|
DEFIBRILLATOR PROTECTA D314VRG
|
Facility
|
OP
|
$79,280.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,784.00 |
| Max. Negotiated Rate |
$76,108.80 |
| Rate for Payer: Aetna Commercial |
$61,045.60
|
| Rate for Payer: Anthem Medicaid |
$27,264.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,838.40
|
| Rate for Payer: Cash Price |
$39,640.00
|
| Rate for Payer: Cigna Commercial |
$65,802.40
|
| Rate for Payer: First Health Commercial |
$75,316.00
|
| Rate for Payer: Humana Commercial |
$67,388.00
|
| Rate for Payer: Humana KY Medicaid |
$27,264.39
|
| Rate for Payer: Kentucky WC Medicaid |
$27,541.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,009.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,508.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,784.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,811.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,766.40
|
| Rate for Payer: Ohio Health Group HMO |
$59,460.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63,424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,973.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,703.20
|
| Rate for Payer: PHCS Commercial |
$76,108.80
|
| Rate for Payer: United Healthcare All Payer |
$69,766.40
|
|
|
DEFIBRILLATOR PROTECTA D314VRG
|
Facility
|
IP
|
$79,280.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,784.00 |
| Max. Negotiated Rate |
$76,108.80 |
| Rate for Payer: Aetna Commercial |
$61,045.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,838.40
|
| Rate for Payer: Cash Price |
$39,640.00
|
| Rate for Payer: Cigna Commercial |
$65,802.40
|
| Rate for Payer: First Health Commercial |
$75,316.00
|
| Rate for Payer: Humana Commercial |
$67,388.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,009.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,508.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,784.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,766.40
|
| Rate for Payer: Ohio Health Group HMO |
$59,460.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63,424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,973.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,703.20
|
| Rate for Payer: PHCS Commercial |
$76,108.80
|
| Rate for Payer: United Healthcare All Payer |
$69,766.40
|
|
|
DEFIBRILLATOR PROTECTA D344TRM
|
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 PROTECTA D344TRM
|
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 QUADRA CD3265-40
|
Facility
|
IP
|
$105,500.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
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 QUADRA CD3265-40
|
Facility
|
OP
|
$105,500.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
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 RF PROMOTE
|
Facility
|
IP
|
$109,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$32,790.00 |
| Max. Negotiated Rate |
$104,928.00 |
| Rate for Payer: Aetna Commercial |
$84,161.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85,254.00
|
| Rate for Payer: Cash Price |
$54,650.00
|
| Rate for Payer: Cigna Commercial |
$90,719.00
|
| Rate for Payer: First Health Commercial |
$103,835.00
|
| Rate for Payer: Humana Commercial |
$92,905.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89,626.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80,663.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,790.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$96,184.00
|
| Rate for Payer: Ohio Health Group HMO |
$81,975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95,091.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75,417.00
|
| Rate for Payer: PHCS Commercial |
$104,928.00
|
| Rate for Payer: United Healthcare All Payer |
$96,184.00
|
|
|
DEFIBRILLATOR RF PROMOTE
|
Facility
|
OP
|
$109,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$32,790.00 |
| Max. Negotiated Rate |
$104,928.00 |
| Rate for Payer: Aetna Commercial |
$84,161.00
|
| Rate for Payer: Anthem Medicaid |
$37,588.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85,254.00
|
| Rate for Payer: Cash Price |
$54,650.00
|
| Rate for Payer: Cigna Commercial |
$90,719.00
|
| Rate for Payer: First Health Commercial |
$103,835.00
|
| Rate for Payer: Humana Commercial |
$92,905.00
|
| Rate for Payer: Humana KY Medicaid |
$37,588.27
|
| Rate for Payer: Kentucky WC Medicaid |
$37,970.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89,626.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80,663.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,790.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$38,342.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$96,184.00
|
| Rate for Payer: Ohio Health Group HMO |
$81,975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95,091.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75,417.00
|
| Rate for Payer: PHCS Commercial |
$104,928.00
|
| Rate for Payer: United Healthcare All Payer |
$96,184.00
|
|
|
DEFIBRILLATOR SECURA D224DRG
|
Facility
|
OP
|
$114,810.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$34,443.00 |
| Max. Negotiated Rate |
$110,217.60 |
| Rate for Payer: Aetna Commercial |
$88,403.70
|
| Rate for Payer: Anthem Medicaid |
$39,483.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89,551.80
|
| Rate for Payer: Cash Price |
$57,405.00
|
| Rate for Payer: Cigna Commercial |
$95,292.30
|
| Rate for Payer: First Health Commercial |
$109,069.50
|
| Rate for Payer: Humana Commercial |
$97,588.50
|
| Rate for Payer: Humana KY Medicaid |
$39,483.16
|
| Rate for Payer: Kentucky WC Medicaid |
$39,884.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94,144.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84,729.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34,443.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$40,275.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$101,032.80
|
| Rate for Payer: Ohio Health Group HMO |
$86,107.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91,848.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99,884.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79,218.90
|
| Rate for Payer: PHCS Commercial |
$110,217.60
|
| Rate for Payer: United Healthcare All Payer |
$101,032.80
|
|
|
DEFIBRILLATOR SECURA D224DRG
|
Facility
|
IP
|
$114,810.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$34,443.00 |
| Max. Negotiated Rate |
$110,217.60 |
| Rate for Payer: Aetna Commercial |
$88,403.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89,551.80
|
| Rate for Payer: Cash Price |
$57,405.00
|
| Rate for Payer: Cigna Commercial |
$95,292.30
|
| Rate for Payer: First Health Commercial |
$109,069.50
|
| Rate for Payer: Humana Commercial |
$97,588.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94,144.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84,729.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34,443.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$101,032.80
|
| Rate for Payer: Ohio Health Group HMO |
$86,107.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91,848.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99,884.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79,218.90
|
| Rate for Payer: PHCS Commercial |
$110,217.60
|
| Rate for Payer: United Healthcare All Payer |
$101,032.80
|
|
|
DEFIBRILLATOR TELIGEN 100 E110
|
Facility
|
IP
|
$83,650.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$25,095.00 |
| Max. Negotiated Rate |
$80,304.00 |
| Rate for Payer: Aetna Commercial |
$64,410.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,247.00
|
| Rate for Payer: Cash Price |
$41,825.00
|
| Rate for Payer: Cigna Commercial |
$69,429.50
|
| Rate for Payer: First Health Commercial |
$79,467.50
|
| Rate for Payer: Humana Commercial |
$71,102.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,593.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,733.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,095.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,612.00
|
| Rate for Payer: Ohio Health Group HMO |
$62,737.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72,775.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,718.50
|
| Rate for Payer: PHCS Commercial |
$80,304.00
|
| Rate for Payer: United Healthcare All Payer |
$73,612.00
|
|
|
DEFIBRILLATOR TELIGEN 100 E110
|
Facility
|
OP
|
$83,650.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$25,095.00 |
| Max. Negotiated Rate |
$80,304.00 |
| Rate for Payer: Aetna Commercial |
$64,410.50
|
| Rate for Payer: Anthem Medicaid |
$28,767.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,247.00
|
| Rate for Payer: Cash Price |
$41,825.00
|
| Rate for Payer: Cigna Commercial |
$69,429.50
|
| Rate for Payer: First Health Commercial |
$79,467.50
|
| Rate for Payer: Humana Commercial |
$71,102.50
|
| Rate for Payer: Humana KY Medicaid |
$28,767.24
|
| Rate for Payer: Kentucky WC Medicaid |
$29,060.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,593.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,733.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,095.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,344.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,612.00
|
| Rate for Payer: Ohio Health Group HMO |
$62,737.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72,775.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,718.50
|
| Rate for Payer: PHCS Commercial |
$80,304.00
|
| Rate for Payer: United Healthcare All Payer |
$73,612.00
|
|
|
DEFIBRILLATOR UNIFY CD3231-40
|
Facility
|
OP
|
$97,900.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
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 UNIFY CD3231-40
|
Facility
|
IP
|
$97,900.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
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 UNIFY CD3231-40Q
|
Facility
|
OP
|
$97,900.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
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 UNIFY CD3231-40Q
|
Facility
|
IP
|
$97,900.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
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 UNIFY CD3257-40
|
Facility
|
OP
|
$101,320.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$30,396.00 |
| Max. Negotiated Rate |
$97,267.20 |
| Rate for Payer: Aetna Commercial |
$78,016.40
|
| Rate for Payer: Anthem Medicaid |
$34,843.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79,029.60
|
| Rate for Payer: Cash Price |
$50,660.00
|
| Rate for Payer: Cigna Commercial |
$84,095.60
|
| Rate for Payer: First Health Commercial |
$96,254.00
|
| Rate for Payer: Humana Commercial |
$86,122.00
|
| Rate for Payer: Humana KY Medicaid |
$34,843.95
|
| Rate for Payer: Kentucky WC Medicaid |
$35,198.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83,082.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74,774.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,396.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$35,543.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$89,161.60
|
| Rate for Payer: Ohio Health Group HMO |
$75,990.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88,148.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69,910.80
|
| Rate for Payer: PHCS Commercial |
$97,267.20
|
| Rate for Payer: United Healthcare All Payer |
$89,161.60
|
|
|
DEFIBRILLATOR UNIFY CD3257-40
|
Facility
|
IP
|
$101,320.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$30,396.00 |
| Max. Negotiated Rate |
$97,267.20 |
| Rate for Payer: Aetna Commercial |
$78,016.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79,029.60
|
| Rate for Payer: Cash Price |
$50,660.00
|
| Rate for Payer: Cigna Commercial |
$84,095.60
|
| Rate for Payer: First Health Commercial |
$96,254.00
|
| Rate for Payer: Humana Commercial |
$86,122.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83,082.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74,774.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,396.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$89,161.60
|
| Rate for Payer: Ohio Health Group HMO |
$75,990.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88,148.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69,910.80
|
| Rate for Payer: PHCS Commercial |
$97,267.20
|
| Rate for Payer: United Healthcare All Payer |
$89,161.60
|
|
|
DEFIBRILLATOR UNIFY CD3257-40Q
|
Facility
|
IP
|
$101,320.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$30,396.00 |
| Max. Negotiated Rate |
$97,267.20 |
| Rate for Payer: Aetna Commercial |
$78,016.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79,029.60
|
| Rate for Payer: Cash Price |
$50,660.00
|
| Rate for Payer: Cigna Commercial |
$84,095.60
|
| Rate for Payer: First Health Commercial |
$96,254.00
|
| Rate for Payer: Humana Commercial |
$86,122.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83,082.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74,774.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,396.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$89,161.60
|
| Rate for Payer: Ohio Health Group HMO |
$75,990.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88,148.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69,910.80
|
| Rate for Payer: PHCS Commercial |
$97,267.20
|
| Rate for Payer: United Healthcare All Payer |
$89,161.60
|
|
|
DEFIBRILLATOR UNIFY CD3257-40Q
|
Facility
|
OP
|
$101,320.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$30,396.00 |
| Max. Negotiated Rate |
$97,267.20 |
| Rate for Payer: Aetna Commercial |
$78,016.40
|
| Rate for Payer: Anthem Medicaid |
$34,843.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79,029.60
|
| Rate for Payer: Cash Price |
$50,660.00
|
| Rate for Payer: Cigna Commercial |
$84,095.60
|
| Rate for Payer: First Health Commercial |
$96,254.00
|
| Rate for Payer: Humana Commercial |
$86,122.00
|
| Rate for Payer: Humana KY Medicaid |
$34,843.95
|
| Rate for Payer: Kentucky WC Medicaid |
$35,198.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83,082.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74,774.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,396.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$35,543.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$89,161.60
|
| Rate for Payer: Ohio Health Group HMO |
$75,990.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88,148.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69,910.80
|
| Rate for Payer: PHCS Commercial |
$97,267.20
|
| Rate for Payer: United Healthcare All Payer |
$89,161.60
|
|
|
DEFIBRILLATOR VISIA MRI DVFB1D
|
Facility
|
IP
|
$37,775.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,332.50 |
| Max. Negotiated Rate |
$36,264.00 |
| Rate for Payer: Aetna Commercial |
$29,086.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,464.50
|
| Rate for Payer: Cash Price |
$18,887.50
|
| Rate for Payer: Cigna Commercial |
$31,353.25
|
| Rate for Payer: First Health Commercial |
$35,886.25
|
| Rate for Payer: Humana Commercial |
$32,108.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,975.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,877.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,332.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,242.00
|
| Rate for Payer: Ohio Health Group HMO |
$28,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,864.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,064.75
|
| Rate for Payer: PHCS Commercial |
$36,264.00
|
| Rate for Payer: United Healthcare All Payer |
$33,242.00
|
|
|
DEFIBRILLATOR VISIA MRI DVFB1D
|
Facility
|
OP
|
$37,775.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,332.50 |
| Max. Negotiated Rate |
$36,264.00 |
| Rate for Payer: Aetna Commercial |
$29,086.75
|
| Rate for Payer: Anthem Medicaid |
$12,990.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,464.50
|
| Rate for Payer: Cash Price |
$18,887.50
|
| Rate for Payer: Cigna Commercial |
$31,353.25
|
| Rate for Payer: First Health Commercial |
$35,886.25
|
| Rate for Payer: Humana Commercial |
$32,108.75
|
| Rate for Payer: Humana KY Medicaid |
$12,990.82
|
| Rate for Payer: Kentucky WC Medicaid |
$13,123.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,975.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,877.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,332.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,251.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,242.00
|
| Rate for Payer: Ohio Health Group HMO |
$28,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,864.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,064.75
|
| Rate for Payer: PHCS Commercial |
$36,264.00
|
| Rate for Payer: United Healthcare All Payer |
$33,242.00
|
|
|
DEFIBRILLATOR VISIA VR DTMB1D1
|
Facility
|
IP
|
$98,280.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$29,484.00 |
| Max. Negotiated Rate |
$94,348.80 |
| Rate for Payer: Aetna Commercial |
$75,675.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,658.40
|
| Rate for Payer: Cash Price |
$49,140.00
|
| Rate for Payer: Cigna Commercial |
$81,572.40
|
| Rate for Payer: First Health Commercial |
$93,366.00
|
| Rate for Payer: Humana Commercial |
$83,538.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,589.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,530.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,484.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,486.40
|
| Rate for Payer: Ohio Health Group HMO |
$73,710.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78,624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85,503.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67,813.20
|
| Rate for Payer: PHCS Commercial |
$94,348.80
|
| Rate for Payer: United Healthcare All Payer |
$86,486.40
|
|
|
DEFIBRILLATOR VISIA VR DTMB1D1
|
Facility
|
OP
|
$98,280.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$29,484.00 |
| Max. Negotiated Rate |
$94,348.80 |
| Rate for Payer: Aetna Commercial |
$75,675.60
|
| Rate for Payer: Anthem Medicaid |
$33,798.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,658.40
|
| Rate for Payer: Cash Price |
$49,140.00
|
| Rate for Payer: Cigna Commercial |
$81,572.40
|
| Rate for Payer: First Health Commercial |
$93,366.00
|
| Rate for Payer: Humana Commercial |
$83,538.00
|
| Rate for Payer: Humana KY Medicaid |
$33,798.49
|
| Rate for Payer: Kentucky WC Medicaid |
$34,142.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,589.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,530.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,484.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,476.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,486.40
|
| Rate for Payer: Ohio Health Group HMO |
$73,710.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78,624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85,503.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67,813.20
|
| Rate for Payer: PHCS Commercial |
$94,348.80
|
| Rate for Payer: United Healthcare All Payer |
$86,486.40
|
|
|
DEFIBRILLATOR VISIA VR DVAB1D4
|
Facility
|
IP
|
$68,640.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$20,592.00 |
| Max. Negotiated Rate |
$65,894.40 |
| Rate for Payer: Aetna Commercial |
$52,852.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,539.20
|
| Rate for Payer: Cash Price |
$34,320.00
|
| Rate for Payer: Cigna Commercial |
$56,971.20
|
| Rate for Payer: First Health Commercial |
$65,208.00
|
| Rate for Payer: Humana Commercial |
$58,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,284.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,656.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,403.20
|
| Rate for Payer: Ohio Health Group HMO |
$51,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,912.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,716.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,361.60
|
| Rate for Payer: PHCS Commercial |
$65,894.40
|
| Rate for Payer: United Healthcare All Payer |
$60,403.20
|
|
