|
AORTC EXT POWRFIT 34-34-120RLE
|
Facility
|
IP
|
$21,856.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,556.88 |
| Max. Negotiated Rate |
$20,982.00 |
| Rate for Payer: Aetna Commercial |
$16,829.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,047.88
|
| Rate for Payer: Cash Price |
$10,928.12
|
| Rate for Payer: Cigna Commercial |
$18,140.69
|
| Rate for Payer: First Health Commercial |
$20,763.44
|
| Rate for Payer: Humana Commercial |
$18,577.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,922.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,129.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,556.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,233.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,392.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,014.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,080.81
|
| Rate for Payer: PHCS Commercial |
$20,982.00
|
| Rate for Payer: United Healthcare All Payer |
$19,233.50
|
|
|
AORTIC BALLOON VALVULOPLASTY
|
Facility
|
IP
|
$7,399.00
|
|
|
Service Code
|
HCPCS 92986
|
| Hospital Charge Code |
48100061
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,219.70 |
| 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 |
$5,919.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,437.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,105.31
|
| Rate for Payer: PHCS Commercial |
$7,103.04
|
| Rate for Payer: United Healthcare All Payer |
$6,511.12
|
|
|
AORTIC BALLOON VALVULOPLASTY
|
Facility
|
OP
|
$7,096.00
|
|
|
Service Code
|
HCPCS 92986
|
| Hospital Charge Code |
76102471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,440.31 |
| Max. Negotiated Rate |
$7,375.33 |
| Rate for Payer: Aetna Commercial |
$5,463.92
|
| Rate for Payer: Anthem Medicaid |
$2,440.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,268.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,534.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| 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 |
$5,268.09
|
| 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 |
$6,321.71
|
| 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 |
$5,676.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,173.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,896.24
|
| Rate for Payer: PHCS Commercial |
$6,812.16
|
| Rate for Payer: United Healthcare All Payer |
$6,244.48
|
|
|
AORTIC BALLOON VALVULOPLASTY
|
Facility
|
IP
|
$7,096.00
|
|
|
Service Code
|
HCPCS 92986
|
| Hospital Charge Code |
76102471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,128.80 |
| 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 |
$5,676.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,173.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,896.24
|
| 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 |
$2,544.52 |
| Max. Negotiated Rate |
$7,375.33 |
| Rate for Payer: Aetna Commercial |
$5,697.23
|
| Rate for Payer: Anthem Medicaid |
$2,544.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,268.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,771.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| 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 |
$5,268.09
|
| 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 |
$6,321.71
|
| 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 |
$5,919.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,437.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,105.31
|
| 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
|
$82,696.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,808.86 |
| Max. Negotiated Rate |
$79,388.35 |
| Rate for Payer: Aetna Commercial |
$63,676.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,503.04
|
| Rate for Payer: Cash Price |
$41,348.10
|
| Rate for Payer: Cigna Commercial |
$68,637.85
|
| Rate for Payer: First Health Commercial |
$78,561.39
|
| Rate for Payer: Humana Commercial |
$70,291.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,810.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,029.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,808.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,772.66
|
| Rate for Payer: Ohio Health Group HMO |
$62,022.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,156.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,945.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,060.38
|
| Rate for Payer: PHCS Commercial |
$79,388.35
|
| Rate for Payer: United Healthcare All Payer |
$72,772.66
|
|
|
AORTIC BODY ALTO PMA 23MM
|
Facility
|
OP
|
$82,696.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,808.86 |
| Max. Negotiated Rate |
$79,388.35 |
| Rate for Payer: Aetna Commercial |
$63,676.07
|
| Rate for Payer: Anthem Medicaid |
$28,439.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,503.04
|
| Rate for Payer: Cash Price |
$41,348.10
|
| Rate for Payer: Cigna Commercial |
$68,637.85
|
| Rate for Payer: First Health Commercial |
$78,561.39
|
| Rate for Payer: Humana Commercial |
$70,291.77
|
| Rate for Payer: Humana KY Medicaid |
$28,439.22
|
| Rate for Payer: Kentucky WC Medicaid |
$28,728.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,810.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,029.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,808.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,009.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,772.66
|
| Rate for Payer: Ohio Health Group HMO |
$62,022.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,156.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,945.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,060.38
|
| Rate for Payer: PHCS Commercial |
$79,388.35
|
| Rate for Payer: United Healthcare All Payer |
$72,772.66
|
|
|
AORTIC BODY ALTO PMA 26MM
|
Facility
|
IP
|
$82,696.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,808.86 |
| Max. Negotiated Rate |
$79,388.35 |
| Rate for Payer: Aetna Commercial |
$63,676.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,503.04
|
| Rate for Payer: Cash Price |
$41,348.10
|
| Rate for Payer: Cigna Commercial |
$68,637.85
|
| Rate for Payer: First Health Commercial |
$78,561.39
|
| Rate for Payer: Humana Commercial |
$70,291.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,810.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,029.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,808.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,772.66
|
| Rate for Payer: Ohio Health Group HMO |
$62,022.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,156.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,945.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,060.38
|
| Rate for Payer: PHCS Commercial |
$79,388.35
|
| Rate for Payer: United Healthcare All Payer |
$72,772.66
|
|
|
AORTIC BODY ALTO PMA 26MM
|
Facility
|
OP
|
$82,696.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,808.86 |
| Max. Negotiated Rate |
$79,388.35 |
| Rate for Payer: Aetna Commercial |
$63,676.07
|
| Rate for Payer: Anthem Medicaid |
$28,439.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,503.04
|
| Rate for Payer: Cash Price |
$41,348.10
|
| Rate for Payer: Cigna Commercial |
$68,637.85
|
| Rate for Payer: First Health Commercial |
$78,561.39
|
| Rate for Payer: Humana Commercial |
$70,291.77
|
| Rate for Payer: Humana KY Medicaid |
$28,439.22
|
| Rate for Payer: Kentucky WC Medicaid |
$28,728.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,810.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,029.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,808.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,009.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,772.66
|
| Rate for Payer: Ohio Health Group HMO |
$62,022.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,156.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,945.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,060.38
|
| Rate for Payer: PHCS Commercial |
$79,388.35
|
| Rate for Payer: United Healthcare All Payer |
$72,772.66
|
|
|
AORTIC BODY ALTO PMA 29MM
|
Facility
|
IP
|
$82,696.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,808.86 |
| Max. Negotiated Rate |
$79,388.35 |
| Rate for Payer: Aetna Commercial |
$63,676.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,503.04
|
| Rate for Payer: Cash Price |
$41,348.10
|
| Rate for Payer: Cigna Commercial |
$68,637.85
|
| Rate for Payer: First Health Commercial |
$78,561.39
|
| Rate for Payer: Humana Commercial |
$70,291.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,810.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,029.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,808.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,772.66
|
| Rate for Payer: Ohio Health Group HMO |
$62,022.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,156.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,945.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,060.38
|
| Rate for Payer: PHCS Commercial |
$79,388.35
|
| Rate for Payer: United Healthcare All Payer |
$72,772.66
|
|
|
AORTIC BODY ALTO PMA 29MM
|
Facility
|
OP
|
$82,696.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,808.86 |
| Max. Negotiated Rate |
$79,388.35 |
| Rate for Payer: Aetna Commercial |
$63,676.07
|
| Rate for Payer: Anthem Medicaid |
$28,439.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,503.04
|
| Rate for Payer: Cash Price |
$41,348.10
|
| Rate for Payer: Cigna Commercial |
$68,637.85
|
| Rate for Payer: First Health Commercial |
$78,561.39
|
| Rate for Payer: Humana Commercial |
$70,291.77
|
| Rate for Payer: Humana KY Medicaid |
$28,439.22
|
| Rate for Payer: Kentucky WC Medicaid |
$28,728.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,810.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,029.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,808.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,009.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,772.66
|
| Rate for Payer: Ohio Health Group HMO |
$62,022.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,156.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,945.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,060.38
|
| Rate for Payer: PHCS Commercial |
$79,388.35
|
| Rate for Payer: United Healthcare All Payer |
$72,772.66
|
|
|
AORTIC BODY ALTO PMA 34MM
|
Facility
|
OP
|
$82,696.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,808.86 |
| Max. Negotiated Rate |
$79,388.35 |
| Rate for Payer: Aetna Commercial |
$63,676.07
|
| Rate for Payer: Anthem Medicaid |
$28,439.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,503.04
|
| Rate for Payer: Cash Price |
$41,348.10
|
| Rate for Payer: Cigna Commercial |
$68,637.85
|
| Rate for Payer: First Health Commercial |
$78,561.39
|
| Rate for Payer: Humana Commercial |
$70,291.77
|
| Rate for Payer: Humana KY Medicaid |
$28,439.22
|
| Rate for Payer: Kentucky WC Medicaid |
$28,728.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,810.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,029.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,808.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,009.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,772.66
|
| Rate for Payer: Ohio Health Group HMO |
$62,022.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,156.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,945.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,060.38
|
| Rate for Payer: PHCS Commercial |
$79,388.35
|
| Rate for Payer: United Healthcare All Payer |
$72,772.66
|
|
|
AORTIC BODY ALTO PMA 34MM
|
Facility
|
IP
|
$82,696.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,808.86 |
| Max. Negotiated Rate |
$79,388.35 |
| Rate for Payer: Aetna Commercial |
$63,676.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,503.04
|
| Rate for Payer: Cash Price |
$41,348.10
|
| Rate for Payer: Cigna Commercial |
$68,637.85
|
| Rate for Payer: First Health Commercial |
$78,561.39
|
| Rate for Payer: Humana Commercial |
$70,291.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,810.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,029.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,808.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,772.66
|
| Rate for Payer: Ohio Health Group HMO |
$62,022.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,156.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,945.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,060.38
|
| Rate for Payer: PHCS Commercial |
$79,388.35
|
| Rate for Payer: United Healthcare All Payer |
$72,772.66
|
|
|
AORTIC BODY SYSTEM ALTO PMA 20
|
Facility
|
IP
|
$82,696.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,808.86 |
| Max. Negotiated Rate |
$79,388.35 |
| Rate for Payer: Aetna Commercial |
$63,676.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,503.04
|
| Rate for Payer: Cash Price |
$41,348.10
|
| Rate for Payer: Cigna Commercial |
$68,637.85
|
| Rate for Payer: First Health Commercial |
$78,561.39
|
| Rate for Payer: Humana Commercial |
$70,291.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,810.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,029.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,808.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,772.66
|
| Rate for Payer: Ohio Health Group HMO |
$62,022.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,156.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,945.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,060.38
|
| Rate for Payer: PHCS Commercial |
$79,388.35
|
| Rate for Payer: United Healthcare All Payer |
$72,772.66
|
|
|
AORTIC BODY SYSTEM ALTO PMA 20
|
Facility
|
OP
|
$82,696.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,808.86 |
| Max. Negotiated Rate |
$79,388.35 |
| Rate for Payer: Aetna Commercial |
$63,676.07
|
| Rate for Payer: Anthem Medicaid |
$28,439.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,503.04
|
| Rate for Payer: Cash Price |
$41,348.10
|
| Rate for Payer: Cigna Commercial |
$68,637.85
|
| Rate for Payer: First Health Commercial |
$78,561.39
|
| Rate for Payer: Humana Commercial |
$70,291.77
|
| Rate for Payer: Humana KY Medicaid |
$28,439.22
|
| Rate for Payer: Kentucky WC Medicaid |
$28,728.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,810.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,029.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,808.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,009.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,772.66
|
| Rate for Payer: Ohio Health Group HMO |
$62,022.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,156.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,945.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,060.38
|
| Rate for Payer: PHCS Commercial |
$79,388.35
|
| Rate for Payer: United Healthcare All Payer |
$72,772.66
|
|
|
AORTIC CIRCULATION ASSIST
|
Facility
|
OP
|
$920.00
|
|
|
Service Code
|
HCPCS 33971
|
| Hospital Charge Code |
76101327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.00 |
| 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 |
$736.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$800.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$634.80
|
| 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: Ambetter Exchange |
$663.50
|
| Rate for Payer: Anthem Medicaid |
$279.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$663.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$663.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$796.20
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$663.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.50
|
| 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 |
$862.55
|
| Rate for Payer: UHCCP Medicaid |
$322.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$281.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$663.50
|
|
|
AORTIC CIRCULATION ASSIST
|
Facility
|
IP
|
$920.00
|
|
|
Service Code
|
HCPCS 33971
|
| Hospital Charge Code |
76101327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.00 |
| 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 |
$736.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$800.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$634.80
|
| Rate for Payer: PHCS Commercial |
$883.20
|
| Rate for Payer: United Healthcare All Payer |
$809.60
|
|
|
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: Ambetter Exchange |
$663.50
|
| Rate for Payer: Anthem Medicaid |
$279.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$663.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$663.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$796.20
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$663.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.50
|
| 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 |
$862.55
|
| Rate for Payer: UHCCP Medicaid |
$322.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$281.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$663.50
|
|
|
AORTIC EXT POWERFIT 25-25-75RL
|
Facility
|
OP
|
$13,757.65
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,127.30 |
| Max. Negotiated Rate |
$13,207.34 |
| Rate for Payer: Aetna Commercial |
$10,593.39
|
| Rate for Payer: Anthem Medicaid |
$4,731.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,730.97
|
| Rate for Payer: Cash Price |
$6,878.82
|
| Rate for Payer: Cigna Commercial |
$11,418.85
|
| Rate for Payer: First Health Commercial |
$13,069.77
|
| Rate for Payer: Humana Commercial |
$11,694.00
|
| Rate for Payer: Humana KY Medicaid |
$4,731.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,779.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,281.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,153.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,127.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,826.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,106.73
|
| Rate for Payer: Ohio Health Group HMO |
$10,318.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,006.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,969.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,492.78
|
| Rate for Payer: PHCS Commercial |
$13,207.34
|
| Rate for Payer: United Healthcare All Payer |
$12,106.73
|
|
|
AORTIC EXT POWERFIT 25-25-75RL
|
Facility
|
IP
|
$13,757.65
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,127.30 |
| Max. Negotiated Rate |
$13,207.34 |
| Rate for Payer: Aetna Commercial |
$10,593.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,730.97
|
| Rate for Payer: Cash Price |
$6,878.82
|
| Rate for Payer: Cigna Commercial |
$11,418.85
|
| Rate for Payer: First Health Commercial |
$13,069.77
|
| Rate for Payer: Humana Commercial |
$11,694.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,281.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,153.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,127.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,106.73
|
| Rate for Payer: Ohio Health Group HMO |
$10,318.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,006.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,969.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,492.78
|
| Rate for Payer: PHCS Commercial |
$13,207.34
|
| Rate for Payer: United Healthcare All Payer |
$12,106.73
|
|
|
AORTIC EXT POWERFIT 25-25-95RL
|
Facility
|
OP
|
$15,851.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,755.45 |
| Max. Negotiated Rate |
$15,217.44 |
| Rate for Payer: Aetna Commercial |
$12,205.66
|
| Rate for Payer: Anthem Medicaid |
$5,451.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,364.17
|
| Rate for Payer: Cash Price |
$7,925.75
|
| Rate for Payer: Cigna Commercial |
$13,156.75
|
| Rate for Payer: First Health Commercial |
$15,058.92
|
| Rate for Payer: Humana Commercial |
$13,473.77
|
| Rate for Payer: Humana KY Medicaid |
$5,451.33
|
| Rate for Payer: Kentucky WC Medicaid |
$5,506.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,998.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,698.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,755.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,560.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,949.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,888.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,681.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,790.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,937.53
|
| Rate for Payer: PHCS Commercial |
$15,217.44
|
| Rate for Payer: United Healthcare All Payer |
$13,949.32
|
|
|
AORTIC EXT POWERFIT 25-25-95RL
|
Facility
|
IP
|
$15,851.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,755.45 |
| Max. Negotiated Rate |
$15,217.44 |
| Rate for Payer: Aetna Commercial |
$12,205.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,364.17
|
| Rate for Payer: Cash Price |
$7,925.75
|
| Rate for Payer: Cigna Commercial |
$13,156.75
|
| Rate for Payer: First Health Commercial |
$15,058.92
|
| Rate for Payer: Humana Commercial |
$13,473.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,998.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,698.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,755.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,949.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,888.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,681.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,790.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,937.53
|
| Rate for Payer: PHCS Commercial |
$15,217.44
|
| Rate for Payer: United Healthcare All Payer |
$13,949.32
|
|
|
AORTIC EXT POWERFIT 28-28-75RL
|
Facility
|
IP
|
$13,757.65
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,127.30 |
| Max. Negotiated Rate |
$13,207.34 |
| Rate for Payer: Aetna Commercial |
$10,593.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,730.97
|
| Rate for Payer: Cash Price |
$6,878.82
|
| Rate for Payer: Cigna Commercial |
$11,418.85
|
| Rate for Payer: First Health Commercial |
$13,069.77
|
| Rate for Payer: Humana Commercial |
$11,694.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,281.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,153.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,127.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,106.73
|
| Rate for Payer: Ohio Health Group HMO |
$10,318.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,006.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,969.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,492.78
|
| Rate for Payer: PHCS Commercial |
$13,207.34
|
| Rate for Payer: United Healthcare All Payer |
$12,106.73
|
|
|
AORTIC EXT POWERFIT 28-28-75RL
|
Facility
|
OP
|
$13,757.65
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,127.30 |
| Max. Negotiated Rate |
$13,207.34 |
| Rate for Payer: Aetna Commercial |
$10,593.39
|
| Rate for Payer: Anthem Medicaid |
$4,731.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,730.97
|
| Rate for Payer: Cash Price |
$6,878.82
|
| Rate for Payer: Cigna Commercial |
$11,418.85
|
| Rate for Payer: First Health Commercial |
$13,069.77
|
| Rate for Payer: Humana Commercial |
$11,694.00
|
| Rate for Payer: Humana KY Medicaid |
$4,731.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,779.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,281.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,153.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,127.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,826.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,106.73
|
| Rate for Payer: Ohio Health Group HMO |
$10,318.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,006.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,969.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,492.78
|
| Rate for Payer: PHCS Commercial |
$13,207.34
|
| Rate for Payer: United Healthcare All Payer |
$12,106.73
|
|
