|
DEFIBRILLATOR ENERGEN BIV N141
|
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 N141
|
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 EPIC HF II V-355
|
Facility
|
IP
|
$107,400.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$32,220.00 |
| Max. Negotiated Rate |
$103,104.00 |
| Rate for Payer: Aetna Commercial |
$82,698.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83,772.00
|
| Rate for Payer: Cash Price |
$53,700.00
|
| Rate for Payer: Cigna Commercial |
$89,142.00
|
| Rate for Payer: First Health Commercial |
$102,030.00
|
| Rate for Payer: Humana Commercial |
$91,290.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88,068.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79,261.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,220.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$94,512.00
|
| Rate for Payer: Ohio Health Group HMO |
$80,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93,438.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74,106.00
|
| Rate for Payer: PHCS Commercial |
$103,104.00
|
| Rate for Payer: United Healthcare All Payer |
$94,512.00
|
|
|
DEFIBRILLATOR EPIC HF II V-355
|
Facility
|
OP
|
$107,400.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$32,220.00 |
| Max. Negotiated Rate |
$103,104.00 |
| Rate for Payer: Aetna Commercial |
$82,698.00
|
| Rate for Payer: Anthem Medicaid |
$36,934.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83,772.00
|
| Rate for Payer: Cash Price |
$53,700.00
|
| Rate for Payer: Cigna Commercial |
$89,142.00
|
| Rate for Payer: First Health Commercial |
$102,030.00
|
| Rate for Payer: Humana Commercial |
$91,290.00
|
| Rate for Payer: Humana KY Medicaid |
$36,934.86
|
| Rate for Payer: Kentucky WC Medicaid |
$37,310.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88,068.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79,261.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,220.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$37,675.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$94,512.00
|
| Rate for Payer: Ohio Health Group HMO |
$80,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93,438.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74,106.00
|
| Rate for Payer: PHCS Commercial |
$103,104.00
|
| Rate for Payer: United Healthcare All Payer |
$94,512.00
|
|
|
DEFIBRILLATOR EPIC HF V-337
|
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
|
|
|
DEFIBRILLATOR EPIC HF V-337
|
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
|
|
|
DEFIBRILLATOR EVERA MRI DDMB1D
|
Facility
|
OP
|
$67,500.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$20,250.00 |
| Max. Negotiated Rate |
$64,800.00 |
| Rate for Payer: Aetna Commercial |
$51,975.00
|
| Rate for Payer: Anthem Medicaid |
$23,213.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52,650.00
|
| Rate for Payer: Cash Price |
$33,750.00
|
| Rate for Payer: Cigna Commercial |
$56,025.00
|
| Rate for Payer: First Health Commercial |
$64,125.00
|
| Rate for Payer: Humana Commercial |
$57,375.00
|
| Rate for Payer: Humana KY Medicaid |
$23,213.25
|
| Rate for Payer: Kentucky WC Medicaid |
$23,449.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55,350.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49,815.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,250.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,679.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$59,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$50,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58,725.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46,575.00
|
| Rate for Payer: PHCS Commercial |
$64,800.00
|
| Rate for Payer: United Healthcare All Payer |
$59,400.00
|
|
|
DEFIBRILLATOR EVERA MRI DDMB1D
|
Facility
|
IP
|
$67,500.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$20,250.00 |
| Max. Negotiated Rate |
$64,800.00 |
| Rate for Payer: Aetna Commercial |
$51,975.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52,650.00
|
| Rate for Payer: Cash Price |
$33,750.00
|
| Rate for Payer: Cigna Commercial |
$56,025.00
|
| Rate for Payer: First Health Commercial |
$64,125.00
|
| Rate for Payer: Humana Commercial |
$57,375.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55,350.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49,815.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,250.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$59,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$50,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58,725.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46,575.00
|
| Rate for Payer: PHCS Commercial |
$64,800.00
|
| Rate for Payer: United Healthcare All Payer |
$59,400.00
|
|
|
DEFIBRILLATOR EVERA MRI DDMC3D
|
Facility
|
IP
|
$80,040.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,012.00 |
| Max. Negotiated Rate |
$76,838.40 |
| Rate for Payer: Aetna Commercial |
$61,630.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,431.20
|
| Rate for Payer: Cash Price |
$40,020.00
|
| Rate for Payer: Cigna Commercial |
$66,433.20
|
| Rate for Payer: First Health Commercial |
$76,038.00
|
| Rate for Payer: Humana Commercial |
$68,034.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,632.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,069.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,012.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,435.20
|
| Rate for Payer: Ohio Health Group HMO |
$60,030.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,032.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69,634.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,227.60
|
| Rate for Payer: PHCS Commercial |
$76,838.40
|
| Rate for Payer: United Healthcare All Payer |
$70,435.20
|
|
|
DEFIBRILLATOR EVERA MRI DDMC3D
|
Facility
|
OP
|
$80,040.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,012.00 |
| Max. Negotiated Rate |
$76,838.40 |
| Rate for Payer: Aetna Commercial |
$61,630.80
|
| Rate for Payer: Anthem Medicaid |
$27,525.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,431.20
|
| Rate for Payer: Cash Price |
$40,020.00
|
| Rate for Payer: Cigna Commercial |
$66,433.20
|
| Rate for Payer: First Health Commercial |
$76,038.00
|
| Rate for Payer: Humana Commercial |
$68,034.00
|
| Rate for Payer: Humana KY Medicaid |
$27,525.76
|
| Rate for Payer: Kentucky WC Medicaid |
$27,805.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,632.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,069.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,012.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,078.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,435.20
|
| Rate for Payer: Ohio Health Group HMO |
$60,030.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,032.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69,634.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,227.60
|
| Rate for Payer: PHCS Commercial |
$76,838.40
|
| Rate for Payer: United Healthcare All Payer |
$70,435.20
|
|
|
DEFIBRILLATOR EVERA MRI DDPB3D
|
Facility
|
OP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
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 EVERA MRI DDPB3D
|
Facility
|
IP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
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 EVERA XT DDBB1D1
|
Facility
|
IP
|
$80,040.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,012.00 |
| Max. Negotiated Rate |
$76,838.40 |
| Rate for Payer: Aetna Commercial |
$61,630.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,431.20
|
| Rate for Payer: Cash Price |
$40,020.00
|
| Rate for Payer: Cigna Commercial |
$66,433.20
|
| Rate for Payer: First Health Commercial |
$76,038.00
|
| Rate for Payer: Humana Commercial |
$68,034.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,632.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,069.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,012.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,435.20
|
| Rate for Payer: Ohio Health Group HMO |
$60,030.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,032.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69,634.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,227.60
|
| Rate for Payer: PHCS Commercial |
$76,838.40
|
| Rate for Payer: United Healthcare All Payer |
$70,435.20
|
|
|
DEFIBRILLATOR EVERA XT DDBB1D1
|
Facility
|
OP
|
$80,040.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,012.00 |
| Max. Negotiated Rate |
$76,838.40 |
| Rate for Payer: Aetna Commercial |
$61,630.80
|
| Rate for Payer: Anthem Medicaid |
$27,525.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,431.20
|
| Rate for Payer: Cash Price |
$40,020.00
|
| Rate for Payer: Cigna Commercial |
$66,433.20
|
| Rate for Payer: First Health Commercial |
$76,038.00
|
| Rate for Payer: Humana Commercial |
$68,034.00
|
| Rate for Payer: Humana KY Medicaid |
$27,525.76
|
| Rate for Payer: Kentucky WC Medicaid |
$27,805.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,632.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,069.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,012.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,078.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,435.20
|
| Rate for Payer: Ohio Health Group HMO |
$60,030.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,032.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69,634.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,227.60
|
| Rate for Payer: PHCS Commercial |
$76,838.40
|
| Rate for Payer: United Healthcare All Payer |
$70,435.20
|
|
|
DEFIBRILLATOR EVERA XT DDBB1D4
|
Facility
|
IP
|
$80,040.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,012.00 |
| Max. Negotiated Rate |
$76,838.40 |
| Rate for Payer: Aetna Commercial |
$61,630.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,431.20
|
| Rate for Payer: Cash Price |
$40,020.00
|
| Rate for Payer: Cigna Commercial |
$66,433.20
|
| Rate for Payer: First Health Commercial |
$76,038.00
|
| Rate for Payer: Humana Commercial |
$68,034.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,632.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,069.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,012.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,435.20
|
| Rate for Payer: Ohio Health Group HMO |
$60,030.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,032.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69,634.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,227.60
|
| Rate for Payer: PHCS Commercial |
$76,838.40
|
| Rate for Payer: United Healthcare All Payer |
$70,435.20
|
|
|
DEFIBRILLATOR EVERA XT DDBB1D4
|
Facility
|
OP
|
$80,040.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,012.00 |
| Max. Negotiated Rate |
$76,838.40 |
| Rate for Payer: Aetna Commercial |
$61,630.80
|
| Rate for Payer: Anthem Medicaid |
$27,525.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,431.20
|
| Rate for Payer: Cash Price |
$40,020.00
|
| Rate for Payer: Cigna Commercial |
$66,433.20
|
| Rate for Payer: First Health Commercial |
$76,038.00
|
| Rate for Payer: Humana Commercial |
$68,034.00
|
| Rate for Payer: Humana KY Medicaid |
$27,525.76
|
| Rate for Payer: Kentucky WC Medicaid |
$27,805.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,632.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,069.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,012.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,078.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,435.20
|
| Rate for Payer: Ohio Health Group HMO |
$60,030.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,032.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69,634.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,227.60
|
| Rate for Payer: PHCS Commercial |
$76,838.40
|
| Rate for Payer: United Healthcare All Payer |
$70,435.20
|
|
|
DEFIBRILLATOR EVERA XT DVBB1D1
|
Facility
|
IP
|
$81,180.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,354.00 |
| Max. Negotiated Rate |
$77,932.80 |
| Rate for Payer: Aetna Commercial |
$62,508.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,320.40
|
| Rate for Payer: Cash Price |
$40,590.00
|
| Rate for Payer: Cigna Commercial |
$67,379.40
|
| Rate for Payer: First Health Commercial |
$77,121.00
|
| Rate for Payer: Humana Commercial |
$69,003.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,567.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,910.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,354.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,438.40
|
| Rate for Payer: Ohio Health Group HMO |
$60,885.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,626.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,014.20
|
| Rate for Payer: PHCS Commercial |
$77,932.80
|
| Rate for Payer: United Healthcare All Payer |
$71,438.40
|
|
|
DEFIBRILLATOR EVERA XT DVBB1D1
|
Facility
|
OP
|
$81,180.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,354.00 |
| Max. Negotiated Rate |
$77,932.80 |
| Rate for Payer: Aetna Commercial |
$62,508.60
|
| Rate for Payer: Anthem Medicaid |
$27,917.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,320.40
|
| Rate for Payer: Cash Price |
$40,590.00
|
| Rate for Payer: Cigna Commercial |
$67,379.40
|
| Rate for Payer: First Health Commercial |
$77,121.00
|
| Rate for Payer: Humana Commercial |
$69,003.00
|
| Rate for Payer: Humana KY Medicaid |
$27,917.80
|
| Rate for Payer: Kentucky WC Medicaid |
$28,201.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,567.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,910.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,354.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,477.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,438.40
|
| Rate for Payer: Ohio Health Group HMO |
$60,885.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,626.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,014.20
|
| Rate for Payer: PHCS Commercial |
$77,932.80
|
| Rate for Payer: United Healthcare All Payer |
$71,438.40
|
|
|
DEFIBRILLATOR EVERA XT DVBB1D4
|
Facility
|
IP
|
$81,180.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,354.00 |
| Max. Negotiated Rate |
$77,932.80 |
| Rate for Payer: Aetna Commercial |
$62,508.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,320.40
|
| Rate for Payer: Cash Price |
$40,590.00
|
| Rate for Payer: Cigna Commercial |
$67,379.40
|
| Rate for Payer: First Health Commercial |
$77,121.00
|
| Rate for Payer: Humana Commercial |
$69,003.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,567.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,910.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,354.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,438.40
|
| Rate for Payer: Ohio Health Group HMO |
$60,885.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,626.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,014.20
|
| Rate for Payer: PHCS Commercial |
$77,932.80
|
| Rate for Payer: United Healthcare All Payer |
$71,438.40
|
|
|
DEFIBRILLATOR EVERA XT DVBB1D4
|
Facility
|
OP
|
$81,180.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,354.00 |
| Max. Negotiated Rate |
$77,932.80 |
| Rate for Payer: Aetna Commercial |
$62,508.60
|
| Rate for Payer: Anthem Medicaid |
$27,917.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,320.40
|
| Rate for Payer: Cash Price |
$40,590.00
|
| Rate for Payer: Cigna Commercial |
$67,379.40
|
| Rate for Payer: First Health Commercial |
$77,121.00
|
| Rate for Payer: Humana Commercial |
$69,003.00
|
| Rate for Payer: Humana KY Medicaid |
$27,917.80
|
| Rate for Payer: Kentucky WC Medicaid |
$28,201.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,567.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,910.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,354.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,477.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,438.40
|
| Rate for Payer: Ohio Health Group HMO |
$60,885.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,626.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,014.20
|
| Rate for Payer: PHCS Commercial |
$77,932.80
|
| Rate for Payer: United Healthcare All Payer |
$71,438.40
|
|
|
DEFIBRILLATOR EVRA MRI DVPB3D4
|
Facility
|
OP
|
$72,440.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$21,732.00 |
| Max. Negotiated Rate |
$69,542.40 |
| Rate for Payer: Aetna Commercial |
$55,778.80
|
| Rate for Payer: Anthem Medicaid |
$24,912.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,503.20
|
| Rate for Payer: Cash Price |
$36,220.00
|
| Rate for Payer: Cigna Commercial |
$60,125.20
|
| Rate for Payer: First Health Commercial |
$68,818.00
|
| Rate for Payer: Humana Commercial |
$61,574.00
|
| Rate for Payer: Humana KY Medicaid |
$24,912.12
|
| Rate for Payer: Kentucky WC Medicaid |
$25,165.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,400.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,460.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,732.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,411.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,747.20
|
| Rate for Payer: Ohio Health Group HMO |
$54,330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,952.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,022.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,983.60
|
| Rate for Payer: PHCS Commercial |
$69,542.40
|
| Rate for Payer: United Healthcare All Payer |
$63,747.20
|
|
|
DEFIBRILLATOR EVRA MRI DVPB3D4
|
Facility
|
IP
|
$72,440.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$21,732.00 |
| Max. Negotiated Rate |
$69,542.40 |
| Rate for Payer: Aetna Commercial |
$55,778.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,503.20
|
| Rate for Payer: Cash Price |
$36,220.00
|
| Rate for Payer: Cigna Commercial |
$60,125.20
|
| Rate for Payer: First Health Commercial |
$68,818.00
|
| Rate for Payer: Humana Commercial |
$61,574.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,400.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,460.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,732.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,747.20
|
| Rate for Payer: Ohio Health Group HMO |
$54,330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,952.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,022.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,983.60
|
| Rate for Payer: PHCS Commercial |
$69,542.40
|
| Rate for Payer: United Healthcare All Payer |
$63,747.20
|
|
|
DEFIBRILLATOR GALLNT CDVRA500Q
|
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 GALLNT CDVRA500Q
|
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
|
|
|
DEFIBRILLATOR INCEPTA E163
|
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
|
|
