|
DEFIBRILLATOR INCEPTA E163
|
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 LUMAX 340 VR-T
|
Facility
|
OP
|
$97,900.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$29,370.00 |
| Max. Negotiated Rate |
$93,984.00 |
| Rate for Payer: Aetna Commercial |
$75,383.00
|
| Rate for Payer: Anthem 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 |
$78,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85,173.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67,551.00
|
| Rate for Payer: PHCS Commercial |
$93,984.00
|
| Rate for Payer: United Healthcare All Payer |
$86,152.00
|
|
|
DEFIBRILLATOR LUMAX 340 VR-T
|
Facility
|
IP
|
$97,900.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$29,370.00 |
| Max. Negotiated Rate |
$93,984.00 |
| Rate for Payer: Aetna Commercial |
$75,383.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,362.00
|
| Rate for Payer: Cash Price |
$48,950.00
|
| Rate for Payer: Cigna Commercial |
$81,257.00
|
| Rate for Payer: First Health Commercial |
$93,005.00
|
| Rate for Payer: Humana Commercial |
$83,215.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,278.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,250.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,370.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,152.00
|
| Rate for Payer: Ohio Health Group HMO |
$73,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85,173.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67,551.00
|
| Rate for Payer: PHCS Commercial |
$93,984.00
|
| Rate for Payer: United Healthcare All Payer |
$86,152.00
|
|
|
DEFIBRILLATOR LUMAX 540 DR-T
|
Facility
|
OP
|
$79,090.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,727.00 |
| Max. Negotiated Rate |
$75,926.40 |
| Rate for Payer: Aetna Commercial |
$60,899.30
|
| Rate for Payer: Anthem Medicaid |
$27,199.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,690.20
|
| Rate for Payer: Cash Price |
$39,545.00
|
| Rate for Payer: Cigna Commercial |
$65,644.70
|
| Rate for Payer: First Health Commercial |
$75,135.50
|
| Rate for Payer: Humana Commercial |
$67,226.50
|
| Rate for Payer: Humana KY Medicaid |
$27,199.05
|
| Rate for Payer: Kentucky WC Medicaid |
$27,475.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,853.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,368.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,727.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,744.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,599.20
|
| Rate for Payer: Ohio Health Group HMO |
$59,317.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63,272.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,808.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,572.10
|
| Rate for Payer: PHCS Commercial |
$75,926.40
|
| Rate for Payer: United Healthcare All Payer |
$69,599.20
|
|
|
DEFIBRILLATOR LUMAX 540 DR-T
|
Facility
|
IP
|
$79,090.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,727.00 |
| Max. Negotiated Rate |
$75,926.40 |
| Rate for Payer: Aetna Commercial |
$60,899.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,690.20
|
| Rate for Payer: Cash Price |
$39,545.00
|
| Rate for Payer: Cigna Commercial |
$65,644.70
|
| Rate for Payer: First Health Commercial |
$75,135.50
|
| Rate for Payer: Humana Commercial |
$67,226.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,853.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,368.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,727.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,599.20
|
| Rate for Payer: Ohio Health Group HMO |
$59,317.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63,272.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,808.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,572.10
|
| Rate for Payer: PHCS Commercial |
$75,926.40
|
| Rate for Payer: United Healthcare All Payer |
$69,599.20
|
|
|
DEFIBRILLATOR LUMAX 540 HF-T
|
Facility
|
IP
|
$124,918.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$37,475.40 |
| Max. Negotiated Rate |
$119,921.28 |
| Rate for Payer: Aetna Commercial |
$96,186.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97,436.04
|
| Rate for Payer: Cash Price |
$62,459.00
|
| Rate for Payer: Cigna Commercial |
$103,681.94
|
| Rate for Payer: First Health Commercial |
$118,672.10
|
| Rate for Payer: Humana Commercial |
$106,180.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102,432.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92,189.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37,475.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$109,927.84
|
| Rate for Payer: Ohio Health Group HMO |
$93,688.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99,934.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108,678.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86,193.42
|
| Rate for Payer: PHCS Commercial |
$119,921.28
|
| Rate for Payer: United Healthcare All Payer |
$109,927.84
|
|
|
DEFIBRILLATOR LUMAX 540 HF-T
|
Facility
|
OP
|
$130,200.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$39,060.00 |
| Max. Negotiated Rate |
$124,992.00 |
| Rate for Payer: Aetna Commercial |
$100,254.00
|
| Rate for Payer: Anthem Medicaid |
$44,775.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101,556.00
|
| Rate for Payer: Cash Price |
$65,100.00
|
| Rate for Payer: Cigna Commercial |
$108,066.00
|
| Rate for Payer: First Health Commercial |
$123,690.00
|
| Rate for Payer: Humana Commercial |
$110,670.00
|
| Rate for Payer: Humana KY Medicaid |
$44,775.78
|
| Rate for Payer: Kentucky WC Medicaid |
$45,231.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106,764.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96,087.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39,060.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$45,674.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$114,576.00
|
| Rate for Payer: Ohio Health Group HMO |
$97,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113,274.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89,838.00
|
| Rate for Payer: PHCS Commercial |
$124,992.00
|
| Rate for Payer: United Healthcare All Payer |
$114,576.00
|
|
|
DEFIBRILLATOR LUMAX 540 HF-T
|
Facility
|
OP
|
$124,918.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$37,475.40 |
| Max. Negotiated Rate |
$119,921.28 |
| Rate for Payer: Aetna Commercial |
$96,186.86
|
| Rate for Payer: Anthem Medicaid |
$42,959.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97,436.04
|
| Rate for Payer: Cash Price |
$62,459.00
|
| Rate for Payer: Cigna Commercial |
$103,681.94
|
| Rate for Payer: First Health Commercial |
$118,672.10
|
| Rate for Payer: Humana Commercial |
$106,180.30
|
| Rate for Payer: Humana KY Medicaid |
$42,959.30
|
| Rate for Payer: Kentucky WC Medicaid |
$43,396.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102,432.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92,189.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37,475.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$43,821.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$109,927.84
|
| Rate for Payer: Ohio Health Group HMO |
$93,688.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99,934.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108,678.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86,193.42
|
| Rate for Payer: PHCS Commercial |
$119,921.28
|
| Rate for Payer: United Healthcare All Payer |
$109,927.84
|
|
|
DEFIBRILLATOR LUMAX 540 HF-T
|
Facility
|
IP
|
$130,200.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$39,060.00 |
| Max. Negotiated Rate |
$124,992.00 |
| Rate for Payer: Aetna Commercial |
$100,254.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101,556.00
|
| Rate for Payer: Cash Price |
$65,100.00
|
| Rate for Payer: Cigna Commercial |
$108,066.00
|
| Rate for Payer: First Health Commercial |
$123,690.00
|
| Rate for Payer: Humana Commercial |
$110,670.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106,764.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96,087.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39,060.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$114,576.00
|
| Rate for Payer: Ohio Health Group HMO |
$97,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113,274.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89,838.00
|
| Rate for Payer: PHCS Commercial |
$124,992.00
|
| Rate for Payer: United Healthcare All Payer |
$114,576.00
|
|
|
DEFIBRILLATOR LUMAX 540 VR-T
|
Facility
|
OP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
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 LUMAX 540 VR-T
|
Facility
|
IP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
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 MOMENTUM D121
|
Facility
|
IP
|
$70,540.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$21,162.00 |
| Max. Negotiated Rate |
$67,718.40 |
| Rate for Payer: Aetna Commercial |
$54,315.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,021.20
|
| Rate for Payer: Cash Price |
$35,270.00
|
| Rate for Payer: Cigna Commercial |
$58,548.20
|
| Rate for Payer: First Health Commercial |
$67,013.00
|
| Rate for Payer: Humana Commercial |
$59,959.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,842.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,058.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,162.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,075.20
|
| Rate for Payer: Ohio Health Group HMO |
$52,905.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,369.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,672.60
|
| Rate for Payer: PHCS Commercial |
$67,718.40
|
| Rate for Payer: United Healthcare All Payer |
$62,075.20
|
|
|
DEFIBRILLATOR MOMENTUM D121
|
Facility
|
OP
|
$70,540.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$21,162.00 |
| Max. Negotiated Rate |
$67,718.40 |
| Rate for Payer: Aetna Commercial |
$54,315.80
|
| Rate for Payer: Anthem Medicaid |
$24,258.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,021.20
|
| Rate for Payer: Cash Price |
$35,270.00
|
| Rate for Payer: Cigna Commercial |
$58,548.20
|
| Rate for Payer: First Health Commercial |
$67,013.00
|
| Rate for Payer: Humana Commercial |
$59,959.00
|
| Rate for Payer: Humana KY Medicaid |
$24,258.71
|
| Rate for Payer: Kentucky WC Medicaid |
$24,505.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,842.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,058.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,162.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,745.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,075.20
|
| Rate for Payer: Ohio Health Group HMO |
$52,905.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,369.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,672.60
|
| Rate for Payer: PHCS Commercial |
$67,718.40
|
| Rate for Payer: United Healthcare All Payer |
$62,075.20
|
|
|
DEFIBRILLATOR MOMENTUM G125
|
Facility
|
IP
|
$80,298.40
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,089.52 |
| Max. Negotiated Rate |
$77,086.46 |
| Rate for Payer: Aetna Commercial |
$61,829.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,632.75
|
| Rate for Payer: Cash Price |
$40,149.20
|
| Rate for Payer: Cigna Commercial |
$66,647.67
|
| Rate for Payer: First Health Commercial |
$76,283.48
|
| Rate for Payer: Humana Commercial |
$68,253.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,844.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,260.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,089.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,662.59
|
| Rate for Payer: Ohio Health Group HMO |
$60,223.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,238.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69,859.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,405.90
|
| Rate for Payer: PHCS Commercial |
$77,086.46
|
| Rate for Payer: United Healthcare All Payer |
$70,662.59
|
|
|
DEFIBRILLATOR MOMENTUM G125
|
Facility
|
OP
|
$80,298.40
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,089.52 |
| Max. Negotiated Rate |
$77,086.46 |
| Rate for Payer: Aetna Commercial |
$61,829.77
|
| Rate for Payer: Anthem Medicaid |
$27,614.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,632.75
|
| Rate for Payer: Cash Price |
$40,149.20
|
| Rate for Payer: Cigna Commercial |
$66,647.67
|
| Rate for Payer: First Health Commercial |
$76,283.48
|
| Rate for Payer: Humana Commercial |
$68,253.64
|
| Rate for Payer: Humana KY Medicaid |
$27,614.62
|
| Rate for Payer: Kentucky WC Medicaid |
$27,895.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,844.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,260.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,089.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,168.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,662.59
|
| Rate for Payer: Ohio Health Group HMO |
$60,223.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,238.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69,859.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,405.90
|
| Rate for Payer: PHCS Commercial |
$77,086.46
|
| Rate for Payer: United Healthcare All Payer |
$70,662.59
|
|
|
DEFIBRILLATOR MOMENTUM G126
|
Facility
|
OP
|
$80,298.40
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,089.52 |
| Max. Negotiated Rate |
$77,086.46 |
| Rate for Payer: Aetna Commercial |
$61,829.77
|
| Rate for Payer: Anthem Medicaid |
$27,614.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,632.75
|
| Rate for Payer: Cash Price |
$40,149.20
|
| Rate for Payer: Cigna Commercial |
$66,647.67
|
| Rate for Payer: First Health Commercial |
$76,283.48
|
| Rate for Payer: Humana Commercial |
$68,253.64
|
| Rate for Payer: Humana KY Medicaid |
$27,614.62
|
| Rate for Payer: Kentucky WC Medicaid |
$27,895.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,844.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,260.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,089.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,168.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,662.59
|
| Rate for Payer: Ohio Health Group HMO |
$60,223.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,238.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69,859.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,405.90
|
| Rate for Payer: PHCS Commercial |
$77,086.46
|
| Rate for Payer: United Healthcare All Payer |
$70,662.59
|
|
|
DEFIBRILLATOR MOMENTUM G126
|
Facility
|
IP
|
$80,298.40
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,089.52 |
| Max. Negotiated Rate |
$77,086.46 |
| Rate for Payer: Aetna Commercial |
$61,829.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,632.75
|
| Rate for Payer: Cash Price |
$40,149.20
|
| Rate for Payer: Cigna Commercial |
$66,647.67
|
| Rate for Payer: First Health Commercial |
$76,283.48
|
| Rate for Payer: Humana Commercial |
$68,253.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,844.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,260.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,089.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,662.59
|
| Rate for Payer: Ohio Health Group HMO |
$60,223.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,238.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69,859.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,405.90
|
| Rate for Payer: PHCS Commercial |
$77,086.46
|
| Rate for Payer: United Healthcare All Payer |
$70,662.59
|
|
|
DEFIBRILLATOR MRI S-ICD
|
Facility
|
IP
|
$94,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$28,230.00 |
| Max. Negotiated Rate |
$90,336.00 |
| Rate for Payer: Aetna Commercial |
$72,457.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,398.00
|
| Rate for Payer: Cash Price |
$47,050.00
|
| Rate for Payer: Cigna Commercial |
$78,103.00
|
| Rate for Payer: First Health Commercial |
$89,395.00
|
| Rate for Payer: Humana Commercial |
$79,985.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,162.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,445.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,230.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,808.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81,867.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64,929.00
|
| Rate for Payer: PHCS Commercial |
$90,336.00
|
| Rate for Payer: United Healthcare All Payer |
$82,808.00
|
|
|
DEFIBRILLATOR MRI S-ICD
|
Facility
|
OP
|
$94,100.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$28,230.00 |
| Max. Negotiated Rate |
$90,336.00 |
| Rate for Payer: Aetna Commercial |
$72,457.00
|
| Rate for Payer: Anthem Medicaid |
$32,360.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,398.00
|
| Rate for Payer: Cash Price |
$47,050.00
|
| Rate for Payer: Cigna Commercial |
$78,103.00
|
| Rate for Payer: First Health Commercial |
$89,395.00
|
| Rate for Payer: Humana Commercial |
$79,985.00
|
| Rate for Payer: Humana KY Medicaid |
$32,360.99
|
| Rate for Payer: Kentucky WC Medicaid |
$32,690.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,162.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,445.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,230.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,010.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,808.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81,867.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64,929.00
|
| Rate for Payer: PHCS Commercial |
$90,336.00
|
| Rate for Payer: United Healthcare All Payer |
$82,808.00
|
|
|
DEFIBRILLATOR PROTECTA D314DRG
|
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 PROTECTA D314DRG
|
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 PROTECTA D314DRM
|
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 PROTECTA D314DRM
|
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 PROTECTA D314TRG
|
Facility
|
IP
|
$101,700.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$30,510.00 |
| Max. Negotiated Rate |
$97,632.00 |
| Rate for Payer: Aetna Commercial |
$78,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79,326.00
|
| Rate for Payer: Cash Price |
$50,850.00
|
| Rate for Payer: Cigna Commercial |
$84,411.00
|
| Rate for Payer: First Health Commercial |
$96,615.00
|
| Rate for Payer: Humana Commercial |
$86,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75,054.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$89,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$76,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70,173.00
|
| Rate for Payer: PHCS Commercial |
$97,632.00
|
| Rate for Payer: United Healthcare All Payer |
$89,496.00
|
|
|
DEFIBRILLATOR PROTECTA D314TRG
|
Facility
|
OP
|
$101,700.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$30,510.00 |
| Max. Negotiated Rate |
$97,632.00 |
| Rate for Payer: Aetna Commercial |
$78,309.00
|
| Rate for Payer: Anthem Medicaid |
$34,974.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79,326.00
|
| Rate for Payer: Cash Price |
$50,850.00
|
| Rate for Payer: Cigna Commercial |
$84,411.00
|
| Rate for Payer: First Health Commercial |
$96,615.00
|
| Rate for Payer: Humana Commercial |
$86,445.00
|
| Rate for Payer: Humana KY Medicaid |
$34,974.63
|
| Rate for Payer: Kentucky WC Medicaid |
$35,330.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75,054.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,510.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$35,676.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$89,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$76,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70,173.00
|
| Rate for Payer: PHCS Commercial |
$97,632.00
|
| Rate for Payer: United Healthcare All Payer |
$89,496.00
|
|
