.00 |
| Max. Negotiated Rate |
$87,052.80 |
| Rate for Payer: Aetna Commercial |
$69,823.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,730.40
|
| Rate for Payer: Cash Price |
$45,340.00
|
| Rate for Payer: Cigna Commercial |
$75,264.40
|
| Rate for Payer: First Health Commercial |
$86,146.00
|
| Rate for Payer: Humana Commercial |
$77,078.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,357.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,921.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,204.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,798.40
|
| Rate for Payer: Ohio Health Group HMO |
$68,010.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72,544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78,891.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62,569.20
|
| Rate for Payer: PHCS Commercial |
$87,052.80
|
| Rate for Payer: United Healthcare All Payer |
$79,798.40
|
|
|
DEFIBRILLATOR CRT-D DTBB1D1
|
Facility
|
OP
|
$90,680.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$27,204.00 |
| Max. Negotiated Rate |
$87,052.80 |
| Rate for Payer: Aetna Commercial |
$69,823.60
|
| Rate for Payer: Anthem Medicaid |
$31,184.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,730.40
|
| Rate for Payer: Cash Price |
$45,340.00
|
| Rate for Payer: Cigna Commercial |
$75,264.40
|
| Rate for Payer: First Health Commercial |
$86,146.00
|
| Rate for Payer: Humana Commercial |
$77,078.00
|
| Rate for Payer: Humana KY Medicaid |
$31,184.85
|
| Rate for Payer: Kentucky WC Medicaid |
$31,502.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,357.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,921.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,204.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,810.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,798.40
|
| Rate for Payer: Ohio Health Group HMO |
$68,010.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72,544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78,891.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62,569.20
|
| Rate for Payer: PHCS Commercial |
$87,052.80
|
| Rate for Payer: United Healthcare All Payer |
$79,798.40
|
|
|
DEFIBRILLATOR CURRENT DR DCRR
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DEFIBRILLATOR CURRENT DR DCRR
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DEFIBRILLATOR DYNAGEN D023
|
Facility
|
OP
|
$77,190.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,157.00 |
| Max. Negotiated Rate |
$74,102.40 |
| Rate for Payer: Aetna Commercial |
$59,436.30
|
| Rate for Payer: Anthem Medicaid |
$26,545.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,208.20
|
| Rate for Payer: Cash Price |
$38,595.00
|
| Rate for Payer: Cigna Commercial |
$64,067.70
|
| Rate for Payer: First Health Commercial |
$73,330.50
|
| Rate for Payer: Humana Commercial |
$65,611.50
|
| Rate for Payer: Humana KY Medicaid |
$26,545.64
|
| Rate for Payer: Kentucky WC Medicaid |
$26,815.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,295.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,966.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,157.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,078.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,927.20
|
| Rate for Payer: Ohio Health Group HMO |
$57,892.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,752.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,155.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,261.10
|
| Rate for Payer: PHCS Commercial |
$74,102.40
|
| Rate for Payer: United Healthcare All Payer |
$67,927.20
|
|
|
DEFIBRILLATOR DYNAGEN D023
|
Facility
|
IP
|
$77,190.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,157.00 |
| Max. Negotiated Rate |
$74,102.40 |
| Rate for Payer: Aetna Commercial |
$59,436.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,208.20
|
| Rate for Payer: Cash Price |
$38,595.00
|
| Rate for Payer: Cigna Commercial |
$64,067.70
|
| Rate for Payer: First Health Commercial |
$73,330.50
|
| Rate for Payer: Humana Commercial |
$65,611.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,295.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,966.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,157.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,927.20
|
| Rate for Payer: Ohio Health Group HMO |
$57,892.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,752.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,155.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,261.10
|
| Rate for Payer: PHCS Commercial |
$74,102.40
|
| Rate for Payer: United Healthcare All Payer |
$67,927.20
|
|
|
DEFIBRILLATOR DYNAGEN G150
|
Facility
|
IP
|
$95,810.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$28,743.00 |
| Max. Negotiated Rate |
$91,977.60 |
| Rate for Payer: Aetna Commercial |
$73,773.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74,731.80
|
| Rate for Payer: Cash Price |
$47,905.00
|
| Rate for Payer: Cigna Commercial |
$79,522.30
|
| Rate for Payer: First Health Commercial |
$91,019.50
|
| Rate for Payer: Humana Commercial |
$81,438.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78,564.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70,707.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,743.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$84,312.80
|
| Rate for Payer: Ohio Health Group HMO |
$71,857.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83,354.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66,108.90
|
| Rate for Payer: PHCS Commercial |
$91,977.60
|
| Rate for Payer: United Healthcare All Payer |
$84,312.80
|
|
|
DEFIBRILLATOR DYNAGEN G150
|
Facility
|
OP
|
$95,810.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$28,743.00 |
| Max. Negotiated Rate |
$91,977.60 |
| Rate for Payer: Aetna Commercial |
$73,773.70
|
| Rate for Payer: Anthem Medicaid |
$32,949.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74,731.80
|
| Rate for Payer: Cash Price |
$47,905.00
|
| Rate for Payer: Cigna Commercial |
$79,522.30
|
| Rate for Payer: First Health Commercial |
$91,019.50
|
| Rate for Payer: Humana Commercial |
$81,438.50
|
| Rate for Payer: Humana KY Medicaid |
$32,949.06
|
| Rate for Payer: Kentucky WC Medicaid |
$33,284.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78,564.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70,707.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,743.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,610.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$84,312.80
|
| Rate for Payer: Ohio Health Group HMO |
$71,857.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83,354.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66,108.90
|
| Rate for Payer: PHCS Commercial |
$91,977.60
|
| Rate for Payer: United Healthcare All Payer |
$84,312.80
|
|
|
DEFIBRILLATOR ENERGEN BIV N140
|
Facility
|
OP
|
$98,850.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$29,655.00 |
| Max. Negotiated Rate |
$94,896.00 |
| Rate for Payer: Aetna Commercial |
$76,114.50
|
| Rate for Payer: Anthem Medicaid |
$33,994.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77,103.00
|
| Rate for Payer: Cash Price |
$49,425.00
|
| Rate for Payer: Cigna Commercial |
$82,045.50
|
| Rate for Payer: First Health Commercial |
$93,907.50
|
| Rate for Payer: Humana Commercial |
$84,022.50
|
| Rate for Payer: Humana KY Medicaid |
$33,994.51
|
| Rate for Payer: Kentucky WC Medicaid |
$34,340.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81,057.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,951.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,655.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,676.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,988.00
|
| Rate for Payer: Ohio Health Group HMO |
$74,137.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85,999.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68,206.50
|
| Rate for Payer: PHCS Commercial |
$94,896.00
|
| Rate for Payer: United Healthcare All Payer |
$86,988.00
|
|
|
DEFIBRILLATOR ENERGEN BIV N140
|
Facility
|
IP
|
$98,850.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$29,655.00 |
| Max. Negotiated Rate |
$94,896.00 |
| Rate for Payer: Aetna Commercial |
$76,114.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77,103.00
|
| Rate for Payer: Cash Price |
$49,425.00
|
| Rate for Payer: Cigna Commercial |
$82,045.50
|
| Rate for Payer: First Health Commercial |
$93,907.50
|
| Rate for Payer: Humana Commercial |
$84,022.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81,057.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,951.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,655.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,988.00
|
| Rate for Payer: Ohio Health Group HMO |
$74,137.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85,999.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68,206.50
|
| Rate for Payer: PHCS Commercial |
$94,896.00
|
| Rate for Payer: United Healthcare All Payer |
$86,988.00
|
|
