|
PACEMAKER ACCENT RF DR PM2210
|
Facility
|
IP
|
$18,275.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,482.50 |
| Max. Negotiated Rate |
$17,544.00 |
| Rate for Payer: Aetna Commercial |
$14,071.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,254.50
|
| Rate for Payer: Cash Price |
$9,137.50
|
| Rate for Payer: Cigna Commercial |
$15,168.25
|
| Rate for Payer: First Health Commercial |
$17,361.25
|
| Rate for Payer: Humana Commercial |
$15,533.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,985.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,486.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,082.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,706.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,899.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,609.75
|
| Rate for Payer: PHCS Commercial |
$17,544.00
|
| Rate for Payer: United Healthcare All Payer |
$16,082.00
|
|
|
PACEMAKER ACCENT RF DR PM2210
|
Facility
|
OP
|
$18,275.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,482.50 |
| Max. Negotiated Rate |
$17,544.00 |
| Rate for Payer: Aetna Commercial |
$14,071.75
|
| Rate for Payer: Anthem Medicaid |
$6,284.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,254.50
|
| Rate for Payer: Cash Price |
$9,137.50
|
| Rate for Payer: Cigna Commercial |
$15,168.25
|
| Rate for Payer: First Health Commercial |
$17,361.25
|
| Rate for Payer: Humana Commercial |
$15,533.75
|
| Rate for Payer: Humana KY Medicaid |
$6,284.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,348.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,985.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,486.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,410.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,082.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,706.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,899.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,609.75
|
| Rate for Payer: PHCS Commercial |
$17,544.00
|
| Rate for Payer: United Healthcare All Payer |
$16,082.00
|
|
|
PACEMAKER ACCENT RF SR PM1210
|
Facility
|
OP
|
$15,870.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,761.00 |
| Max. Negotiated Rate |
$15,235.20 |
| Rate for Payer: Aetna Commercial |
$12,219.90
|
| Rate for Payer: Anthem Medicaid |
$5,457.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,378.60
|
| Rate for Payer: Cash Price |
$7,935.00
|
| Rate for Payer: Cigna Commercial |
$13,172.10
|
| Rate for Payer: First Health Commercial |
$15,076.50
|
| Rate for Payer: Humana Commercial |
$13,489.50
|
| Rate for Payer: Humana KY Medicaid |
$5,457.69
|
| Rate for Payer: Kentucky WC Medicaid |
$5,513.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,013.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,712.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,761.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,567.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,965.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,902.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,806.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,950.30
|
| Rate for Payer: PHCS Commercial |
$15,235.20
|
| Rate for Payer: United Healthcare All Payer |
$13,965.60
|
|
|
PACEMAKER ACCENT RF SR PM1210
|
Facility
|
IP
|
$15,870.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,761.00 |
| Max. Negotiated Rate |
$15,235.20 |
| Rate for Payer: Aetna Commercial |
$12,219.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,378.60
|
| Rate for Payer: Cash Price |
$7,935.00
|
| Rate for Payer: Cigna Commercial |
$13,172.10
|
| Rate for Payer: First Health Commercial |
$15,076.50
|
| Rate for Payer: Humana Commercial |
$13,489.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,013.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,712.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,761.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,965.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,902.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,806.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,950.30
|
| Rate for Payer: PHCS Commercial |
$15,235.20
|
| Rate for Payer: United Healthcare All Payer |
$13,965.60
|
|
|
PACEMAKER ACCOLAD DCRR L301
|
Facility
|
IP
|
$18,460.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,538.00 |
| Max. Negotiated Rate |
$17,721.60 |
| Rate for Payer: Aetna Commercial |
$14,214.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,398.80
|
| Rate for Payer: Cash Price |
$9,230.00
|
| Rate for Payer: Cigna Commercial |
$15,321.80
|
| Rate for Payer: First Health Commercial |
$17,537.00
|
| Rate for Payer: Humana Commercial |
$15,691.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,137.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,623.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,538.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,244.80
|
| Rate for Payer: Ohio Health Group HMO |
$13,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,060.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,737.40
|
| Rate for Payer: PHCS Commercial |
$17,721.60
|
| Rate for Payer: United Healthcare All Payer |
$16,244.80
|
|
|
PACEMAKER ACCOLAD DCRR L301
|
Facility
|
OP
|
$18,460.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,538.00 |
| Max. Negotiated Rate |
$17,721.60 |
| Rate for Payer: Aetna Commercial |
$14,214.20
|
| Rate for Payer: Anthem Medicaid |
$6,348.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,398.80
|
| Rate for Payer: Cash Price |
$9,230.00
|
| Rate for Payer: Cigna Commercial |
$15,321.80
|
| Rate for Payer: First Health Commercial |
$17,537.00
|
| Rate for Payer: Humana Commercial |
$15,691.00
|
| Rate for Payer: Humana KY Medicaid |
$6,348.39
|
| Rate for Payer: Kentucky WC Medicaid |
$6,413.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,137.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,623.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,538.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,475.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,244.80
|
| Rate for Payer: Ohio Health Group HMO |
$13,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,060.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,737.40
|
| Rate for Payer: PHCS Commercial |
$17,721.60
|
| Rate for Payer: United Healthcare All Payer |
$16,244.80
|
|
|
PACEMAKER ACCOLADE DCRR L301
|
Facility
|
IP
|
$18,460.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,538.00 |
| Max. Negotiated Rate |
$17,721.60 |
| Rate for Payer: Aetna Commercial |
$14,214.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,398.80
|
| Rate for Payer: Cash Price |
$9,230.00
|
| Rate for Payer: Cigna Commercial |
$15,321.80
|
| Rate for Payer: First Health Commercial |
$17,537.00
|
| Rate for Payer: Humana Commercial |
$15,691.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,137.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,623.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,538.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,244.80
|
| Rate for Payer: Ohio Health Group HMO |
$13,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,060.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,737.40
|
| Rate for Payer: PHCS Commercial |
$17,721.60
|
| Rate for Payer: United Healthcare All Payer |
$16,244.80
|
|
|
PACEMAKER ACCOLADE DCRR L301
|
Facility
|
OP
|
$18,460.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,538.00 |
| Max. Negotiated Rate |
$17,721.60 |
| Rate for Payer: Aetna Commercial |
$14,214.20
|
| Rate for Payer: Anthem Medicaid |
$6,348.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,398.80
|
| Rate for Payer: Cash Price |
$9,230.00
|
| Rate for Payer: Cigna Commercial |
$15,321.80
|
| Rate for Payer: First Health Commercial |
$17,537.00
|
| Rate for Payer: Humana Commercial |
$15,691.00
|
| Rate for Payer: Humana KY Medicaid |
$6,348.39
|
| Rate for Payer: Kentucky WC Medicaid |
$6,413.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,137.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,623.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,538.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,475.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,244.80
|
| Rate for Payer: Ohio Health Group HMO |
$13,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,060.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,737.40
|
| Rate for Payer: PHCS Commercial |
$17,721.60
|
| Rate for Payer: United Healthcare All Payer |
$16,244.80
|
|
|
PACEMAKER ACCOLADE MRI SR IS-1
|
Facility
|
OP
|
$14,286.13
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,285.84 |
| Max. Negotiated Rate |
$13,714.68 |
| Rate for Payer: Aetna Commercial |
$11,000.32
|
| Rate for Payer: Anthem Medicaid |
$4,913.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,143.18
|
| Rate for Payer: Cash Price |
$7,143.06
|
| Rate for Payer: Cigna Commercial |
$11,857.49
|
| Rate for Payer: First Health Commercial |
$13,571.82
|
| Rate for Payer: Humana Commercial |
$12,143.21
|
| Rate for Payer: Humana KY Medicaid |
$4,913.00
|
| Rate for Payer: Kentucky WC Medicaid |
$4,963.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,714.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,543.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,285.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,011.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,571.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,714.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,428.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,428.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,857.43
|
| Rate for Payer: PHCS Commercial |
$13,714.68
|
| Rate for Payer: United Healthcare All Payer |
$12,571.79
|
|
|
PACEMAKER ACCOLADE MRI SR IS-1
|
Facility
|
IP
|
$14,286.13
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,285.84 |
| Max. Negotiated Rate |
$13,714.68 |
| Rate for Payer: Aetna Commercial |
$11,000.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,143.18
|
| Rate for Payer: Cash Price |
$7,143.06
|
| Rate for Payer: Cigna Commercial |
$11,857.49
|
| Rate for Payer: First Health Commercial |
$13,571.82
|
| Rate for Payer: Humana Commercial |
$12,143.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,714.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,543.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,285.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,571.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,714.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,428.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,428.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,857.43
|
| Rate for Payer: PHCS Commercial |
$13,714.68
|
| Rate for Payer: United Healthcare All Payer |
$12,571.79
|
|
|
PACEMAKER ACCOLADE SCRR L300
|
Facility
|
OP
|
$13,170.45
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,951.14 |
| Max. Negotiated Rate |
$12,643.63 |
| Rate for Payer: Aetna Commercial |
$10,141.25
|
| Rate for Payer: Anthem Medicaid |
$4,529.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,272.95
|
| Rate for Payer: Cash Price |
$6,585.23
|
| Rate for Payer: Cigna Commercial |
$10,931.47
|
| Rate for Payer: First Health Commercial |
$12,511.93
|
| Rate for Payer: Humana Commercial |
$11,194.88
|
| Rate for Payer: Humana KY Medicaid |
$4,529.32
|
| Rate for Payer: Kentucky WC Medicaid |
$4,575.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,799.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,719.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,951.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,620.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,590.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,877.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,536.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,458.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,087.61
|
| Rate for Payer: PHCS Commercial |
$12,643.63
|
| Rate for Payer: United Healthcare All Payer |
$11,590.00
|
|
|
PACEMAKER ACCOLADE SCRR L300
|
Facility
|
IP
|
$13,170.45
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,951.14 |
| Max. Negotiated Rate |
$12,643.63 |
| Rate for Payer: Aetna Commercial |
$10,141.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,272.95
|
| Rate for Payer: Cash Price |
$6,585.23
|
| Rate for Payer: Cigna Commercial |
$10,931.47
|
| Rate for Payer: First Health Commercial |
$12,511.93
|
| Rate for Payer: Humana Commercial |
$11,194.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,799.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,719.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,951.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,590.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,877.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,536.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,458.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,087.61
|
| Rate for Payer: PHCS Commercial |
$12,643.63
|
| Rate for Payer: United Healthcare All Payer |
$11,590.00
|
|
|
PACEMAKER ADAPTER DF1-C6HV
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem Medicaid |
$708.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Humana KY Medicaid |
$708.43
|
| Rate for Payer: Kentucky WC Medicaid |
$715.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
PACEMAKER ADAPTER DF1-C6HV
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
PACEMAKER ADAPTER IS1-C5PS
|
Facility
|
OP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$2,550.62
|
| Rate for Payer: Anthem Medicaid |
$1,139.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,656.25
|
| Rate for Payer: Cigna Commercial |
$2,749.38
|
| Rate for Payer: First Health Commercial |
$3,146.88
|
| Rate for Payer: Humana Commercial |
$2,815.62
|
| Rate for Payer: Humana KY Medicaid |
$1,139.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,150.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,162.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.62
|
| Rate for Payer: PHCS Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare All Payer |
$2,915.00
|
|
|
PACEMAKER ADAPTER IS1-C5PS
|
Facility
|
IP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$2,550.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,656.25
|
| Rate for Payer: Cigna Commercial |
$2,749.38
|
| Rate for Payer: First Health Commercial |
$3,146.88
|
| Rate for Payer: Humana Commercial |
$2,815.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.62
|
| Rate for Payer: PHCS Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare All Payer |
$2,915.00
|
|
|
PACEMAKER ADVANTIO K062 SR
|
Facility
|
OP
|
$13,170.45
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,951.14 |
| Max. Negotiated Rate |
$12,643.63 |
| Rate for Payer: Aetna Commercial |
$10,141.25
|
| Rate for Payer: Anthem Medicaid |
$4,529.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,272.95
|
| Rate for Payer: Cash Price |
$6,585.23
|
| Rate for Payer: Cigna Commercial |
$10,931.47
|
| Rate for Payer: First Health Commercial |
$12,511.93
|
| Rate for Payer: Humana Commercial |
$11,194.88
|
| Rate for Payer: Humana KY Medicaid |
$4,529.32
|
| Rate for Payer: Kentucky WC Medicaid |
$4,575.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,799.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,719.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,951.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,620.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,590.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,877.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,536.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,458.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,087.61
|
| Rate for Payer: PHCS Commercial |
$12,643.63
|
| Rate for Payer: United Healthcare All Payer |
$11,590.00
|
|
|
PACEMAKER ADVANTIO K062 SR
|
Facility
|
IP
|
$13,170.45
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,951.14 |
| Max. Negotiated Rate |
$12,643.63 |
| Rate for Payer: Aetna Commercial |
$10,141.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,272.95
|
| Rate for Payer: Cash Price |
$6,585.23
|
| Rate for Payer: Cigna Commercial |
$10,931.47
|
| Rate for Payer: First Health Commercial |
$12,511.93
|
| Rate for Payer: Humana Commercial |
$11,194.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,799.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,719.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,951.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,590.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,877.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,536.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,458.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,087.61
|
| Rate for Payer: PHCS Commercial |
$12,643.63
|
| Rate for Payer: United Healthcare All Payer |
$11,590.00
|
|
|
PACEMAKER ADVISA DR A2DR01
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem Medicaid |
$6,878.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Humana KY Medicaid |
$6,878.00
|
| Rate for Payer: Kentucky WC Medicaid |
$6,948.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,016.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
PACEMAKER ADVISA DR A2DR01
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
PACEMAKER ADVISA MRI A3SR01
|
Facility
|
OP
|
$16,980.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,094.00 |
| Max. Negotiated Rate |
$16,300.80 |
| Rate for Payer: Aetna Commercial |
$13,074.60
|
| Rate for Payer: Anthem Medicaid |
$5,839.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,244.40
|
| Rate for Payer: Cash Price |
$8,490.00
|
| Rate for Payer: Cigna Commercial |
$14,093.40
|
| Rate for Payer: First Health Commercial |
$16,131.00
|
| Rate for Payer: Humana Commercial |
$14,433.00
|
| Rate for Payer: Humana KY Medicaid |
$5,839.42
|
| Rate for Payer: Kentucky WC Medicaid |
$5,898.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,923.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,531.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,094.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,956.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,942.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,735.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,584.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,772.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,716.20
|
| Rate for Payer: PHCS Commercial |
$16,300.80
|
| Rate for Payer: United Healthcare All Payer |
$14,942.40
|
|
|
PACEMAKER ADVISA MRI A3SR01
|
Facility
|
IP
|
$16,980.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,094.00 |
| Max. Negotiated Rate |
$16,300.80 |
| Rate for Payer: Aetna Commercial |
$13,074.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,244.40
|
| Rate for Payer: Cash Price |
$8,490.00
|
| Rate for Payer: Cigna Commercial |
$14,093.40
|
| Rate for Payer: First Health Commercial |
$16,131.00
|
| Rate for Payer: Humana Commercial |
$14,433.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,923.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,531.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,094.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,942.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,735.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,584.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,772.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,716.20
|
| Rate for Payer: PHCS Commercial |
$16,300.80
|
| Rate for Payer: United Healthcare All Payer |
$14,942.40
|
|
|
PACEMAKER ALLURE BI-VI PM3222
|
Facility
|
IP
|
$18,460.00
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,538.00 |
| Max. Negotiated Rate |
$17,721.60 |
| Rate for Payer: Aetna Commercial |
$14,214.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,398.80
|
| Rate for Payer: Cash Price |
$9,230.00
|
| Rate for Payer: Cigna Commercial |
$15,321.80
|
| Rate for Payer: First Health Commercial |
$17,537.00
|
| Rate for Payer: Humana Commercial |
$15,691.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,137.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,623.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,538.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,244.80
|
| Rate for Payer: Ohio Health Group HMO |
$13,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,060.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,737.40
|
| Rate for Payer: PHCS Commercial |
$17,721.60
|
| Rate for Payer: United Healthcare All Payer |
$16,244.80
|
|
|
PACEMAKER ALLURE BI-VI PM3222
|
Facility
|
OP
|
$18,460.00
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,538.00 |
| Max. Negotiated Rate |
$17,721.60 |
| Rate for Payer: Aetna Commercial |
$14,214.20
|
| Rate for Payer: Anthem Medicaid |
$6,348.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,398.80
|
| Rate for Payer: Cash Price |
$9,230.00
|
| Rate for Payer: Cigna Commercial |
$15,321.80
|
| Rate for Payer: First Health Commercial |
$17,537.00
|
| Rate for Payer: Humana Commercial |
$15,691.00
|
| Rate for Payer: Humana KY Medicaid |
$6,348.39
|
| Rate for Payer: Kentucky WC Medicaid |
$6,413.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,137.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,623.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,538.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,475.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,244.80
|
| Rate for Payer: Ohio Health Group HMO |
$13,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,060.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,737.40
|
| Rate for Payer: PHCS Commercial |
$17,721.60
|
| Rate for Payer: United Healthcare All Payer |
$16,244.80
|
|
|
PACEMAKER ALTRUA 60 DDDR IS -1
|
Facility
|
OP
|
$17,720.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,316.00 |
| Max. Negotiated Rate |
$17,011.20 |
| Rate for Payer: Aetna Commercial |
$13,644.40
|
| Rate for Payer: Anthem Medicaid |
$6,093.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,821.60
|
| Rate for Payer: Cash Price |
$8,860.00
|
| Rate for Payer: Cigna Commercial |
$14,707.60
|
| Rate for Payer: First Health Commercial |
$16,834.00
|
| Rate for Payer: Humana Commercial |
$15,062.00
|
| Rate for Payer: Humana KY Medicaid |
$6,093.91
|
| Rate for Payer: Kentucky WC Medicaid |
$6,155.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,530.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,077.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,316.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,216.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,593.60
|
| Rate for Payer: Ohio Health Group HMO |
$13,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,416.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,226.80
|
| Rate for Payer: PHCS Commercial |
$17,011.20
|
| Rate for Payer: United Healthcare All Payer |
$15,593.60
|
|
