|
OXYTROL 3.9 MG 24 HR PATCH
|
Facility
|
IP
|
$156.98
|
|
|
Service Code
|
NDC 23615308
|
| Hospital Charge Code |
25001153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$150.70 |
| Rate for Payer: Aetna Commercial |
$120.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.44
|
| Rate for Payer: Cash Price |
$78.49
|
| Rate for Payer: Cigna Commercial |
$130.29
|
| Rate for Payer: First Health Commercial |
$149.13
|
| Rate for Payer: Humana Commercial |
$133.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$128.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$138.14
|
| Rate for Payer: Ohio Health Group HMO |
$117.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.66
|
| Rate for Payer: PHCS Commercial |
$150.70
|
| Rate for Payer: United Healthcare All Payer |
$138.14
|
|
|
PACEMAKER ACCENT DR PM2110
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PACEMAKER ACCENT DR PM2110
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PACEMAKER ACCENT RF DR PM2210
|
Facility
|
OP
|
$17,700.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,301.00 |
| Max. Negotiated Rate |
$16,992.00 |
| Rate for Payer: Aetna Commercial |
$13,629.00
|
| Rate for Payer: Anthem Medicaid |
$6,087.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,806.00
|
| Rate for Payer: Cash Price |
$8,850.00
|
| Rate for Payer: Cigna Commercial |
$14,691.00
|
| Rate for Payer: First Health Commercial |
$16,815.00
|
| Rate for Payer: Humana Commercial |
$15,045.00
|
| Rate for Payer: Humana KY Medicaid |
$6,087.03
|
| Rate for Payer: Kentucky WC Medicaid |
$6,148.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,514.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,062.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,310.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,209.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,576.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,301.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,487.00
|
| Rate for Payer: PHCS Commercial |
$16,992.00
|
| Rate for Payer: United Healthcare All Payer |
$15,576.00
|
|
|
PACEMAKER ACCENT RF DR PM2210
|
Facility
|
IP
|
$17,700.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,301.00 |
| Max. Negotiated Rate |
$16,992.00 |
| Rate for Payer: Aetna Commercial |
$13,629.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,806.00
|
| Rate for Payer: Cash Price |
$8,850.00
|
| Rate for Payer: Cigna Commercial |
$14,691.00
|
| Rate for Payer: First Health Commercial |
$16,815.00
|
| Rate for Payer: Humana Commercial |
$15,045.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,514.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,062.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,310.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,576.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,301.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,487.00
|
| Rate for Payer: PHCS Commercial |
$16,992.00
|
| Rate for Payer: United Healthcare All Payer |
$15,576.00
|
|
|
PACEMAKER ACCENT RF SR PM1210
|
Facility
|
OP
|
$15,360.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,996.80 |
| Max. Negotiated Rate |
$14,745.60 |
| Rate for Payer: Aetna Commercial |
$11,827.20
|
| Rate for Payer: Anthem Medicaid |
$5,282.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,980.80
|
| Rate for Payer: Cash Price |
$7,680.00
|
| Rate for Payer: Cigna Commercial |
$12,748.80
|
| Rate for Payer: First Health Commercial |
$14,592.00
|
| Rate for Payer: Humana Commercial |
$13,056.00
|
| Rate for Payer: Humana KY Medicaid |
$5,282.30
|
| Rate for Payer: Kentucky WC Medicaid |
$5,336.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,595.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,335.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,608.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,388.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,516.80
|
| Rate for Payer: Ohio Health Group HMO |
$11,520.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,996.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,761.60
|
| Rate for Payer: PHCS Commercial |
$14,745.60
|
| Rate for Payer: United Healthcare All Payer |
$13,516.80
|
|
|
PACEMAKER ACCENT RF SR PM1210
|
Facility
|
IP
|
$15,360.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,996.80 |
| Max. Negotiated Rate |
$14,745.60 |
| Rate for Payer: Aetna Commercial |
$11,827.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,980.80
|
| Rate for Payer: Cash Price |
$7,680.00
|
| Rate for Payer: Cigna Commercial |
$12,748.80
|
| Rate for Payer: First Health Commercial |
$14,592.00
|
| Rate for Payer: Humana Commercial |
$13,056.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,595.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,335.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,608.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,516.80
|
| Rate for Payer: Ohio Health Group HMO |
$11,520.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,996.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,761.60
|
| Rate for Payer: PHCS Commercial |
$14,745.60
|
| Rate for Payer: United Healthcare All Payer |
$13,516.80
|
|
|
PACEMAKER ACCOLAD DCRR L301
|
Facility
|
OP
|
$17,880.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,324.40 |
| Max. Negotiated Rate |
$17,164.80 |
| Rate for Payer: Aetna Commercial |
$13,767.60
|
| Rate for Payer: Anthem Medicaid |
$6,148.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,946.40
|
| Rate for Payer: Cash Price |
$8,940.00
|
| Rate for Payer: Cigna Commercial |
$14,840.40
|
| Rate for Payer: First Health Commercial |
$16,986.00
|
| Rate for Payer: Humana Commercial |
$15,198.00
|
| Rate for Payer: Humana KY Medicaid |
$6,148.93
|
| Rate for Payer: Kentucky WC Medicaid |
$6,211.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,661.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,195.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,364.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,272.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,734.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,410.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,324.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,542.80
|
| Rate for Payer: PHCS Commercial |
$17,164.80
|
| Rate for Payer: United Healthcare All Payer |
$15,734.40
|
|
|
PACEMAKER ACCOLAD DCRR L301
|
Facility
|
IP
|
$17,880.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,324.40 |
| Max. Negotiated Rate |
$17,164.80 |
| Rate for Payer: Aetna Commercial |
$13,767.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,946.40
|
| Rate for Payer: Cash Price |
$8,940.00
|
| Rate for Payer: Cigna Commercial |
$14,840.40
|
| Rate for Payer: First Health Commercial |
$16,986.00
|
| Rate for Payer: Humana Commercial |
$15,198.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,661.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,195.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,364.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,734.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,410.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,324.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,542.80
|
| Rate for Payer: PHCS Commercial |
$17,164.80
|
| Rate for Payer: United Healthcare All Payer |
$15,734.40
|
|
|
PACEMAKER ACCOLADE DCRR L301
|
Facility
|
OP
|
$17,880.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,324.40 |
| Max. Negotiated Rate |
$17,164.80 |
| Rate for Payer: Aetna Commercial |
$13,767.60
|
| Rate for Payer: Anthem Medicaid |
$6,148.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,946.40
|
| Rate for Payer: Cash Price |
$8,940.00
|
| Rate for Payer: Cigna Commercial |
$14,840.40
|
| Rate for Payer: First Health Commercial |
$16,986.00
|
| Rate for Payer: Humana Commercial |
$15,198.00
|
| Rate for Payer: Humana KY Medicaid |
$6,148.93
|
| Rate for Payer: Kentucky WC Medicaid |
$6,211.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,661.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,195.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,364.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,272.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,734.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,410.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,324.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,542.80
|
| Rate for Payer: PHCS Commercial |
$17,164.80
|
| Rate for Payer: United Healthcare All Payer |
$15,734.40
|
|
|
PACEMAKER ACCOLADE DCRR L301
|
Facility
|
IP
|
$17,880.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,324.40 |
| Max. Negotiated Rate |
$17,164.80 |
| Rate for Payer: Aetna Commercial |
$13,767.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,946.40
|
| Rate for Payer: Cash Price |
$8,940.00
|
| Rate for Payer: Cigna Commercial |
$14,840.40
|
| Rate for Payer: First Health Commercial |
$16,986.00
|
| Rate for Payer: Humana Commercial |
$15,198.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,661.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,195.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,364.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,734.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,410.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,324.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,542.80
|
| Rate for Payer: PHCS Commercial |
$17,164.80
|
| Rate for Payer: United Healthcare All Payer |
$15,734.40
|
|
|
PACEMAKER ACCOLADE MRI SR IS-1
|
Facility
|
IP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
PACEMAKER ACCOLADE MRI SR IS-1
|
Facility
|
OP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem Medicaid |
$7,299.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Humana KY Medicaid |
$7,299.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,373.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,445.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
PACEMAKER ACCOLADE SCRR L300
|
Facility
|
OP
|
$12,917.75
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,679.31 |
| Max. Negotiated Rate |
$12,401.04 |
| Rate for Payer: Aetna Commercial |
$9,946.67
|
| Rate for Payer: Anthem Medicaid |
$4,442.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,075.84
|
| Rate for Payer: Cash Price |
$6,458.88
|
| Rate for Payer: Cigna Commercial |
$10,721.73
|
| Rate for Payer: First Health Commercial |
$12,271.86
|
| Rate for Payer: Humana Commercial |
$10,980.09
|
| Rate for Payer: Humana KY Medicaid |
$4,442.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,487.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,592.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,533.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,875.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,531.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,367.62
|
| Rate for Payer: Ohio Health Group HMO |
$9,688.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,583.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,004.50
|
| Rate for Payer: PHCS Commercial |
$12,401.04
|
| Rate for Payer: United Healthcare All Payer |
$11,367.62
|
|
|
PACEMAKER ACCOLADE SCRR L300
|
Facility
|
IP
|
$12,917.75
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,679.31 |
| Max. Negotiated Rate |
$12,401.04 |
| Rate for Payer: Aetna Commercial |
$9,946.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,075.84
|
| Rate for Payer: Cash Price |
$6,458.88
|
| Rate for Payer: Cigna Commercial |
$10,721.73
|
| Rate for Payer: First Health Commercial |
$12,271.86
|
| Rate for Payer: Humana Commercial |
$10,980.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,592.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,533.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,875.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,367.62
|
| Rate for Payer: Ohio Health Group HMO |
$9,688.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,583.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,004.50
|
| Rate for Payer: PHCS Commercial |
$12,401.04
|
| Rate for Payer: United Healthcare All Payer |
$11,367.62
|
|
|
PACEMAKER ADAPTER DF1-C6HV
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
PACEMAKER ADAPTER DF1-C6HV
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
PACEMAKER ADAPTER IS1-C5PS
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.25 |
| 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 |
$1,189.84
|
| 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 |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
PACEMAKER ADAPTER IS1-C5PS
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.25 |
| 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 |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
PACEMAKER ADVANTIO K062 SR
|
Facility
|
IP
|
$12,917.75
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,679.31 |
| Max. Negotiated Rate |
$12,401.04 |
| Rate for Payer: Aetna Commercial |
$9,946.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,075.84
|
| Rate for Payer: Cash Price |
$6,458.88
|
| Rate for Payer: Cigna Commercial |
$10,721.73
|
| Rate for Payer: First Health Commercial |
$12,271.86
|
| Rate for Payer: Humana Commercial |
$10,980.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,592.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,533.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,875.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,367.62
|
| Rate for Payer: Ohio Health Group HMO |
$9,688.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,583.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,004.50
|
| Rate for Payer: PHCS Commercial |
$12,401.04
|
| Rate for Payer: United Healthcare All Payer |
$11,367.62
|
|
|
PACEMAKER ADVANTIO K062 SR
|
Facility
|
OP
|
$12,917.75
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,679.31 |
| Max. Negotiated Rate |
$12,401.04 |
| Rate for Payer: Aetna Commercial |
$9,946.67
|
| Rate for Payer: Anthem Medicaid |
$4,442.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,075.84
|
| Rate for Payer: Cash Price |
$6,458.88
|
| Rate for Payer: Cigna Commercial |
$10,721.73
|
| Rate for Payer: First Health Commercial |
$12,271.86
|
| Rate for Payer: Humana Commercial |
$10,980.09
|
| Rate for Payer: Humana KY Medicaid |
$4,442.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,487.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,592.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,533.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,875.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,531.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,367.62
|
| Rate for Payer: Ohio Health Group HMO |
$9,688.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,583.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,004.50
|
| Rate for Payer: PHCS Commercial |
$12,401.04
|
| Rate for Payer: United Healthcare All Payer |
$11,367.62
|
|
|
PACEMAKER ADVISA DR A2DR01
|
Facility
|
IP
|
$19,400.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,522.00 |
| Max. Negotiated Rate |
$18,624.00 |
| Rate for Payer: Aetna Commercial |
$14,938.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,132.00
|
| Rate for Payer: Cash Price |
$9,700.00
|
| Rate for Payer: Cigna Commercial |
$16,102.00
|
| Rate for Payer: First Health Commercial |
$18,430.00
|
| Rate for Payer: Humana Commercial |
$16,490.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,908.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,317.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,820.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,072.00
|
| Rate for Payer: Ohio Health Group HMO |
$14,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,014.00
|
| Rate for Payer: PHCS Commercial |
$18,624.00
|
| Rate for Payer: United Healthcare All Payer |
$17,072.00
|
|
|
PACEMAKER ADVISA DR A2DR01
|
Facility
|
OP
|
$19,400.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,522.00 |
| Max. Negotiated Rate |
$18,624.00 |
| Rate for Payer: Aetna Commercial |
$14,938.00
|
| Rate for Payer: Anthem Medicaid |
$6,671.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,132.00
|
| Rate for Payer: Cash Price |
$9,700.00
|
| Rate for Payer: Cigna Commercial |
$16,102.00
|
| Rate for Payer: First Health Commercial |
$18,430.00
|
| Rate for Payer: Humana Commercial |
$16,490.00
|
| Rate for Payer: Humana KY Medicaid |
$6,671.66
|
| Rate for Payer: Kentucky WC Medicaid |
$6,739.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,908.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,317.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,820.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,805.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,072.00
|
| Rate for Payer: Ohio Health Group HMO |
$14,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,014.00
|
| Rate for Payer: PHCS Commercial |
$18,624.00
|
| Rate for Payer: United Healthcare All Payer |
$17,072.00
|
|
|
PACEMAKER ADVISA MRI A3SR01
|
Facility
|
OP
|
$16,440.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,137.20 |
| Max. Negotiated Rate |
$15,782.40 |
| Rate for Payer: Aetna Commercial |
$12,658.80
|
| Rate for Payer: Anthem Medicaid |
$5,653.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,823.20
|
| Rate for Payer: Cash Price |
$8,220.00
|
| Rate for Payer: Cigna Commercial |
$13,645.20
|
| Rate for Payer: First Health Commercial |
$15,618.00
|
| Rate for Payer: Humana Commercial |
$13,974.00
|
| Rate for Payer: Humana KY Medicaid |
$5,653.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,711.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,480.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,132.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,932.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,767.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,467.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,137.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,096.40
|
| Rate for Payer: PHCS Commercial |
$15,782.40
|
| Rate for Payer: United Healthcare All Payer |
$14,467.20
|
|
|
PACEMAKER ADVISA MRI A3SR01
|
Facility
|
IP
|
$16,440.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,137.20 |
| Max. Negotiated Rate |
$15,782.40 |
| Rate for Payer: Aetna Commercial |
$12,658.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,823.20
|
| Rate for Payer: Cash Price |
$8,220.00
|
| Rate for Payer: Cigna Commercial |
$13,645.20
|
| Rate for Payer: First Health Commercial |
$15,618.00
|
| Rate for Payer: Humana Commercial |
$13,974.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,480.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,132.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,932.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,467.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,137.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,096.40
|
| Rate for Payer: PHCS Commercial |
$15,782.40
|
| Rate for Payer: United Healthcare All Payer |
$14,467.20
|
|
