|
DEFIBRILLATOR EVERA XT DVBB1D1
|
Facility
|
IP
|
$78,460.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,199.80 |
| Max. Negotiated Rate |
$75,321.60 |
| Rate for Payer: Aetna Commercial |
$60,414.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,198.80
|
| Rate for Payer: Cash Price |
$39,230.00
|
| Rate for Payer: Cigna Commercial |
$65,121.80
|
| Rate for Payer: First Health Commercial |
$74,537.00
|
| Rate for Payer: Humana Commercial |
$66,691.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,337.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,903.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,538.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,044.80
|
| Rate for Payer: Ohio Health Group HMO |
$58,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,199.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,322.60
|
| Rate for Payer: PHCS Commercial |
$75,321.60
|
| Rate for Payer: United Healthcare All Payer |
$69,044.80
|
|
|
DEFIBRILLATOR EVERA XT DVBB1D4
|
Facility
|
IP
|
$78,460.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,199.80 |
| Max. Negotiated Rate |
$75,321.60 |
| Rate for Payer: Aetna Commercial |
$60,414.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,198.80
|
| Rate for Payer: Cash Price |
$39,230.00
|
| Rate for Payer: Cigna Commercial |
$65,121.80
|
| Rate for Payer: First Health Commercial |
$74,537.00
|
| Rate for Payer: Humana Commercial |
$66,691.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,337.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,903.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,538.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,044.80
|
| Rate for Payer: Ohio Health Group HMO |
$58,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,199.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,322.60
|
| Rate for Payer: PHCS Commercial |
$75,321.60
|
| Rate for Payer: United Healthcare All Payer |
$69,044.80
|
|
|
DEFIBRILLATOR EVERA XT DVBB1D4
|
Facility
|
OP
|
$78,460.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,199.80 |
| Max. Negotiated Rate |
$75,321.60 |
| Rate for Payer: Aetna Commercial |
$60,414.20
|
| Rate for Payer: Anthem Medicaid |
$26,982.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,198.80
|
| Rate for Payer: Cash Price |
$39,230.00
|
| Rate for Payer: Cigna Commercial |
$65,121.80
|
| Rate for Payer: First Health Commercial |
$74,537.00
|
| Rate for Payer: Humana Commercial |
$66,691.00
|
| Rate for Payer: Humana KY Medicaid |
$26,982.39
|
| Rate for Payer: Kentucky WC Medicaid |
$27,257.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,337.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,903.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,538.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,523.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,044.80
|
| Rate for Payer: Ohio Health Group HMO |
$58,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,199.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,322.60
|
| Rate for Payer: PHCS Commercial |
$75,321.60
|
| Rate for Payer: United Healthcare All Payer |
$69,044.80
|
|
|
DEFIBRILLATOR EVRA MRI DVPB3D4
|
Facility
|
OP
|
$70,180.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,123.40 |
| Max. Negotiated Rate |
$67,372.80 |
| Rate for Payer: Aetna Commercial |
$54,038.60
|
| Rate for Payer: Anthem Medicaid |
$24,134.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,740.40
|
| Rate for Payer: Cash Price |
$35,090.00
|
| Rate for Payer: Cigna Commercial |
$58,249.40
|
| Rate for Payer: First Health Commercial |
$66,671.00
|
| Rate for Payer: Humana Commercial |
$59,653.00
|
| Rate for Payer: Humana KY Medicaid |
$24,134.90
|
| Rate for Payer: Kentucky WC Medicaid |
$24,380.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,547.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,792.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,054.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,619.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,758.40
|
| Rate for Payer: Ohio Health Group HMO |
$52,635.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,123.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,755.80
|
| Rate for Payer: PHCS Commercial |
$67,372.80
|
| Rate for Payer: United Healthcare All Payer |
$61,758.40
|
|
|
DEFIBRILLATOR EVRA MRI DVPB3D4
|
Facility
|
IP
|
$70,180.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,123.40 |
| Max. Negotiated Rate |
$67,372.80 |
| Rate for Payer: Aetna Commercial |
$54,038.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,740.40
|
| Rate for Payer: Cash Price |
$35,090.00
|
| Rate for Payer: Cigna Commercial |
$58,249.40
|
| Rate for Payer: First Health Commercial |
$66,671.00
|
| Rate for Payer: Humana Commercial |
$59,653.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,547.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,792.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,054.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,758.40
|
| Rate for Payer: Ohio Health Group HMO |
$52,635.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,123.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,755.80
|
| Rate for Payer: PHCS Commercial |
$67,372.80
|
| Rate for Payer: United Healthcare All Payer |
$61,758.40
|
|
|
DEFIBRILLATOR GALLNT CDVRA500Q
|
Facility
|
IP
|
$25,787.50
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,352.38 |
| Max. Negotiated Rate |
$24,756.00 |
| Rate for Payer: Aetna Commercial |
$19,856.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,114.25
|
| Rate for Payer: Cash Price |
$12,893.75
|
| Rate for Payer: Cigna Commercial |
$21,403.62
|
| Rate for Payer: First Health Commercial |
$24,498.12
|
| Rate for Payer: Humana Commercial |
$21,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,145.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,031.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,736.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,693.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,340.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,157.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,352.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,994.12
|
| Rate for Payer: PHCS Commercial |
$24,756.00
|
| Rate for Payer: United Healthcare All Payer |
$22,693.00
|
|
|
DEFIBRILLATOR GALLNT CDVRA500Q
|
Facility
|
OP
|
$25,787.50
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,352.38 |
| Max. Negotiated Rate |
$24,756.00 |
| Rate for Payer: Aetna Commercial |
$19,856.38
|
| Rate for Payer: Anthem Medicaid |
$8,868.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,114.25
|
| Rate for Payer: Cash Price |
$12,893.75
|
| Rate for Payer: Cigna Commercial |
$21,403.62
|
| Rate for Payer: First Health Commercial |
$24,498.12
|
| Rate for Payer: Humana Commercial |
$21,919.38
|
| Rate for Payer: Humana KY Medicaid |
$8,868.32
|
| Rate for Payer: Kentucky WC Medicaid |
$8,958.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,145.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,031.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,736.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,046.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,693.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,340.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,157.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,352.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,994.12
|
| Rate for Payer: PHCS Commercial |
$24,756.00
|
| Rate for Payer: United Healthcare All Payer |
$22,693.00
|
|
|
DEFIBRILLATOR INCEPTA E163
|
Facility
|
OP
|
$74,680.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,708.40 |
| Max. Negotiated Rate |
$71,692.80 |
| Rate for Payer: First Health Commercial |
$70,946.00
|
| Rate for Payer: Humana Commercial |
$63,478.00
|
| Rate for Payer: Humana KY Medicaid |
$25,682.45
|
| Rate for Payer: Kentucky WC Medicaid |
$25,943.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,237.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,113.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,404.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,197.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,718.40
|
| Rate for Payer: Ohio Health Group HMO |
$56,010.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,708.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,150.80
|
| Rate for Payer: PHCS Commercial |
$71,692.80
|
| Rate for Payer: United Healthcare All Payer |
$65,718.40
|
| Rate for Payer: Aetna Commercial |
$57,503.60
|
| Rate for Payer: Anthem Medicaid |
$25,682.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,250.40
|
| Rate for Payer: Cash Price |
$37,340.00
|
| Rate for Payer: Cigna Commercial |
$61,984.40
|
|
|
DEFIBRILLATOR INCEPTA E163
|
Facility
|
IP
|
$74,680.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,708.40 |
| Max. Negotiated Rate |
$71,692.80 |
| Rate for Payer: Aetna Commercial |
$57,503.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,250.40
|
| Rate for Payer: Cash Price |
$37,340.00
|
| Rate for Payer: Cigna Commercial |
$61,984.40
|
| Rate for Payer: First Health Commercial |
$70,946.00
|
| Rate for Payer: Humana Commercial |
$63,478.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,237.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,113.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,404.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,718.40
|
| Rate for Payer: Ohio Health Group HMO |
$56,010.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,708.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,150.80
|
| Rate for Payer: PHCS Commercial |
$71,692.80
|
| Rate for Payer: United Healthcare All Payer |
$65,718.40
|
|
|
DEFIBRILLATOR LUMAX 340 VR-T
|
Facility
|
IP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
DEFIBRILLATOR LUMAX 340 VR-T
|
Facility
|
OP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Anthem Medicaid |
$32,429.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Humana KY Medicaid |
$32,429.77
|
| Rate for Payer: Kentucky WC Medicaid |
$32,759.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
| Rate for Payer: Aetna Commercial |
$72,611.00
|
|
|
DEFIBRILLATOR LUMAX 540 DR-T
|
Facility
|
IP
|
$76,480.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,942.40 |
| Max. Negotiated Rate |
$73,420.80 |
| Rate for Payer: Aetna Commercial |
$58,889.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,654.40
|
| Rate for Payer: Cash Price |
$38,240.00
|
| Rate for Payer: Cigna Commercial |
$63,478.40
|
| Rate for Payer: First Health Commercial |
$72,656.00
|
| Rate for Payer: Humana Commercial |
$65,008.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,713.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,442.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,944.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,302.40
|
| Rate for Payer: Ohio Health Group HMO |
$57,360.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,296.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,942.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,708.80
|
| Rate for Payer: PHCS Commercial |
$73,420.80
|
| Rate for Payer: United Healthcare All Payer |
$67,302.40
|
|
|
DEFIBRILLATOR LUMAX 540 DR-T
|
Facility
|
OP
|
$76,480.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,942.40 |
| Max. Negotiated Rate |
$73,420.80 |
| Rate for Payer: Aetna Commercial |
$58,889.60
|
| Rate for Payer: Anthem Medicaid |
$26,301.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,654.40
|
| Rate for Payer: Cash Price |
$38,240.00
|
| Rate for Payer: Cigna Commercial |
$63,478.40
|
| Rate for Payer: First Health Commercial |
$72,656.00
|
| Rate for Payer: Humana Commercial |
$65,008.00
|
| Rate for Payer: Humana KY Medicaid |
$26,301.47
|
| Rate for Payer: Kentucky WC Medicaid |
$26,569.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,713.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,442.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,944.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,829.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,302.40
|
| Rate for Payer: Ohio Health Group HMO |
$57,360.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,296.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,942.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,708.80
|
| Rate for Payer: PHCS Commercial |
$73,420.80
|
| Rate for Payer: United Healthcare All Payer |
$67,302.40
|
|
|
DEFIBRILLATOR LUMAX 540 HF-T
|
Facility
|
IP
|
$119,896.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$15,586.48 |
| Max. Negotiated Rate |
$115,100.16 |
| Rate for Payer: Aetna Commercial |
$92,319.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93,518.88
|
| Rate for Payer: Cash Price |
$59,948.00
|
| Rate for Payer: Cigna Commercial |
$99,513.68
|
| Rate for Payer: First Health Commercial |
$113,901.20
|
| Rate for Payer: Humana Commercial |
$101,911.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98,314.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88,483.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35,968.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$105,508.48
|
| Rate for Payer: Ohio Health Group HMO |
$89,922.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,979.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,586.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37,167.76
|
| Rate for Payer: PHCS Commercial |
$115,100.16
|
| Rate for Payer: United Healthcare All Payer |
$105,508.48
|
|
|
DEFIBRILLATOR LUMAX 540 HF-T
|
Facility
|
OP
|
$124,900.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$16,237.00 |
| Max. Negotiated Rate |
$119,904.00 |
| Rate for Payer: Aetna Commercial |
$96,173.00
|
| Rate for Payer: Anthem Medicaid |
$42,953.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97,422.00
|
| Rate for Payer: Cash Price |
$62,450.00
|
| Rate for Payer: Cigna Commercial |
$103,667.00
|
| Rate for Payer: First Health Commercial |
$118,655.00
|
| Rate for Payer: Humana Commercial |
$106,165.00
|
| Rate for Payer: Humana KY Medicaid |
$42,953.11
|
| Rate for Payer: Kentucky WC Medicaid |
$43,390.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102,418.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92,176.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37,470.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$43,814.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$109,912.00
|
| Rate for Payer: Ohio Health Group HMO |
$93,675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,237.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38,719.00
|
| Rate for Payer: PHCS Commercial |
$119,904.00
|
| Rate for Payer: United Healthcare All Payer |
$109,912.00
|
|
|
DEFIBRILLATOR LUMAX 540 HF-T
|
Facility
|
IP
|
$124,900.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$16,237.00 |
| Max. Negotiated Rate |
$119,904.00 |
| Rate for Payer: Aetna Commercial |
$96,173.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97,422.00
|
| Rate for Payer: Cash Price |
$62,450.00
|
| Rate for Payer: Cigna Commercial |
$103,667.00
|
| Rate for Payer: First Health Commercial |
$118,655.00
|
| Rate for Payer: Humana Commercial |
$106,165.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102,418.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92,176.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37,470.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$109,912.00
|
| Rate for Payer: Ohio Health Group HMO |
$93,675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,237.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38,719.00
|
| Rate for Payer: PHCS Commercial |
$119,904.00
|
| Rate for Payer: United Healthcare All Payer |
$109,912.00
|
|
|
DEFIBRILLATOR LUMAX 540 HF-T
|
Facility
|
OP
|
$119,896.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$15,586.48 |
| Max. Negotiated Rate |
$115,100.16 |
| Rate for Payer: Aetna Commercial |
$92,319.92
|
| Rate for Payer: Anthem Medicaid |
$41,232.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93,518.88
|
| Rate for Payer: Cash Price |
$59,948.00
|
| Rate for Payer: Cigna Commercial |
$99,513.68
|
| Rate for Payer: First Health Commercial |
$113,901.20
|
| Rate for Payer: Humana Commercial |
$101,911.60
|
| Rate for Payer: Humana KY Medicaid |
$41,232.23
|
| Rate for Payer: Kentucky WC Medicaid |
$41,651.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98,314.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88,483.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35,968.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$42,059.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$105,508.48
|
| Rate for Payer: Ohio Health Group HMO |
$89,922.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,979.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,586.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37,167.76
|
| Rate for Payer: PHCS Commercial |
$115,100.16
|
| Rate for Payer: United Healthcare All Payer |
$105,508.48
|
|
|
DEFIBRILLATOR LUMAX 540 VR-T
|
Facility
|
IP
|
$78,100.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,153.00 |
| Max. Negotiated Rate |
$74,976.00 |
| Rate for Payer: Aetna Commercial |
$60,137.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,918.00
|
| Rate for Payer: Cash Price |
$39,050.00
|
| Rate for Payer: Cigna Commercial |
$64,823.00
|
| Rate for Payer: First Health Commercial |
$74,195.00
|
| Rate for Payer: Humana Commercial |
$66,385.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,042.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,637.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,430.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$58,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,153.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,211.00
|
| Rate for Payer: PHCS Commercial |
$74,976.00
|
| Rate for Payer: United Healthcare All Payer |
$68,728.00
|
|
|
DEFIBRILLATOR LUMAX 540 VR-T
|
Facility
|
OP
|
$78,100.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27000004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,153.00 |
| Max. Negotiated Rate |
$74,976.00 |
| Rate for Payer: Aetna Commercial |
$60,137.00
|
| Rate for Payer: Anthem Medicaid |
$26,858.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,918.00
|
| Rate for Payer: Cash Price |
$39,050.00
|
| Rate for Payer: Cigna Commercial |
$64,823.00
|
| Rate for Payer: First Health Commercial |
$74,195.00
|
| Rate for Payer: Humana Commercial |
$66,385.00
|
| Rate for Payer: Humana KY Medicaid |
$26,858.59
|
| Rate for Payer: Kentucky WC Medicaid |
$27,131.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,042.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,637.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,430.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,397.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$58,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,153.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,211.00
|
| Rate for Payer: PHCS Commercial |
$74,976.00
|
| Rate for Payer: United Healthcare All Payer |
$68,728.00
|
|
|
DEFIBRILLATOR MOMENTUM D121
|
Facility
|
IP
|
$68,380.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,889.40 |
| Max. Negotiated Rate |
$65,644.80 |
| Rate for Payer: Aetna Commercial |
$52,652.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,336.40
|
| Rate for Payer: Cash Price |
$34,190.00
|
| Rate for Payer: Cigna Commercial |
$56,755.40
|
| Rate for Payer: First Health Commercial |
$64,961.00
|
| Rate for Payer: Humana Commercial |
$58,123.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,071.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,464.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,514.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,174.40
|
| Rate for Payer: Ohio Health Group HMO |
$51,285.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,676.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,889.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,197.80
|
| Rate for Payer: PHCS Commercial |
$65,644.80
|
| Rate for Payer: United Healthcare All Payer |
$60,174.40
|
|
|
DEFIBRILLATOR MOMENTUM D121
|
Facility
|
OP
|
$68,380.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,889.40 |
| Max. Negotiated Rate |
$65,644.80 |
| Rate for Payer: Aetna Commercial |
$52,652.60
|
| Rate for Payer: Anthem Medicaid |
$23,515.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,336.40
|
| Rate for Payer: Cash Price |
$34,190.00
|
| Rate for Payer: Cigna Commercial |
$56,755.40
|
| Rate for Payer: First Health Commercial |
$64,961.00
|
| Rate for Payer: Humana Commercial |
$58,123.00
|
| Rate for Payer: Humana KY Medicaid |
$23,515.88
|
| Rate for Payer: Kentucky WC Medicaid |
$23,755.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,071.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,464.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,514.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,987.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,174.40
|
| Rate for Payer: Ohio Health Group HMO |
$51,285.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,676.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,889.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,197.80
|
| Rate for Payer: PHCS Commercial |
$65,644.80
|
| Rate for Payer: United Healthcare All Payer |
$60,174.40
|
|
|
DEFIBRILLATOR MOMENTUM G125
|
Facility
|
OP
|
$77,624.80
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,091.22 |
| Max. Negotiated Rate |
$74,519.81 |
| Rate for Payer: Aetna Commercial |
$59,771.10
|
| Rate for Payer: Anthem Medicaid |
$26,695.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,547.34
|
| Rate for Payer: Cash Price |
$38,812.40
|
| Rate for Payer: Cigna Commercial |
$64,428.58
|
| Rate for Payer: First Health Commercial |
$73,743.56
|
| Rate for Payer: Humana Commercial |
$65,981.08
|
| Rate for Payer: Humana KY Medicaid |
$26,695.17
|
| Rate for Payer: Kentucky WC Medicaid |
$26,966.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,652.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,287.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,287.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,230.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,309.82
|
| Rate for Payer: Ohio Health Group HMO |
$58,218.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,524.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,091.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,063.69
|
| Rate for Payer: PHCS Commercial |
$74,519.81
|
| Rate for Payer: United Healthcare All Payer |
$68,309.82
|
|
|
DEFIBRILLATOR MOMENTUM G125
|
Facility
|
IP
|
$77,624.80
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,091.22 |
| Max. Negotiated Rate |
$74,519.81 |
| Rate for Payer: Aetna Commercial |
$59,771.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,547.34
|
| Rate for Payer: Cash Price |
$38,812.40
|
| Rate for Payer: Cigna Commercial |
$64,428.58
|
| Rate for Payer: First Health Commercial |
$73,743.56
|
| Rate for Payer: Humana Commercial |
$65,981.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,652.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,287.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,287.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,309.82
|
| Rate for Payer: Ohio Health Group HMO |
$58,218.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,524.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,091.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,063.69
|
| Rate for Payer: PHCS Commercial |
$74,519.81
|
| Rate for Payer: United Healthcare All Payer |
$68,309.82
|
|
|
DEFIBRILLATOR MOMENTUM G126
|
Facility
|
OP
|
$77,624.80
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,091.22 |
| Max. Negotiated Rate |
$74,519.81 |
| Rate for Payer: Aetna Commercial |
$59,771.10
|
| Rate for Payer: Anthem Medicaid |
$26,695.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,547.34
|
| Rate for Payer: Cash Price |
$38,812.40
|
| Rate for Payer: Cigna Commercial |
$64,428.58
|
| Rate for Payer: First Health Commercial |
$73,743.56
|
| Rate for Payer: Humana Commercial |
$65,981.08
|
| Rate for Payer: Humana KY Medicaid |
$26,695.17
|
| Rate for Payer: Kentucky WC Medicaid |
$26,966.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,652.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,287.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,287.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,230.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,309.82
|
| Rate for Payer: Ohio Health Group HMO |
$58,218.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,524.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,091.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,063.69
|
| Rate for Payer: PHCS Commercial |
$74,519.81
|
| Rate for Payer: United Healthcare All Payer |
$68,309.82
|
|
|
DEFIBRILLATOR MOMENTUM G126
|
Facility
|
IP
|
$77,624.80
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,091.22 |
| Max. Negotiated Rate |
$74,519.81 |
| Rate for Payer: Aetna Commercial |
$59,771.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,547.34
|
| Rate for Payer: Cash Price |
$38,812.40
|
| Rate for Payer: Cigna Commercial |
$64,428.58
|
| Rate for Payer: First Health Commercial |
$73,743.56
|
| Rate for Payer: Humana Commercial |
$65,981.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,652.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,287.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,287.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,309.82
|
| Rate for Payer: Ohio Health Group HMO |
$58,218.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,524.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,091.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,063.69
|
| Rate for Payer: PHCS Commercial |
$74,519.81
|
| Rate for Payer: United Healthcare All Payer |
$68,309.82
|
|
