|
IMMUNOTHERAPY SINGLE INJECTION
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 95120
|
| Hospital Charge Code |
94000009
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$179.40
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.30
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
IMMUNOTHERAPY SINGLE INJECTION
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 95120
|
| Hospital Charge Code |
940P0009
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna Commercial |
$16.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$25.43
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$23.75
|
| Rate for Payer: Multiplan PHCS |
$18.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$21.00
|
| Rate for Payer: UHCCP Medicaid |
$10.50
|
|
|
IMODIUM A-D 1MG/7.5ML LIQUID
|
Facility
|
IP
|
$4.43
|
|
|
Service Code
|
NDC 46122054426
|
| Hospital Charge Code |
25000774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: First Health Commercial |
$4.21
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
|
IMODIUM A-D 1MG/7.5ML LIQUID
|
Facility
|
OP
|
$4.43
|
|
|
Service Code
|
NDC 46122054426
|
| Hospital Charge Code |
25000774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: First Health Commercial |
$4.21
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
|
IMODIUM (LOPERAMIDE) 2MG/1CAP
|
Facility
|
IP
|
$5.05
|
|
|
Service Code
|
NDC 60687022901
|
| Hospital Charge Code |
25000773
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Aetna Commercial |
$3.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.94
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.19
|
| Rate for Payer: First Health Commercial |
$4.80
|
| Rate for Payer: Humana Commercial |
$4.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.57
|
| Rate for Payer: PHCS Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
IMODIUM (LOPERAMIDE) 2MG/1CAP
|
Facility
|
OP
|
$5.05
|
|
|
Service Code
|
NDC 60687022901
|
| Hospital Charge Code |
25000773
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Aetna Commercial |
$3.89
|
| Rate for Payer: Anthem Medicaid |
$1.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.94
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.19
|
| Rate for Payer: First Health Commercial |
$4.80
|
| Rate for Payer: Humana Commercial |
$4.29
|
| Rate for Payer: Humana KY Medicaid |
$1.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.57
|
| Rate for Payer: PHCS Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
IMPACT PEPTIDE 1.5 250mL BTL
|
Facility
|
OP
|
$72.86
|
|
|
Service Code
|
HCPCS B4153
|
| Hospital Charge Code |
27000288
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$69.95 |
| Rate for Payer: Aetna Commercial |
$56.10
|
| Rate for Payer: Anthem Medicaid |
$25.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.83
|
| Rate for Payer: Cash Price |
$36.43
|
| Rate for Payer: Cigna Commercial |
$60.47
|
| Rate for Payer: First Health Commercial |
$69.22
|
| Rate for Payer: Humana Commercial |
$61.93
|
| Rate for Payer: Humana KY Medicaid |
$25.06
|
| Rate for Payer: Kentucky WC Medicaid |
$25.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.12
|
| Rate for Payer: Ohio Health Group HMO |
$54.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.59
|
| Rate for Payer: PHCS Commercial |
$69.95
|
| Rate for Payer: United Healthcare All Payer |
$64.12
|
|
|
IMPACT PEPTIDE 1.5 250mL BTL
|
Facility
|
IP
|
$72.86
|
|
|
Service Code
|
HCPCS B4153
|
| Hospital Charge Code |
27000288
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$69.95 |
| Rate for Payer: Aetna Commercial |
$56.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.83
|
| Rate for Payer: Cash Price |
$36.43
|
| Rate for Payer: Cigna Commercial |
$60.47
|
| Rate for Payer: First Health Commercial |
$69.22
|
| Rate for Payer: Humana Commercial |
$61.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.12
|
| Rate for Payer: Ohio Health Group HMO |
$54.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.59
|
| Rate for Payer: PHCS Commercial |
$69.95
|
| Rate for Payer: United Healthcare All Payer |
$64.12
|
|
|
IMPEDANCE
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS 92567
|
| Hospital Charge Code |
47000013
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem Medicaid |
$41.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.82
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$100.43
|
| Rate for Payer: First Health Commercial |
$114.95
|
| Rate for Payer: Humana Commercial |
$102.85
|
| Rate for Payer: Humana KY Medicaid |
$41.61
|
| Rate for Payer: Humana Medicare Advantage |
$34.68
|
| Rate for Payer: Kentucky WC Medicaid |
$42.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.48
|
| Rate for Payer: Ohio Health Group HMO |
$90.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.51
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
|
IMPEDANCE
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS 92567
|
| Hospital Charge Code |
47000013
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.38
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$100.43
|
| Rate for Payer: First Health Commercial |
$114.95
|
| Rate for Payer: Humana Commercial |
$102.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.48
|
| Rate for Payer: Ohio Health Group HMO |
$90.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.51
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
|
IMP/EXT REPLACEMENT TIPS
|
Facility
|
IP
|
$4,055.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.15 |
| Max. Negotiated Rate |
$3,892.80 |
| Rate for Payer: Aetna Commercial |
$3,122.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,162.90
|
| Rate for Payer: Cash Price |
$2,027.50
|
| Rate for Payer: Cigna Commercial |
$3,365.65
|
| Rate for Payer: First Health Commercial |
$3,852.25
|
| Rate for Payer: Humana Commercial |
$3,446.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,325.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,992.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,216.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,568.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,041.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$811.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$527.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,257.05
|
| Rate for Payer: PHCS Commercial |
$3,892.80
|
| Rate for Payer: United Healthcare All Payer |
$3,568.40
|
|
|
IMP/EXT REPLACEMENT TIPS
|
Facility
|
OP
|
$4,055.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.15 |
| Max. Negotiated Rate |
$3,892.80 |
| Rate for Payer: Aetna Commercial |
$3,122.35
|
| Rate for Payer: Anthem Medicaid |
$1,394.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,162.90
|
| Rate for Payer: Cash Price |
$2,027.50
|
| Rate for Payer: Cigna Commercial |
$3,365.65
|
| Rate for Payer: First Health Commercial |
$3,852.25
|
| Rate for Payer: Humana Commercial |
$3,446.75
|
| Rate for Payer: Humana KY Medicaid |
$1,394.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,408.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,325.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,992.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,216.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,422.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,568.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,041.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$811.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$527.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,257.05
|
| Rate for Payer: PHCS Commercial |
$3,892.80
|
| Rate for Payer: United Healthcare All Payer |
$3,568.40
|
|
|
IMPLANT BIO TRANSFIX 5*50MM
|
Facility
|
IP
|
$3,211.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$417.50 |
| Max. Negotiated Rate |
$3,083.04 |
| Rate for Payer: Aetna Commercial |
$2,472.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,504.97
|
| Rate for Payer: Cash Price |
$1,605.75
|
| Rate for Payer: Cigna Commercial |
$2,665.54
|
| Rate for Payer: First Health Commercial |
$3,050.92
|
| Rate for Payer: Humana Commercial |
$2,729.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,633.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,370.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$963.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,826.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,408.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$642.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$995.56
|
| Rate for Payer: PHCS Commercial |
$3,083.04
|
| Rate for Payer: United Healthcare All Payer |
$2,826.12
|
|
|
IMPLANT BIO TRANSFIX 5*50MM
|
Facility
|
OP
|
$3,211.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$417.50 |
| Max. Negotiated Rate |
$3,083.04 |
| Rate for Payer: Aetna Commercial |
$2,472.86
|
| Rate for Payer: Anthem Medicaid |
$1,104.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,504.97
|
| Rate for Payer: Cash Price |
$1,605.75
|
| Rate for Payer: Cigna Commercial |
$2,665.54
|
| Rate for Payer: First Health Commercial |
$3,050.92
|
| Rate for Payer: Humana Commercial |
$2,729.78
|
| Rate for Payer: Humana KY Medicaid |
$1,104.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,115.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,633.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,370.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$963.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,126.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,826.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,408.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$642.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$995.56
|
| Rate for Payer: PHCS Commercial |
$3,083.04
|
| Rate for Payer: United Healthcare All Payer |
$2,826.12
|
|
|
IMPLANT CARDIAC EV RECORD
|
Facility
|
IP
|
$36,965.00
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
36000022
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,805.45 |
| Max. Negotiated Rate |
$35,486.40 |
| Rate for Payer: Aetna Commercial |
$28,463.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,832.70
|
| Rate for Payer: Cash Price |
$18,482.50
|
| Rate for Payer: Cigna Commercial |
$30,680.95
|
| Rate for Payer: First Health Commercial |
$35,116.75
|
| Rate for Payer: Humana Commercial |
$31,420.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,311.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,280.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,089.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,529.20
|
| Rate for Payer: Ohio Health Group HMO |
$27,723.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,805.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,459.15
|
| Rate for Payer: PHCS Commercial |
$35,486.40
|
| Rate for Payer: United Healthcare All Payer |
$32,529.20
|
|
|
IMPLANT CARDIAC EV RECORD
|
Facility
|
IP
|
$37,260.00
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
76101279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,843.80 |
| Max. Negotiated Rate |
$35,769.60 |
| Rate for Payer: Aetna Commercial |
$28,690.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,062.80
|
| Rate for Payer: Cash Price |
$18,630.00
|
| Rate for Payer: Cigna Commercial |
$30,925.80
|
| Rate for Payer: First Health Commercial |
$35,397.00
|
| Rate for Payer: Humana Commercial |
$31,671.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,553.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,497.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,178.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,788.80
|
| Rate for Payer: Ohio Health Group HMO |
$27,945.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,452.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,843.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,550.60
|
| Rate for Payer: PHCS Commercial |
$35,769.60
|
| Rate for Payer: United Healthcare All Payer |
$32,788.80
|
|
|
IMPLANT CARDIAC EV RECORD
|
Facility
|
OP
|
$36,965.00
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
36000022
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,805.45 |
| Max. Negotiated Rate |
$35,486.40 |
| Rate for Payer: Aetna Commercial |
$28,463.05
|
| Rate for Payer: Anthem Medicaid |
$12,712.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,346.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,832.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,285.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,918.00
|
| Rate for Payer: Cash Price |
$18,482.50
|
| Rate for Payer: Cash Price |
$18,482.50
|
| Rate for Payer: Cigna Commercial |
$30,680.95
|
| Rate for Payer: First Health Commercial |
$35,116.75
|
| Rate for Payer: Humana Commercial |
$31,420.25
|
| Rate for Payer: Humana KY Medicaid |
$12,712.26
|
| Rate for Payer: Humana Medicare Advantage |
$7,346.67
|
| Rate for Payer: Kentucky WC Medicaid |
$12,841.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,311.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,280.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,816.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,967.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,529.20
|
| Rate for Payer: Ohio Health Group HMO |
$27,723.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,805.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,459.15
|
| Rate for Payer: PHCS Commercial |
$35,486.40
|
| Rate for Payer: United Healthcare All Payer |
$32,529.20
|
|
|
IMPLANT CARDIAC EV RECORD
|
Professional
|
Both
|
$37,260.00
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
76101279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.42 |
| Max. Negotiated Rate |
$37,260.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.05
|
| Rate for Payer: Anthem Medicaid |
$72.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$37,260.00
|
| Rate for Payer: Cash Price |
$18,630.00
|
| Rate for Payer: Cash Price |
$18,630.00
|
| Rate for Payer: Cigna Commercial |
$163.34
|
| Rate for Payer: Humana Medicaid |
$72.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$123.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.87
|
| Rate for Payer: Molina Healthcare Passport |
$72.42
|
| Rate for Payer: Multiplan PHCS |
$22,356.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$26,082.00
|
| Rate for Payer: UHCCP Medicaid |
$76.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.14
|
|
|
IMPLANT CARDIAC EV RECORD
|
Facility
|
IP
|
$36,965.00
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
48000103
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,805.45 |
| Max. Negotiated Rate |
$35,486.40 |
| Rate for Payer: Aetna Commercial |
$28,463.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,832.70
|
| Rate for Payer: Cash Price |
$18,482.50
|
| Rate for Payer: Cigna Commercial |
$30,680.95
|
| Rate for Payer: First Health Commercial |
$35,116.75
|
| Rate for Payer: Humana Commercial |
$31,420.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,311.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,280.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,089.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,529.20
|
| Rate for Payer: Ohio Health Group HMO |
$27,723.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,805.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,459.15
|
| Rate for Payer: PHCS Commercial |
$35,486.40
|
| Rate for Payer: United Healthcare All Payer |
$32,529.20
|
|
|
IMPLANT CARDIAC EV RECORD
|
Facility
|
OP
|
$37,260.00
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
76101279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,843.80 |
| Max. Negotiated Rate |
$35,769.60 |
| Rate for Payer: Aetna Commercial |
$28,690.20
|
| Rate for Payer: Anthem Medicaid |
$12,813.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,346.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,062.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,285.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,918.00
|
| Rate for Payer: Cash Price |
$18,630.00
|
| Rate for Payer: Cash Price |
$18,630.00
|
| Rate for Payer: Cigna Commercial |
$30,925.80
|
| Rate for Payer: First Health Commercial |
$35,397.00
|
| Rate for Payer: Humana Commercial |
$31,671.00
|
| Rate for Payer: Humana KY Medicaid |
$12,813.71
|
| Rate for Payer: Humana Medicare Advantage |
$7,346.67
|
| Rate for Payer: Kentucky WC Medicaid |
$12,944.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,553.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,497.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,816.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,070.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,788.80
|
| Rate for Payer: Ohio Health Group HMO |
$27,945.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,452.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,843.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,550.60
|
| Rate for Payer: PHCS Commercial |
$35,769.60
|
| Rate for Payer: United Healthcare All Payer |
$32,788.80
|
|
|
IMPLANT CARDIAC EV RECORD
|
Facility
|
OP
|
$36,965.00
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
48000103
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,805.45 |
| Max. Negotiated Rate |
$35,486.40 |
| Rate for Payer: Aetna Commercial |
$28,463.05
|
| Rate for Payer: Anthem Medicaid |
$12,712.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,346.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,832.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,285.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,918.00
|
| Rate for Payer: Cash Price |
$18,482.50
|
| Rate for Payer: Cash Price |
$18,482.50
|
| Rate for Payer: Cigna Commercial |
$30,680.95
|
| Rate for Payer: First Health Commercial |
$35,116.75
|
| Rate for Payer: Humana Commercial |
$31,420.25
|
| Rate for Payer: Humana KY Medicaid |
$12,712.26
|
| Rate for Payer: Humana Medicare Advantage |
$7,346.67
|
| Rate for Payer: Kentucky WC Medicaid |
$12,841.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,311.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,280.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,816.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,967.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,529.20
|
| Rate for Payer: Ohio Health Group HMO |
$27,723.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,805.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,459.15
|
| Rate for Payer: PHCS Commercial |
$35,486.40
|
| Rate for Payer: United Healthcare All Payer |
$32,529.20
|
|
|
IMPLANT CARDIAC EV RECORD(P
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
761P1279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.42 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.05
|
| Rate for Payer: Anthem Medicaid |
$72.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$295.00
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$163.34
|
| Rate for Payer: Humana Medicaid |
$72.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$123.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.87
|
| Rate for Payer: Molina Healthcare Passport |
$72.42
|
| Rate for Payer: Multiplan PHCS |
$177.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$206.50
|
| Rate for Payer: UHCCP Medicaid |
$76.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.14
|
|
|
IMPLANT CARDIAC EV RECORD(T
|
Facility
|
IP
|
$36,965.00
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
761T1279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,805.45 |
| Max. Negotiated Rate |
$35,486.40 |
| Rate for Payer: Aetna Commercial |
$28,463.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,832.70
|
| Rate for Payer: Cash Price |
$18,482.50
|
| Rate for Payer: Cigna Commercial |
$30,680.95
|
| Rate for Payer: First Health Commercial |
$35,116.75
|
| Rate for Payer: Humana Commercial |
$31,420.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,311.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,280.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,089.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,529.20
|
| Rate for Payer: Ohio Health Group HMO |
$27,723.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,805.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,459.15
|
| Rate for Payer: PHCS Commercial |
$35,486.40
|
| Rate for Payer: United Healthcare All Payer |
$32,529.20
|
|
|
IMPLANT CARDIAC EV RECORD(T
|
Facility
|
OP
|
$36,965.00
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
761T1279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,805.45 |
| Max. Negotiated Rate |
$35,486.40 |
| Rate for Payer: Aetna Commercial |
$28,463.05
|
| Rate for Payer: Anthem Medicaid |
$12,712.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,346.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,832.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,285.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,918.00
|
| Rate for Payer: Cash Price |
$18,482.50
|
| Rate for Payer: Cash Price |
$18,482.50
|
| Rate for Payer: Cigna Commercial |
$30,680.95
|
| Rate for Payer: First Health Commercial |
$35,116.75
|
| Rate for Payer: Humana Commercial |
$31,420.25
|
| Rate for Payer: Humana KY Medicaid |
$12,712.26
|
| Rate for Payer: Humana Medicare Advantage |
$7,346.67
|
| Rate for Payer: Kentucky WC Medicaid |
$12,841.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,311.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,280.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,816.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,967.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,529.20
|
| Rate for Payer: Ohio Health Group HMO |
$27,723.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,805.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,459.15
|
| Rate for Payer: PHCS Commercial |
$35,486.40
|
| Rate for Payer: United Healthcare All Payer |
$32,529.20
|
|
|
IMPLANT HORMONE PELLET(S)
|
Professional
|
Both
|
$763.00
|
|
|
Service Code
|
HCPCS 11980
|
| Hospital Charge Code |
76100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.38 |
| Max. Negotiated Rate |
$763.00 |
| Rate for Payer: Aetna Commercial |
$122.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.37
|
| Rate for Payer: Anthem Medicaid |
$51.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$763.00
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$146.54
|
| Rate for Payer: Healthspan PPO |
$121.08
|
| Rate for Payer: Humana Medicaid |
$51.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.41
|
| Rate for Payer: Molina Healthcare Passport |
$51.38
|
| Rate for Payer: Multiplan PHCS |
$457.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$534.10
|
| Rate for Payer: UHCCP Medicaid |
$58.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.89
|
|
