|
AORTC EXT POWRFIT 34-34-100RLE
|
Facility
|
OP
|
$20,111.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,614.53 |
| Max. Negotiated Rate |
$19,307.28 |
| Rate for Payer: Aetna Commercial |
$15,486.05
|
| Rate for Payer: Anthem Medicaid |
$6,916.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,687.16
|
| Rate for Payer: Cash Price |
$10,055.88
|
| Rate for Payer: Cigna Commercial |
$16,692.75
|
| Rate for Payer: First Health Commercial |
$19,106.16
|
| Rate for Payer: Humana Commercial |
$17,094.99
|
| Rate for Payer: Humana KY Medicaid |
$6,916.43
|
| Rate for Payer: Kentucky WC Medicaid |
$6,986.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,491.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,842.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,033.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,055.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,698.34
|
| Rate for Payer: Ohio Health Group HMO |
$15,083.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,022.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,614.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,234.64
|
| Rate for Payer: PHCS Commercial |
$19,307.28
|
| Rate for Payer: United Healthcare All Payer |
$17,698.34
|
|
|
AORTC EXT POWRFIT 34-34-100RLE
|
Facility
|
IP
|
$20,111.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,614.53 |
| Max. Negotiated Rate |
$19,307.28 |
| Rate for Payer: Aetna Commercial |
$15,486.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,687.16
|
| Rate for Payer: Cash Price |
$10,055.88
|
| Rate for Payer: Cigna Commercial |
$16,692.75
|
| Rate for Payer: First Health Commercial |
$19,106.16
|
| Rate for Payer: Humana Commercial |
$17,094.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,491.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,842.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,033.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,698.34
|
| Rate for Payer: Ohio Health Group HMO |
$15,083.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,022.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,614.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,234.64
|
| Rate for Payer: PHCS Commercial |
$19,307.28
|
| Rate for Payer: United Healthcare All Payer |
$17,698.34
|
|
|
AORTC EXT POWRFIT 34-34-120RLE
|
Facility
|
OP
|
$21,206.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,756.88 |
| Max. Negotiated Rate |
$20,358.48 |
| Rate for Payer: Aetna Commercial |
$16,329.20
|
| Rate for Payer: Anthem Medicaid |
$7,293.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,541.26
|
| Rate for Payer: Cash Price |
$10,603.38
|
| Rate for Payer: Cigna Commercial |
$17,601.60
|
| Rate for Payer: First Health Commercial |
$20,146.41
|
| Rate for Payer: Humana Commercial |
$18,025.74
|
| Rate for Payer: Humana KY Medicaid |
$7,293.00
|
| Rate for Payer: Kentucky WC Medicaid |
$7,367.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,389.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,650.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,362.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,439.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,661.94
|
| Rate for Payer: Ohio Health Group HMO |
$15,905.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,241.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,756.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,574.09
|
| Rate for Payer: PHCS Commercial |
$20,358.48
|
| Rate for Payer: United Healthcare All Payer |
$18,661.94
|
|
|
AORTC EXT POWRFIT 34-34-120RLE
|
Facility
|
IP
|
$21,206.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,756.88 |
| Max. Negotiated Rate |
$20,358.48 |
| Rate for Payer: Aetna Commercial |
$16,329.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,541.26
|
| Rate for Payer: Cash Price |
$10,603.38
|
| Rate for Payer: Cigna Commercial |
$17,601.60
|
| Rate for Payer: First Health Commercial |
$20,146.41
|
| Rate for Payer: Humana Commercial |
$18,025.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,389.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,650.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,362.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,661.94
|
| Rate for Payer: Ohio Health Group HMO |
$15,905.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,241.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,756.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,574.09
|
| Rate for Payer: PHCS Commercial |
$20,358.48
|
| Rate for Payer: United Healthcare All Payer |
$18,661.94
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC
|
Facility
|
IP
|
$80,187.66
|
|
|
Service Code
|
MSDRG 268
|
| Min. Negotiated Rate |
$54,413.06 |
| Max. Negotiated Rate |
$80,187.66 |
| Rate for Payer: Anthem Medicaid |
$54,413.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$57,276.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$80,187.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$77,323.82
|
| Rate for Payer: Humana KY Medicaid |
$54,413.06
|
| Rate for Payer: Humana Medicare Advantage |
$57,276.90
|
| Rate for Payer: Kentucky WC Medicaid |
$54,957.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68,732.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$55,501.32
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC
|
Facility
|
IP
|
$48,648.17
|
|
|
Service Code
|
MSDRG 269
|
| Min. Negotiated Rate |
$33,011.26 |
| Max. Negotiated Rate |
$48,648.17 |
| Rate for Payer: Anthem Medicaid |
$33,011.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34,748.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48,648.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$46,910.73
|
| Rate for Payer: Humana KY Medicaid |
$33,011.26
|
| Rate for Payer: Humana Medicare Advantage |
$34,748.69
|
| Rate for Payer: Kentucky WC Medicaid |
$33,341.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41,698.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,671.48
|
|
|
AORTIC BALLOON VALVULOPLASTY
|
Facility
|
OP
|
$7,096.00
|
|
|
Service Code
|
HCPCS 92986
|
| Hospital Charge Code |
76102471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$922.48 |
| Max. Negotiated Rate |
$6,919.70 |
| Rate for Payer: Aetna Commercial |
$5,463.92
|
| Rate for Payer: Anthem Medicaid |
$2,440.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,942.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,534.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,919.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,672.56
|
| Rate for Payer: Cash Price |
$3,548.00
|
| Rate for Payer: Cash Price |
$3,548.00
|
| Rate for Payer: Cigna Commercial |
$5,889.68
|
| Rate for Payer: First Health Commercial |
$6,741.20
|
| Rate for Payer: Humana Commercial |
$6,031.60
|
| Rate for Payer: Humana KY Medicaid |
$2,440.31
|
| Rate for Payer: Humana Medicare Advantage |
$4,942.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,465.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,818.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,236.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,931.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,489.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,244.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,322.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,419.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,199.76
|
| Rate for Payer: PHCS Commercial |
$6,812.16
|
| Rate for Payer: United Healthcare All Payer |
$6,244.48
|
|
|
AORTIC BALLOON VALVULOPLASTY
|
Facility
|
IP
|
$7,399.00
|
|
|
Service Code
|
HCPCS 92986
|
| Hospital Charge Code |
48100061
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$961.87 |
| Max. Negotiated Rate |
$7,103.04 |
| Rate for Payer: Aetna Commercial |
$5,697.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,771.22
|
| Rate for Payer: Cash Price |
$3,699.50
|
| Rate for Payer: Cigna Commercial |
$6,141.17
|
| Rate for Payer: First Health Commercial |
$7,029.05
|
| Rate for Payer: Humana Commercial |
$6,289.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,067.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,460.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,219.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,511.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,549.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,479.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,293.69
|
| Rate for Payer: PHCS Commercial |
$7,103.04
|
| Rate for Payer: United Healthcare All Payer |
$6,511.12
|
|
|
AORTIC BALLOON VALVULOPLASTY
|
Facility
|
IP
|
$7,096.00
|
|
|
Service Code
|
HCPCS 92986
|
| Hospital Charge Code |
76102471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$922.48 |
| Max. Negotiated Rate |
$6,812.16 |
| Rate for Payer: Aetna Commercial |
$5,463.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,534.88
|
| Rate for Payer: Cash Price |
$3,548.00
|
| Rate for Payer: Cigna Commercial |
$5,889.68
|
| Rate for Payer: First Health Commercial |
$6,741.20
|
| Rate for Payer: Humana Commercial |
$6,031.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,818.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,236.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,128.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,244.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,322.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,419.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,199.76
|
| Rate for Payer: PHCS Commercial |
$6,812.16
|
| Rate for Payer: United Healthcare All Payer |
$6,244.48
|
|
|
AORTIC BALLOON VALVULOPLASTY
|
Facility
|
OP
|
$7,399.00
|
|
|
Service Code
|
HCPCS 92986
|
| Hospital Charge Code |
48100061
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$961.87 |
| Max. Negotiated Rate |
$7,103.04 |
| Rate for Payer: Aetna Commercial |
$5,697.23
|
| Rate for Payer: Anthem Medicaid |
$2,544.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,942.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,771.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,919.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,672.56
|
| Rate for Payer: Cash Price |
$3,699.50
|
| Rate for Payer: Cash Price |
$3,699.50
|
| Rate for Payer: Cigna Commercial |
$6,141.17
|
| Rate for Payer: First Health Commercial |
$7,029.05
|
| Rate for Payer: Humana Commercial |
$6,289.15
|
| Rate for Payer: Humana KY Medicaid |
$2,544.52
|
| Rate for Payer: Humana Medicare Advantage |
$4,942.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,570.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,067.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,460.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,931.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,595.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,511.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,549.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,479.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,293.69
|
| Rate for Payer: PHCS Commercial |
$7,103.04
|
| Rate for Payer: United Healthcare All Payer |
$6,511.12
|
|
|
AORTIC BODY ALTO PMA 23MM
|
Facility
|
IP
|
$79,896.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,386.53 |
| Max. Negotiated Rate |
$76,700.54 |
| Rate for Payer: Aetna Commercial |
$61,520.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,319.19
|
| Rate for Payer: Cash Price |
$39,948.20
|
| Rate for Payer: Cigna Commercial |
$66,314.01
|
| Rate for Payer: First Health Commercial |
$75,901.58
|
| Rate for Payer: Humana Commercial |
$67,911.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,515.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,963.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,968.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,308.83
|
| Rate for Payer: Ohio Health Group HMO |
$59,922.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,979.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,386.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,767.88
|
| Rate for Payer: PHCS Commercial |
$76,700.54
|
| Rate for Payer: United Healthcare All Payer |
$70,308.83
|
|
|
AORTIC BODY ALTO PMA 23MM
|
Facility
|
OP
|
$79,896.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,386.53 |
| Max. Negotiated Rate |
$76,700.54 |
| Rate for Payer: Aetna Commercial |
$61,520.23
|
| Rate for Payer: Anthem Medicaid |
$27,476.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,319.19
|
| Rate for Payer: Cash Price |
$39,948.20
|
| Rate for Payer: Cigna Commercial |
$66,314.01
|
| Rate for Payer: First Health Commercial |
$75,901.58
|
| Rate for Payer: Humana Commercial |
$67,911.94
|
| Rate for Payer: Humana KY Medicaid |
$27,476.37
|
| Rate for Payer: Kentucky WC Medicaid |
$27,756.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,515.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,963.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,968.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,027.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,308.83
|
| Rate for Payer: Ohio Health Group HMO |
$59,922.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,979.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,386.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,767.88
|
| Rate for Payer: PHCS Commercial |
$76,700.54
|
| Rate for Payer: United Healthcare All Payer |
$70,308.83
|
|
|
AORTIC BODY ALTO PMA 26MM
|
Facility
|
IP
|
$79,896.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,386.53 |
| Max. Negotiated Rate |
$76,700.54 |
| Rate for Payer: Aetna Commercial |
$61,520.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,319.19
|
| Rate for Payer: Cash Price |
$39,948.20
|
| Rate for Payer: Cigna Commercial |
$66,314.01
|
| Rate for Payer: First Health Commercial |
$75,901.58
|
| Rate for Payer: Humana Commercial |
$67,911.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,515.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,963.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,968.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,308.83
|
| Rate for Payer: Ohio Health Group HMO |
$59,922.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,979.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,386.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,767.88
|
| Rate for Payer: PHCS Commercial |
$76,700.54
|
| Rate for Payer: United Healthcare All Payer |
$70,308.83
|
|
|
AORTIC BODY ALTO PMA 26MM
|
Facility
|
OP
|
$79,896.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,386.53 |
| Max. Negotiated Rate |
$76,700.54 |
| Rate for Payer: Aetna Commercial |
$61,520.23
|
| Rate for Payer: Anthem Medicaid |
$27,476.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,319.19
|
| Rate for Payer: Cash Price |
$39,948.20
|
| Rate for Payer: Cigna Commercial |
$66,314.01
|
| Rate for Payer: First Health Commercial |
$75,901.58
|
| Rate for Payer: Humana Commercial |
$67,911.94
|
| Rate for Payer: Humana KY Medicaid |
$27,476.37
|
| Rate for Payer: Kentucky WC Medicaid |
$27,756.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,515.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,963.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,968.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,027.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,308.83
|
| Rate for Payer: Ohio Health Group HMO |
$59,922.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,979.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,386.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,767.88
|
| Rate for Payer: PHCS Commercial |
$76,700.54
|
| Rate for Payer: United Healthcare All Payer |
$70,308.83
|
|
|
AORTIC BODY ALTO PMA 29MM
|
Facility
|
OP
|
$79,896.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,386.53 |
| Max. Negotiated Rate |
$76,700.54 |
| Rate for Payer: Aetna Commercial |
$61,520.23
|
| Rate for Payer: Anthem Medicaid |
$27,476.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,319.19
|
| Rate for Payer: Cash Price |
$39,948.20
|
| Rate for Payer: Cigna Commercial |
$66,314.01
|
| Rate for Payer: First Health Commercial |
$75,901.58
|
| Rate for Payer: Humana Commercial |
$67,911.94
|
| Rate for Payer: Humana KY Medicaid |
$27,476.37
|
| Rate for Payer: Kentucky WC Medicaid |
$27,756.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,515.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,963.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,968.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,027.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,308.83
|
| Rate for Payer: Ohio Health Group HMO |
$59,922.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,979.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,386.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,767.88
|
| Rate for Payer: PHCS Commercial |
$76,700.54
|
| Rate for Payer: United Healthcare All Payer |
$70,308.83
|
|
|
AORTIC BODY ALTO PMA 29MM
|
Facility
|
IP
|
$79,896.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,386.53 |
| Max. Negotiated Rate |
$76,700.54 |
| Rate for Payer: Aetna Commercial |
$61,520.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,319.19
|
| Rate for Payer: Cash Price |
$39,948.20
|
| Rate for Payer: Cigna Commercial |
$66,314.01
|
| Rate for Payer: First Health Commercial |
$75,901.58
|
| Rate for Payer: Humana Commercial |
$67,911.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,515.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,963.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,968.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,308.83
|
| Rate for Payer: Ohio Health Group HMO |
$59,922.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,979.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,386.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,767.88
|
| Rate for Payer: PHCS Commercial |
$76,700.54
|
| Rate for Payer: United Healthcare All Payer |
$70,308.83
|
|
|
AORTIC BODY ALTO PMA 34MM
|
Facility
|
IP
|
$79,896.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,386.53 |
| Max. Negotiated Rate |
$76,700.54 |
| Rate for Payer: Aetna Commercial |
$61,520.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,319.19
|
| Rate for Payer: Cash Price |
$39,948.20
|
| Rate for Payer: Cigna Commercial |
$66,314.01
|
| Rate for Payer: First Health Commercial |
$75,901.58
|
| Rate for Payer: Humana Commercial |
$67,911.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,515.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,963.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,968.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,308.83
|
| Rate for Payer: Ohio Health Group HMO |
$59,922.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,979.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,386.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,767.88
|
| Rate for Payer: PHCS Commercial |
$76,700.54
|
| Rate for Payer: United Healthcare All Payer |
$70,308.83
|
|
|
AORTIC BODY ALTO PMA 34MM
|
Facility
|
OP
|
$79,896.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,386.53 |
| Max. Negotiated Rate |
$76,700.54 |
| Rate for Payer: Aetna Commercial |
$61,520.23
|
| Rate for Payer: Anthem Medicaid |
$27,476.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,319.19
|
| Rate for Payer: Cash Price |
$39,948.20
|
| Rate for Payer: Cigna Commercial |
$66,314.01
|
| Rate for Payer: First Health Commercial |
$75,901.58
|
| Rate for Payer: Humana Commercial |
$67,911.94
|
| Rate for Payer: Humana KY Medicaid |
$27,476.37
|
| Rate for Payer: Kentucky WC Medicaid |
$27,756.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,515.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,963.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,968.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,027.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,308.83
|
| Rate for Payer: Ohio Health Group HMO |
$59,922.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,979.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,386.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,767.88
|
| Rate for Payer: PHCS Commercial |
$76,700.54
|
| Rate for Payer: United Healthcare All Payer |
$70,308.83
|
|
|
AORTIC BODY SYSTEM ALTO PMA 20
|
Facility
|
IP
|
$79,896.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,386.53 |
| Max. Negotiated Rate |
$76,700.54 |
| Rate for Payer: Aetna Commercial |
$61,520.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,319.19
|
| Rate for Payer: Cash Price |
$39,948.20
|
| Rate for Payer: Cigna Commercial |
$66,314.01
|
| Rate for Payer: First Health Commercial |
$75,901.58
|
| Rate for Payer: Humana Commercial |
$67,911.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,515.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,963.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,968.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,308.83
|
| Rate for Payer: Ohio Health Group HMO |
$59,922.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,979.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,386.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,767.88
|
| Rate for Payer: PHCS Commercial |
$76,700.54
|
| Rate for Payer: United Healthcare All Payer |
$70,308.83
|
|
|
AORTIC BODY SYSTEM ALTO PMA 20
|
Facility
|
OP
|
$79,896.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,386.53 |
| Max. Negotiated Rate |
$76,700.54 |
| Rate for Payer: Aetna Commercial |
$61,520.23
|
| Rate for Payer: Anthem Medicaid |
$27,476.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,319.19
|
| Rate for Payer: Cash Price |
$39,948.20
|
| Rate for Payer: Cigna Commercial |
$66,314.01
|
| Rate for Payer: First Health Commercial |
$75,901.58
|
| Rate for Payer: Humana Commercial |
$67,911.94
|
| Rate for Payer: Humana KY Medicaid |
$27,476.37
|
| Rate for Payer: Kentucky WC Medicaid |
$27,756.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,515.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,963.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,968.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,027.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,308.83
|
| Rate for Payer: Ohio Health Group HMO |
$59,922.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,979.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,386.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,767.88
|
| Rate for Payer: PHCS Commercial |
$76,700.54
|
| Rate for Payer: United Healthcare All Payer |
$70,308.83
|
|
|
AORTIC CIRCULATION ASSIST
|
Facility
|
OP
|
$920.00
|
|
|
Service Code
|
HCPCS 33971
|
| Hospital Charge Code |
76101327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$883.20 |
| Rate for Payer: Aetna Commercial |
$708.40
|
| Rate for Payer: Anthem Medicaid |
$316.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$717.60
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cigna Commercial |
$763.60
|
| Rate for Payer: First Health Commercial |
$874.00
|
| Rate for Payer: Humana Commercial |
$782.00
|
| Rate for Payer: Humana KY Medicaid |
$316.39
|
| Rate for Payer: Kentucky WC Medicaid |
$319.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$754.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$678.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$276.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$322.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$809.60
|
| Rate for Payer: Ohio Health Group HMO |
$690.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$119.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$285.20
|
| Rate for Payer: PHCS Commercial |
$883.20
|
| Rate for Payer: United Healthcare All Payer |
$809.60
|
|
|
AORTIC CIRCULATION ASSIST
|
Facility
|
IP
|
$920.00
|
|
|
Service Code
|
HCPCS 33971
|
| Hospital Charge Code |
76101327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$883.20 |
| Rate for Payer: Aetna Commercial |
$708.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$717.60
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cigna Commercial |
$763.60
|
| Rate for Payer: First Health Commercial |
$874.00
|
| Rate for Payer: Humana Commercial |
$782.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$754.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$678.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$276.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$809.60
|
| Rate for Payer: Ohio Health Group HMO |
$690.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$119.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$285.20
|
| Rate for Payer: PHCS Commercial |
$883.20
|
| Rate for Payer: United Healthcare All Payer |
$809.60
|
|
|
AORTIC CIRCULATION ASSIST
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 33971
|
| Hospital Charge Code |
76101327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.06 |
| Max. Negotiated Rate |
$1,203.53 |
| Rate for Payer: Aetna Commercial |
$1,203.53
|
| Rate for Payer: Anthem Medicaid |
$279.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$920.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cigna Commercial |
$1,125.13
|
| Rate for Payer: Healthspan PPO |
$1,183.30
|
| Rate for Payer: Humana Medicaid |
$279.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,001.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$284.64
|
| Rate for Payer: Molina Healthcare Passport |
$279.06
|
| Rate for Payer: Multiplan PHCS |
$552.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$644.00
|
| Rate for Payer: UHCCP Medicaid |
$322.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$281.85
|
|
|
AORTIC CIRCULATION ASSIST(P
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 33971
|
| Hospital Charge Code |
761P1327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.06 |
| Max. Negotiated Rate |
$1,203.53 |
| Rate for Payer: Aetna Commercial |
$1,203.53
|
| Rate for Payer: Anthem Medicaid |
$279.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$920.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cigna Commercial |
$1,125.13
|
| Rate for Payer: Healthspan PPO |
$1,183.30
|
| Rate for Payer: Humana Medicaid |
$279.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,001.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$284.64
|
| Rate for Payer: Molina Healthcare Passport |
$279.06
|
| Rate for Payer: Multiplan PHCS |
$552.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$644.00
|
| Rate for Payer: UHCCP Medicaid |
$322.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$281.85
|
|
|
AORTIC EXT POWERFIT 25-25-75RL
|
Facility
|
IP
|
$13,501.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.23 |
| Max. Negotiated Rate |
$12,961.68 |
| Rate for Payer: Aetna Commercial |
$10,396.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,531.36
|
| Rate for Payer: Cash Price |
$6,750.88
|
| Rate for Payer: Cigna Commercial |
$11,206.45
|
| Rate for Payer: First Health Commercial |
$12,826.66
|
| Rate for Payer: Humana Commercial |
$11,476.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,071.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,964.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,050.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,881.54
|
| Rate for Payer: Ohio Health Group HMO |
$10,126.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,700.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,185.54
|
| Rate for Payer: PHCS Commercial |
$12,961.68
|
| Rate for Payer: United Healthcare All Payer |
$11,881.54
|
|
