|
LEAD US MKT 419688
|
Facility
|
OP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem Medicaid |
$3,040.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Humana KY Medicaid |
$3,040.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
LEAD US MKT 419688
|
Facility
|
IP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
LEAD VENT AROX 338 021
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem Medicaid |
$1,332.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Humana KY Medicaid |
$1,332.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
LEAD VENT AROX 338 021
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
LEAD VENT KENTROX SL 347 351
|
Facility
|
IP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,205.00 |
| Max. Negotiated Rate |
$16,656.00 |
| Rate for Payer: Aetna Commercial |
$13,359.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,533.00
|
| Rate for Payer: Cash Price |
$8,675.00
|
| Rate for Payer: Cigna Commercial |
$14,400.50
|
| Rate for Payer: First Health Commercial |
$16,482.50
|
| Rate for Payer: Humana Commercial |
$14,747.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,227.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,804.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,205.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,094.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,971.50
|
| Rate for Payer: PHCS Commercial |
$16,656.00
|
| Rate for Payer: United Healthcare All Payer |
$15,268.00
|
|
|
LEAD VENT KENTROX SL 347 351
|
Facility
|
OP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,205.00 |
| Max. Negotiated Rate |
$16,656.00 |
| Rate for Payer: Aetna Commercial |
$13,359.50
|
| Rate for Payer: Anthem Medicaid |
$5,966.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,533.00
|
| Rate for Payer: Cash Price |
$8,675.00
|
| Rate for Payer: Cigna Commercial |
$14,400.50
|
| Rate for Payer: First Health Commercial |
$16,482.50
|
| Rate for Payer: Humana Commercial |
$14,747.50
|
| Rate for Payer: Humana KY Medicaid |
$5,966.66
|
| Rate for Payer: Kentucky WC Medicaid |
$6,027.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,227.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,804.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,205.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,086.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,094.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,971.50
|
| Rate for Payer: PHCS Commercial |
$16,656.00
|
| Rate for Payer: United Healthcare All Payer |
$15,268.00
|
|
|
LEAD VENTRICAL 1570/65
|
Facility
|
OP
|
$20,937.50
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,281.25 |
| Max. Negotiated Rate |
$20,100.00 |
| Rate for Payer: Aetna Commercial |
$16,121.88
|
| Rate for Payer: Anthem Medicaid |
$7,200.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,331.25
|
| Rate for Payer: Cash Price |
$10,468.75
|
| Rate for Payer: Cigna Commercial |
$17,378.12
|
| Rate for Payer: First Health Commercial |
$19,890.62
|
| Rate for Payer: Humana Commercial |
$17,796.88
|
| Rate for Payer: Humana KY Medicaid |
$7,200.41
|
| Rate for Payer: Kentucky WC Medicaid |
$7,273.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,168.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,451.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,281.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,344.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,425.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,703.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,750.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,215.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,446.88
|
| Rate for Payer: PHCS Commercial |
$20,100.00
|
| Rate for Payer: United Healthcare All Payer |
$18,425.00
|
|
|
LEAD VENTRICAL 1570/65
|
Facility
|
IP
|
$20,937.50
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,281.25 |
| Max. Negotiated Rate |
$20,100.00 |
| Rate for Payer: Aetna Commercial |
$16,121.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,331.25
|
| Rate for Payer: Cash Price |
$10,468.75
|
| Rate for Payer: Cigna Commercial |
$17,378.12
|
| Rate for Payer: First Health Commercial |
$19,890.62
|
| Rate for Payer: Humana Commercial |
$17,796.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,168.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,451.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,281.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,425.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,703.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,750.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,215.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,446.88
|
| Rate for Payer: PHCS Commercial |
$20,100.00
|
| Rate for Payer: United Healthcare All Payer |
$18,425.00
|
|
|
LEAD VENTRICAL SILICON 5071-35
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,027.50 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,363.25
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
LEAD VENTRICAL SILICON 5071-35
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,027.50 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,363.25
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
LEAD VENTRICULAR 4592-52
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,027.50 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,363.25
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
LEAD VENTRICULAR 4592-52
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,027.50 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,363.25
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
LEAD VENT SELOX 343 083
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
LEAD VENT SELOX 343 083
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem Medicaid |
$1,332.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Humana KY Medicaid |
$1,332.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
LEFORT I-2 PIECE W/O GRAFT
|
Professional
|
Both
|
$4,300.00
|
|
|
Service Code
|
HCPCS 21142
|
| Hospital Charge Code |
76100374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$956.18 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna Commercial |
$1,951.91
|
| Rate for Payer: Ambetter Exchange |
$1,277.97
|
| Rate for Payer: Anthem Medicaid |
$956.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,277.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,277.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,533.56
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$2,117.94
|
| Rate for Payer: Healthspan PPO |
$1,768.01
|
| Rate for Payer: Humana Medicaid |
$956.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,739.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,277.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$975.30
|
| Rate for Payer: Molina Healthcare Passport |
$956.18
|
| Rate for Payer: Multiplan PHCS |
$2,580.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,661.36
|
| Rate for Payer: UHCCP Medicaid |
$1,505.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$965.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,277.97
|
|
|
LEFORT I-2 PIECE W/O GRAFT
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS 21142
|
| Hospital Charge Code |
76100374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,290.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,741.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,967.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
LEFORT I-2 PIECE W/O GRAFT
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS 21142
|
| Hospital Charge Code |
76100374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,478.77 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,741.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,967.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
LEFORT I-2 PIECE W/O GRAFT(P
|
Professional
|
Both
|
$4,300.00
|
|
|
Service Code
|
HCPCS 21142
|
| Hospital Charge Code |
761P0374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$956.18 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna Commercial |
$1,951.91
|
| Rate for Payer: Ambetter Exchange |
$1,277.97
|
| Rate for Payer: Anthem Medicaid |
$956.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,277.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,277.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,533.56
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$2,117.94
|
| Rate for Payer: Healthspan PPO |
$1,768.01
|
| Rate for Payer: Humana Medicaid |
$956.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,739.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,277.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$975.30
|
| Rate for Payer: Molina Healthcare Passport |
$956.18
|
| Rate for Payer: Multiplan PHCS |
$2,580.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,661.36
|
| Rate for Payer: UHCCP Medicaid |
$1,505.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$965.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,277.97
|
|
|
LEFT ANTEVERTED MOD NECK
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem Medicaid |
$1,332.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Humana KY Medicaid |
$1,332.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
LEFT ANTEVERTED MOD NECK
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
LEFT BREAST SURGERY
|
Professional
|
Both
|
$790.00
|
|
| Hospital Charge Code |
22200367
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$276.50 |
| Max. Negotiated Rate |
$553.00 |
| Rate for Payer: Cash Price |
$395.00
|
| Rate for Payer: Multiplan PHCS |
$474.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$553.00
|
| Rate for Payer: UHCCP Medicaid |
$276.50
|
|
|
LEFT HRT CATH W/VENTRCLGRPH(P
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 93452
|
| Hospital Charge Code |
761P2476
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$1,456.69 |
| Rate for Payer: Aetna Commercial |
$1,330.14
|
| Rate for Payer: Ambetter Exchange |
$772.53
|
| Rate for Payer: Anthem Medicaid |
$740.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$772.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$772.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$927.04
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$1,456.69
|
| Rate for Payer: Healthspan PPO |
$988.48
|
| Rate for Payer: Humana Medicaid |
$740.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$354.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$772.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$772.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$755.08
|
| Rate for Payer: Molina Healthcare Passport |
$740.27
|
| Rate for Payer: Multiplan PHCS |
$282.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,004.29
|
| Rate for Payer: UHCCP Medicaid |
$164.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$747.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$772.53
|
|
|
LEFT HRT CATH W/VENTRCLGRPH(T
|
Facility
|
IP
|
$10,902.00
|
|
|
Service Code
|
HCPCS 93452
|
| Hospital Charge Code |
761T2476
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,270.60 |
| Max. Negotiated Rate |
$10,465.92 |
| Rate for Payer: Aetna Commercial |
$8,394.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,503.56
|
| Rate for Payer: Cash Price |
$5,451.00
|
| Rate for Payer: Cigna Commercial |
$9,048.66
|
| Rate for Payer: First Health Commercial |
$10,356.90
|
| Rate for Payer: Humana Commercial |
$9,266.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,939.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,045.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,270.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,593.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,176.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,721.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,484.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,522.38
|
| Rate for Payer: PHCS Commercial |
$10,465.92
|
| Rate for Payer: United Healthcare All Payer |
$9,593.76
|
|
|
LEFT HRT CATH W/VENTRCLGRPH(T
|
Facility
|
OP
|
$10,902.00
|
|
|
Service Code
|
HCPCS 93452
|
| Hospital Charge Code |
761T2476
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$10,465.92 |
| Rate for Payer: Aetna Commercial |
$8,394.54
|
| Rate for Payer: Anthem Medicaid |
$3,749.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,503.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$5,451.00
|
| Rate for Payer: Cash Price |
$5,451.00
|
| Rate for Payer: Cigna Commercial |
$9,048.66
|
| Rate for Payer: First Health Commercial |
$10,356.90
|
| Rate for Payer: Humana Commercial |
$9,266.70
|
| Rate for Payer: Humana KY Medicaid |
$3,749.20
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,787.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,939.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,045.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,824.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,593.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,176.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,721.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,484.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,522.38
|
| Rate for Payer: PHCS Commercial |
$10,465.92
|
| Rate for Payer: United Healthcare All Payer |
$9,593.76
|
|
|
LEFT HRT CATH W/VENTRCLGRPHY
|
Professional
|
Both
|
$11,372.00
|
|
|
Service Code
|
HCPCS 93452
|
| Hospital Charge Code |
76102476
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$354.69 |
| Max. Negotiated Rate |
$6,823.20 |
| Rate for Payer: Aetna Commercial |
$1,330.14
|
| Rate for Payer: Ambetter Exchange |
$772.53
|
| Rate for Payer: Anthem Medicaid |
$740.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$772.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$772.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$927.04
|
| Rate for Payer: Cash Price |
$5,686.00
|
| Rate for Payer: Cash Price |
$5,686.00
|
| Rate for Payer: Cigna Commercial |
$1,456.69
|
| Rate for Payer: Healthspan PPO |
$988.48
|
| Rate for Payer: Humana Medicaid |
$740.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$354.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$772.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$772.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$755.08
|
| Rate for Payer: Molina Healthcare Passport |
$740.27
|
| Rate for Payer: Multiplan PHCS |
$6,823.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,004.29
|
| Rate for Payer: UHCCP Medicaid |
$3,980.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$747.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$772.53
|
|
