|
IMPEDANCE
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS 92567
|
| Hospital Charge Code |
47000013
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$119.04 |
| Rate for Payer: Aetna Commercial |
$95.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96.72
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cigna Commercial |
$102.92
|
| Rate for Payer: First Health Commercial |
$117.80
|
| Rate for Payer: Humana Commercial |
$105.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$101.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$91.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$109.12
|
| Rate for Payer: Ohio Health Group HMO |
$93.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$85.56
|
| Rate for Payer: PHCS Commercial |
$119.04
|
| Rate for Payer: United Healthcare All Payer |
$109.12
|
|
|
IMPEDANCE
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS 92567
|
| Hospital Charge Code |
47000013
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$36.27 |
| Max. Negotiated Rate |
$119.04 |
| Rate for Payer: Aetna Commercial |
$95.48
|
| Rate for Payer: Anthem Medicaid |
$42.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$36.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$50.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$48.96
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cigna Commercial |
$102.92
|
| Rate for Payer: First Health Commercial |
$117.80
|
| Rate for Payer: Humana Commercial |
$105.40
|
| Rate for Payer: Humana KY Medicaid |
$42.64
|
| Rate for Payer: Humana Medicare Advantage |
$36.27
|
| Rate for Payer: Kentucky WC Medicaid |
$43.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$101.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$91.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$109.12
|
| Rate for Payer: Ohio Health Group HMO |
$93.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$85.56
|
| Rate for Payer: PHCS Commercial |
$119.04
|
| Rate for Payer: United Healthcare All Payer |
$109.12
|
|
|
IMP/EXT REPLACEMENT TIPS
|
Facility
|
OP
|
$3,987.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,196.25 |
| Max. Negotiated Rate |
$3,828.00 |
| Rate for Payer: Aetna Commercial |
$3,070.38
|
| Rate for Payer: Anthem Medicaid |
$1,371.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,110.25
|
| Rate for Payer: Cash Price |
$1,993.75
|
| Rate for Payer: Cigna Commercial |
$3,309.62
|
| Rate for Payer: First Health Commercial |
$3,788.12
|
| Rate for Payer: Humana Commercial |
$3,389.38
|
| Rate for Payer: Humana KY Medicaid |
$1,371.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,385.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,269.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,942.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,196.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,398.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,509.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,990.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,469.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,751.38
|
| Rate for Payer: PHCS Commercial |
$3,828.00
|
| Rate for Payer: United Healthcare All Payer |
$3,509.00
|
|
|
IMP/EXT REPLACEMENT TIPS
|
Facility
|
IP
|
$3,987.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,196.25 |
| Max. Negotiated Rate |
$3,828.00 |
| Rate for Payer: Aetna Commercial |
$3,070.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,110.25
|
| Rate for Payer: Cash Price |
$1,993.75
|
| Rate for Payer: Cigna Commercial |
$3,309.62
|
| Rate for Payer: First Health Commercial |
$3,788.12
|
| Rate for Payer: Humana Commercial |
$3,389.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,269.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,942.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,196.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,509.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,990.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,469.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,751.38
|
| Rate for Payer: PHCS Commercial |
$3,828.00
|
| Rate for Payer: United Healthcare All Payer |
$3,509.00
|
|
|
IMPLANT BIO TRANSFIX 5*50MM
|
Facility
|
OP
|
$3,083.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$925.12 |
| Max. Negotiated Rate |
$2,960.40 |
| Rate for Payer: Aetna Commercial |
$2,374.49
|
| Rate for Payer: Anthem Medicaid |
$1,060.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,405.32
|
| Rate for Payer: Cash Price |
$1,541.88
|
| Rate for Payer: Cigna Commercial |
$2,559.51
|
| Rate for Payer: First Health Commercial |
$2,929.56
|
| Rate for Payer: Humana Commercial |
$2,621.19
|
| Rate for Payer: Humana KY Medicaid |
$1,060.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,071.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,528.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,275.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$925.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,081.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,713.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,312.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,682.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,127.79
|
| Rate for Payer: PHCS Commercial |
$2,960.40
|
| Rate for Payer: United Healthcare All Payer |
$2,713.70
|
|
|
IMPLANT BIO TRANSFIX 5*50MM
|
Facility
|
IP
|
$3,083.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$925.12 |
| Max. Negotiated Rate |
$2,960.40 |
| Rate for Payer: Aetna Commercial |
$2,374.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,405.32
|
| Rate for Payer: Cash Price |
$1,541.88
|
| Rate for Payer: Cigna Commercial |
$2,559.51
|
| Rate for Payer: First Health Commercial |
$2,929.56
|
| Rate for Payer: Humana Commercial |
$2,621.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,528.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,275.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$925.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,713.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,312.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,682.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,127.79
|
| Rate for Payer: PHCS Commercial |
$2,960.40
|
| Rate for Payer: United Healthcare All Payer |
$2,713.70
|
|
|
IMPLANT CARDIAC EV RECORD
|
Facility
|
OP
|
$39,672.00
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
48000103
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7,646.84 |
| Max. Negotiated Rate |
$38,085.12 |
| Rate for Payer: Aetna Commercial |
$30,547.44
|
| Rate for Payer: Anthem Medicaid |
$13,643.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,646.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,944.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,705.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,323.23
|
| Rate for Payer: Cash Price |
$19,836.00
|
| Rate for Payer: Cash Price |
$19,836.00
|
| Rate for Payer: Cigna Commercial |
$32,927.76
|
| Rate for Payer: First Health Commercial |
$37,688.40
|
| Rate for Payer: Humana Commercial |
$33,721.20
|
| Rate for Payer: Humana KY Medicaid |
$13,643.20
|
| Rate for Payer: Humana Medicare Advantage |
$7,646.84
|
| Rate for Payer: Kentucky WC Medicaid |
$13,782.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,531.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,277.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,176.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,916.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,911.36
|
| Rate for Payer: Ohio Health Group HMO |
$29,754.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,737.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,514.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,373.68
|
| Rate for Payer: PHCS Commercial |
$38,085.12
|
| Rate for Payer: United Healthcare All Payer |
$34,911.36
|
|
|
IMPLANT CARDIAC EV RECORD
|
Facility
|
IP
|
$39,672.00
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
36000022
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,901.60 |
| Max. Negotiated Rate |
$38,085.12 |
| Rate for Payer: Aetna Commercial |
$30,547.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,944.16
|
| Rate for Payer: Cash Price |
$19,836.00
|
| Rate for Payer: Cigna Commercial |
$32,927.76
|
| Rate for Payer: First Health Commercial |
$37,688.40
|
| Rate for Payer: Humana Commercial |
$33,721.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,531.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,277.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,901.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,911.36
|
| Rate for Payer: Ohio Health Group HMO |
$29,754.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,737.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,514.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,373.68
|
| Rate for Payer: PHCS Commercial |
$38,085.12
|
| Rate for Payer: United Healthcare All Payer |
$34,911.36
|
|
|
IMPLANT CARDIAC EV RECORD
|
Professional
|
Both
|
$39,967.00
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
76101279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.05 |
| Max. Negotiated Rate |
$23,980.20 |
| Rate for Payer: Ambetter Exchange |
$81.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.05
|
| Rate for Payer: Anthem Medicaid |
$3,818.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$81.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$81.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$98.17
|
| Rate for Payer: Cash Price |
$19,983.50
|
| Rate for Payer: Cash Price |
$19,983.50
|
| Rate for Payer: Cigna Commercial |
$163.34
|
| Rate for Payer: Humana Medicaid |
$3,818.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$81.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3,895.00
|
| Rate for Payer: Molina Healthcare Passport |
$3,818.63
|
| Rate for Payer: Multiplan PHCS |
$23,980.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$106.35
|
| Rate for Payer: UHCCP Medicaid |
$76.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3,856.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$81.81
|
|
|
IMPLANT CARDIAC EV RECORD
|
Facility
|
IP
|
$39,967.00
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
76101279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11,990.10 |
| Max. Negotiated Rate |
$38,368.32 |
| Rate for Payer: Aetna Commercial |
$30,774.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,174.26
|
| Rate for Payer: Cash Price |
$19,983.50
|
| Rate for Payer: Cigna Commercial |
$33,172.61
|
| Rate for Payer: First Health Commercial |
$37,968.65
|
| Rate for Payer: Humana Commercial |
$33,971.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,772.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,495.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,990.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,170.96
|
| Rate for Payer: Ohio Health Group HMO |
$29,975.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,973.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,771.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,577.23
|
| Rate for Payer: PHCS Commercial |
$38,368.32
|
| Rate for Payer: United Healthcare All Payer |
$35,170.96
|
|
|
IMPLANT CARDIAC EV RECORD
|
Facility
|
OP
|
$39,672.00
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
36000022
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,646.84 |
| Max. Negotiated Rate |
$38,085.12 |
| Rate for Payer: Aetna Commercial |
$30,547.44
|
| Rate for Payer: Anthem Medicaid |
$13,643.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,646.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,944.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,705.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,323.23
|
| Rate for Payer: Cash Price |
$19,836.00
|
| Rate for Payer: Cash Price |
$19,836.00
|
| Rate for Payer: Cigna Commercial |
$32,927.76
|
| Rate for Payer: First Health Commercial |
$37,688.40
|
| Rate for Payer: Humana Commercial |
$33,721.20
|
| Rate for Payer: Humana KY Medicaid |
$13,643.20
|
| Rate for Payer: Humana Medicare Advantage |
$7,646.84
|
| Rate for Payer: Kentucky WC Medicaid |
$13,782.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,531.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,277.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,176.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,916.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,911.36
|
| Rate for Payer: Ohio Health Group HMO |
$29,754.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,737.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,514.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,373.68
|
| Rate for Payer: PHCS Commercial |
$38,085.12
|
| Rate for Payer: United Healthcare All Payer |
$34,911.36
|
|
|
IMPLANT CARDIAC EV RECORD
|
Facility
|
IP
|
$39,672.00
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
48000103
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$11,901.60 |
| Max. Negotiated Rate |
$38,085.12 |
| Rate for Payer: Aetna Commercial |
$30,547.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,944.16
|
| Rate for Payer: Cash Price |
$19,836.00
|
| Rate for Payer: Cigna Commercial |
$32,927.76
|
| Rate for Payer: First Health Commercial |
$37,688.40
|
| Rate for Payer: Humana Commercial |
$33,721.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,531.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,277.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,901.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,911.36
|
| Rate for Payer: Ohio Health Group HMO |
$29,754.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,737.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,514.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,373.68
|
| Rate for Payer: PHCS Commercial |
$38,085.12
|
| Rate for Payer: United Healthcare All Payer |
$34,911.36
|
|
|
IMPLANT CARDIAC EV RECORD
|
Facility
|
OP
|
$39,967.00
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
76101279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,646.84 |
| Max. Negotiated Rate |
$38,368.32 |
| Rate for Payer: Aetna Commercial |
$30,774.59
|
| Rate for Payer: Anthem Medicaid |
$13,744.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,646.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,174.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,705.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,323.23
|
| Rate for Payer: Cash Price |
$19,983.50
|
| Rate for Payer: Cash Price |
$19,983.50
|
| Rate for Payer: Cigna Commercial |
$33,172.61
|
| Rate for Payer: First Health Commercial |
$37,968.65
|
| Rate for Payer: Humana Commercial |
$33,971.95
|
| Rate for Payer: Humana KY Medicaid |
$13,744.65
|
| Rate for Payer: Humana Medicare Advantage |
$7,646.84
|
| Rate for Payer: Kentucky WC Medicaid |
$13,884.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,772.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,495.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,176.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,020.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,170.96
|
| Rate for Payer: Ohio Health Group HMO |
$29,975.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,973.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,771.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,577.23
|
| Rate for Payer: PHCS Commercial |
$38,368.32
|
| Rate for Payer: United Healthcare All Payer |
$35,170.96
|
|
|
IMPLANT CARDIAC EV RECORD(P
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
761P1279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.05 |
| Max. Negotiated Rate |
$3,895.00 |
| Rate for Payer: Ambetter Exchange |
$81.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.05
|
| Rate for Payer: Anthem Medicaid |
$3,818.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$81.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$81.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$98.17
|
| 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 |
$3,818.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$81.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3,895.00
|
| Rate for Payer: Molina Healthcare Passport |
$3,818.63
|
| Rate for Payer: Multiplan PHCS |
$177.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$106.35
|
| Rate for Payer: UHCCP Medicaid |
$76.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3,856.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$81.81
|
|
|
IMPLANT CARDIAC EV RECORD(T
|
Facility
|
OP
|
$39,672.00
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
761T1279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,646.84 |
| Max. Negotiated Rate |
$38,085.12 |
| Rate for Payer: Aetna Commercial |
$30,547.44
|
| Rate for Payer: Anthem Medicaid |
$13,643.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,646.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,944.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,705.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,323.23
|
| Rate for Payer: Cash Price |
$19,836.00
|
| Rate for Payer: Cash Price |
$19,836.00
|
| Rate for Payer: Cigna Commercial |
$32,927.76
|
| Rate for Payer: First Health Commercial |
$37,688.40
|
| Rate for Payer: Humana Commercial |
$33,721.20
|
| Rate for Payer: Humana KY Medicaid |
$13,643.20
|
| Rate for Payer: Humana Medicare Advantage |
$7,646.84
|
| Rate for Payer: Kentucky WC Medicaid |
$13,782.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,531.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,277.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,176.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,916.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,911.36
|
| Rate for Payer: Ohio Health Group HMO |
$29,754.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,737.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,514.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,373.68
|
| Rate for Payer: PHCS Commercial |
$38,085.12
|
| Rate for Payer: United Healthcare All Payer |
$34,911.36
|
|
|
IMPLANT CARDIAC EV RECORD(T
|
Facility
|
IP
|
$39,672.00
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
761T1279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11,901.60 |
| Max. Negotiated Rate |
$38,085.12 |
| Rate for Payer: Aetna Commercial |
$30,547.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,944.16
|
| Rate for Payer: Cash Price |
$19,836.00
|
| Rate for Payer: Cigna Commercial |
$32,927.76
|
| Rate for Payer: First Health Commercial |
$37,688.40
|
| Rate for Payer: Humana Commercial |
$33,721.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,531.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,277.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,901.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,911.36
|
| Rate for Payer: Ohio Health Group HMO |
$29,754.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,737.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,514.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,373.68
|
| Rate for Payer: PHCS Commercial |
$38,085.12
|
| Rate for Payer: United Healthcare All Payer |
$34,911.36
|
|
|
IMPLANT HORMONE PELLET(S)
|
Facility
|
IP
|
$798.00
|
|
|
Service Code
|
HCPCS 11980
|
| Hospital Charge Code |
76100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$239.40 |
| Max. Negotiated Rate |
$766.08 |
| Rate for Payer: Aetna Commercial |
$614.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$622.44
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$662.34
|
| Rate for Payer: First Health Commercial |
$758.10
|
| Rate for Payer: Humana Commercial |
$678.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$654.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$588.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$702.24
|
| Rate for Payer: Ohio Health Group HMO |
$598.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$638.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$694.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$550.62
|
| Rate for Payer: PHCS Commercial |
$766.08
|
| Rate for Payer: United Healthcare All Payer |
$702.24
|
|
|
IMPLANT HORMONE PELLET(S)
|
Professional
|
Both
|
$798.00
|
|
|
Service Code
|
HCPCS 11980
|
| Hospital Charge Code |
76100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.38 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Aetna Commercial |
$122.00
|
| Rate for Payer: Ambetter Exchange |
$52.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.37
|
| Rate for Payer: Anthem Medicaid |
$74.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$52.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$52.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$62.86
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$146.54
|
| Rate for Payer: Healthspan PPO |
$121.08
|
| Rate for Payer: Humana Medicaid |
$74.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$52.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.47
|
| Rate for Payer: Molina Healthcare Passport |
$74.97
|
| Rate for Payer: Multiplan PHCS |
$478.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$68.09
|
| Rate for Payer: UHCCP Medicaid |
$58.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$52.38
|
|
|
IMPLANT HORMONE PELLET(S)
|
Facility
|
OP
|
$798.00
|
|
|
Service Code
|
HCPCS 11980
|
| Hospital Charge Code |
76100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.43 |
| Max. Negotiated Rate |
$766.08 |
| Rate for Payer: Aetna Commercial |
$614.46
|
| Rate for Payer: Anthem Medicaid |
$274.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$622.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$662.34
|
| Rate for Payer: First Health Commercial |
$758.10
|
| Rate for Payer: Humana Commercial |
$678.30
|
| Rate for Payer: Humana KY Medicaid |
$274.43
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$277.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$654.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$588.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$279.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$702.24
|
| Rate for Payer: Ohio Health Group HMO |
$598.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$638.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$694.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$550.62
|
| Rate for Payer: PHCS Commercial |
$766.08
|
| Rate for Payer: United Healthcare All Payer |
$702.24
|
|
|
IMPLANT HORMONE PELLET(S)(P
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 11980
|
| Hospital Charge Code |
761P0116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.38 |
| Max. Negotiated Rate |
$146.54 |
| Rate for Payer: Aetna Commercial |
$122.00
|
| Rate for Payer: Ambetter Exchange |
$52.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.37
|
| Rate for Payer: Anthem Medicaid |
$74.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$52.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$52.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$62.86
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$146.54
|
| Rate for Payer: Healthspan PPO |
$121.08
|
| Rate for Payer: Humana Medicaid |
$74.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$52.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.47
|
| Rate for Payer: Molina Healthcare Passport |
$74.97
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$68.09
|
| Rate for Payer: UHCCP Medicaid |
$58.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$52.38
|
|
|
IMPLANT HORMONE PELLET(S)(T
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
HCPCS 11980
|
| Hospital Charge Code |
761T0116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.40 |
| Max. Negotiated Rate |
$554.88 |
| Rate for Payer: Aetna Commercial |
$445.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$450.84
|
| Rate for Payer: Cash Price |
$289.00
|
| Rate for Payer: Cigna Commercial |
$479.74
|
| Rate for Payer: First Health Commercial |
$549.10
|
| Rate for Payer: Humana Commercial |
$491.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$473.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$426.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$508.64
|
| Rate for Payer: Ohio Health Group HMO |
$433.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$462.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$398.82
|
| Rate for Payer: PHCS Commercial |
$554.88
|
| Rate for Payer: United Healthcare All Payer |
$508.64
|
|
|
IMPLANT HORMONE PELLET(S)(T
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
HCPCS 11980
|
| Hospital Charge Code |
761T0116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.77 |
| Max. Negotiated Rate |
$554.88 |
| Rate for Payer: Aetna Commercial |
$445.06
|
| Rate for Payer: Anthem Medicaid |
$198.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$450.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$289.00
|
| Rate for Payer: Cash Price |
$289.00
|
| Rate for Payer: Cigna Commercial |
$479.74
|
| Rate for Payer: First Health Commercial |
$549.10
|
| Rate for Payer: Humana Commercial |
$491.30
|
| Rate for Payer: Humana KY Medicaid |
$198.77
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$200.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$473.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$426.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$202.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$508.64
|
| Rate for Payer: Ohio Health Group HMO |
$433.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$462.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$398.82
|
| Rate for Payer: PHCS Commercial |
$554.88
|
| Rate for Payer: United Healthcare All Payer |
$508.64
|
|
|
IMPLANT OS ANT FLNGE AUG 3.5MM
|
Facility
|
OP
|
$78,064.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,419.20 |
| Max. Negotiated Rate |
$74,941.44 |
| Rate for Payer: Aetna Commercial |
$60,109.28
|
| Rate for Payer: Anthem Medicaid |
$26,846.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,889.92
|
| Rate for Payer: Cash Price |
$39,032.00
|
| Rate for Payer: Cigna Commercial |
$64,793.12
|
| Rate for Payer: First Health Commercial |
$74,160.80
|
| Rate for Payer: Humana Commercial |
$66,354.40
|
| Rate for Payer: Humana KY Medicaid |
$26,846.21
|
| Rate for Payer: Kentucky WC Medicaid |
$27,119.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,012.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,611.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,419.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,384.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,696.32
|
| Rate for Payer: Ohio Health Group HMO |
$58,548.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,451.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,915.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,864.16
|
| Rate for Payer: PHCS Commercial |
$74,941.44
|
| Rate for Payer: United Healthcare All Payer |
$68,696.32
|
|
|
IMPLANT OS ANT FLNGE AUG 3.5MM
|
Facility
|
IP
|
$78,064.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,419.20 |
| Max. Negotiated Rate |
$74,941.44 |
| Rate for Payer: Aetna Commercial |
$60,109.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,889.92
|
| Rate for Payer: Cash Price |
$39,032.00
|
| Rate for Payer: Cigna Commercial |
$64,793.12
|
| Rate for Payer: First Health Commercial |
$74,160.80
|
| Rate for Payer: Humana Commercial |
$66,354.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,012.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,611.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,419.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,696.32
|
| Rate for Payer: Ohio Health Group HMO |
$58,548.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,451.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,915.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,864.16
|
| Rate for Payer: PHCS Commercial |
$74,941.44
|
| Rate for Payer: United Healthcare All Payer |
$68,696.32
|
|
|
IMPLANT OS RS RESURF FMRL 3 L
|
Facility
|
IP
|
$71,497.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,449.28 |
| Max. Negotiated Rate |
$68,637.70 |
| Rate for Payer: Aetna Commercial |
$55,053.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,768.13
|
| Rate for Payer: Cash Price |
$35,748.80
|
| Rate for Payer: Cigna Commercial |
$59,343.01
|
| Rate for Payer: First Health Commercial |
$67,922.72
|
| Rate for Payer: Humana Commercial |
$60,772.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,628.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,765.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,449.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,917.89
|
| Rate for Payer: Ohio Health Group HMO |
$53,623.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,198.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,202.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,333.34
|
| Rate for Payer: PHCS Commercial |
$68,637.70
|
| Rate for Payer: United Healthcare All Payer |
$62,917.89
|
|
