|
PACEMAKER ALTRUA 60 DDDR IS -1
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PACEMAKER ANALYSIS W/PROG SC
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS 93279
|
| Hospital Charge Code |
76102474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem Medicaid |
$99.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.52
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Humana KY Medicaid |
$99.04
|
| Rate for Payer: Humana Medicare Advantage |
$34.46
|
| Rate for Payer: Kentucky WC Medicaid |
$100.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.72
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
PACEMAKER ANALYSIS W/PROG SC
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
HCPCS 93279
|
| Hospital Charge Code |
92100001
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$57.30 |
| Max. Negotiated Rate |
$183.36 |
| Rate for Payer: Aetna Commercial |
$147.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.98
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$158.53
|
| Rate for Payer: First Health Commercial |
$181.45
|
| Rate for Payer: Humana Commercial |
$162.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.08
|
| Rate for Payer: Ohio Health Group HMO |
$143.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.79
|
| Rate for Payer: PHCS Commercial |
$183.36
|
| Rate for Payer: United Healthcare All Payer |
$168.08
|
|
|
PACEMAKER ANALYSIS W/PROG SC
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
HCPCS 93279
|
| Hospital Charge Code |
92100001
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$183.36 |
| Rate for Payer: Aetna Commercial |
$147.07
|
| Rate for Payer: Anthem Medicaid |
$65.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.52
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$158.53
|
| Rate for Payer: First Health Commercial |
$181.45
|
| Rate for Payer: Humana Commercial |
$162.35
|
| Rate for Payer: Humana KY Medicaid |
$65.68
|
| Rate for Payer: Humana Medicare Advantage |
$34.46
|
| Rate for Payer: Kentucky WC Medicaid |
$66.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$67.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.08
|
| Rate for Payer: Ohio Health Group HMO |
$143.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.79
|
| Rate for Payer: PHCS Commercial |
$183.36
|
| Rate for Payer: United Healthcare All Payer |
$168.08
|
|
|
PACEMAKER ANALYSIS W/PROG SC
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS 93279
|
| Hospital Charge Code |
76102474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.72
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
PACEMAKER ANALYSIS W/PROG SC
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
HCPCS 93279
|
| Hospital Charge Code |
76102474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.46 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$91.09
|
| Rate for Payer: Ambetter Exchange |
$60.63
|
| Rate for Payer: Anthem Medicaid |
$47.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$60.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$60.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$72.76
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$91.94
|
| Rate for Payer: Healthspan PPO |
$85.62
|
| Rate for Payer: Humana Medicaid |
$47.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$60.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.12
|
| Rate for Payer: Molina Healthcare Passport |
$47.18
|
| Rate for Payer: Multiplan PHCS |
$172.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$78.82
|
| Rate for Payer: UHCCP Medicaid |
$100.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$60.63
|
|
|
PACEMAKER ANALYSIS W/PROG SC(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 93279
|
| Hospital Charge Code |
761P2474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.46 |
| Max. Negotiated Rate |
$91.94 |
| Rate for Payer: Aetna Commercial |
$91.09
|
| Rate for Payer: Ambetter Exchange |
$60.63
|
| Rate for Payer: Anthem Medicaid |
$47.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$60.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$60.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$72.76
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$91.94
|
| Rate for Payer: Healthspan PPO |
$85.62
|
| Rate for Payer: Humana Medicaid |
$47.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$60.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.12
|
| Rate for Payer: Molina Healthcare Passport |
$47.18
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$78.82
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$60.63
|
|
|
PACEMAKER ANALYSIS W/PROG SC(T
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS 93279
|
| Hospital Charge Code |
761T2474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$107.64
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$114.54
|
| Rate for Payer: First Health Commercial |
$131.10
|
| Rate for Payer: Humana Commercial |
$117.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.44
|
| Rate for Payer: Ohio Health Group HMO |
$103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.22
|
| Rate for Payer: PHCS Commercial |
$132.48
|
| Rate for Payer: United Healthcare All Payer |
$121.44
|
|
|
PACEMAKER ANALYSIS W/PROG SC(T
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS 93279
|
| Hospital Charge Code |
761T2474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Anthem Medicaid |
$47.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$107.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.52
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$114.54
|
| Rate for Payer: First Health Commercial |
$131.10
|
| Rate for Payer: Humana Commercial |
$117.30
|
| Rate for Payer: Humana KY Medicaid |
$47.46
|
| Rate for Payer: Humana Medicare Advantage |
$34.46
|
| Rate for Payer: Kentucky WC Medicaid |
$47.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.44
|
| Rate for Payer: Ohio Health Group HMO |
$103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.22
|
| Rate for Payer: PHCS Commercial |
$132.48
|
| Rate for Payer: United Healthcare All Payer |
$121.44
|
|
|
PACEMAKER ASSURITY DCRR PM2240
|
Facility
|
IP
|
$11,526.29
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,457.89 |
| Max. Negotiated Rate |
$11,065.24 |
| Rate for Payer: Aetna Commercial |
$8,875.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,990.51
|
| Rate for Payer: Cash Price |
$5,763.15
|
| Rate for Payer: Cigna Commercial |
$9,566.82
|
| Rate for Payer: First Health Commercial |
$10,949.98
|
| Rate for Payer: Humana Commercial |
$9,797.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,451.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,506.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,457.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,143.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,644.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,221.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,027.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,953.14
|
| Rate for Payer: PHCS Commercial |
$11,065.24
|
| Rate for Payer: United Healthcare All Payer |
$10,143.14
|
|
|
PACEMAKER ASSURITY DCRR PM2240
|
Facility
|
OP
|
$11,526.29
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,457.89 |
| Max. Negotiated Rate |
$11,065.24 |
| Rate for Payer: Aetna Commercial |
$8,875.24
|
| Rate for Payer: Anthem Medicaid |
$3,963.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,990.51
|
| Rate for Payer: Cash Price |
$5,763.15
|
| Rate for Payer: Cigna Commercial |
$9,566.82
|
| Rate for Payer: First Health Commercial |
$10,949.98
|
| Rate for Payer: Humana Commercial |
$9,797.35
|
| Rate for Payer: Humana KY Medicaid |
$3,963.89
|
| Rate for Payer: Kentucky WC Medicaid |
$4,004.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,451.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,506.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,457.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,043.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,143.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,644.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,221.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,027.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,953.14
|
| Rate for Payer: PHCS Commercial |
$11,065.24
|
| Rate for Payer: United Healthcare All Payer |
$10,143.14
|
|
|
PACEMAKER ASSURITY DCRR PM2272
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
PACEMAKER ASSURITY DCRR PM2272
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
PACEMAKER ASSURITY DR PM2272 C
|
Facility
|
IP
|
$19,015.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,704.50 |
| Max. Negotiated Rate |
$18,254.40 |
| Rate for Payer: Aetna Commercial |
$14,641.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,831.70
|
| Rate for Payer: Cash Price |
$9,507.50
|
| Rate for Payer: Cigna Commercial |
$15,782.45
|
| Rate for Payer: First Health Commercial |
$18,064.25
|
| Rate for Payer: Humana Commercial |
$16,162.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,592.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,033.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,704.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,733.20
|
| Rate for Payer: Ohio Health Group HMO |
$14,261.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,212.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,543.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,120.35
|
| Rate for Payer: PHCS Commercial |
$18,254.40
|
| Rate for Payer: United Healthcare All Payer |
$16,733.20
|
|
|
PACEMAKER ASSURITY DR PM2272 C
|
Facility
|
OP
|
$19,015.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,704.50 |
| Max. Negotiated Rate |
$18,254.40 |
| Rate for Payer: Aetna Commercial |
$14,641.55
|
| Rate for Payer: Anthem Medicaid |
$6,539.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,831.70
|
| Rate for Payer: Cash Price |
$9,507.50
|
| Rate for Payer: Cigna Commercial |
$15,782.45
|
| Rate for Payer: First Health Commercial |
$18,064.25
|
| Rate for Payer: Humana Commercial |
$16,162.75
|
| Rate for Payer: Humana KY Medicaid |
$6,539.26
|
| Rate for Payer: Kentucky WC Medicaid |
$6,605.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,592.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,033.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,704.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,670.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,733.20
|
| Rate for Payer: Ohio Health Group HMO |
$14,261.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,212.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,543.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,120.35
|
| Rate for Payer: PHCS Commercial |
$18,254.40
|
| Rate for Payer: United Healthcare All Payer |
$16,733.20
|
|
|
PACEMAKER ASSURITY PM2240 CELL
|
Facility
|
OP
|
$19,015.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,704.50 |
| Max. Negotiated Rate |
$18,254.40 |
| Rate for Payer: Aetna Commercial |
$14,641.55
|
| Rate for Payer: Anthem Medicaid |
$6,539.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,831.70
|
| Rate for Payer: Cash Price |
$9,507.50
|
| Rate for Payer: Cigna Commercial |
$15,782.45
|
| Rate for Payer: First Health Commercial |
$18,064.25
|
| Rate for Payer: Humana Commercial |
$16,162.75
|
| Rate for Payer: Humana KY Medicaid |
$6,539.26
|
| Rate for Payer: Kentucky WC Medicaid |
$6,605.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,592.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,033.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,704.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,670.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,733.20
|
| Rate for Payer: Ohio Health Group HMO |
$14,261.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,212.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,543.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,120.35
|
| Rate for Payer: PHCS Commercial |
$18,254.40
|
| Rate for Payer: United Healthcare All Payer |
$16,733.20
|
|
|
PACEMAKER ASSURITY PM2240 CELL
|
Facility
|
IP
|
$19,015.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,704.50 |
| Max. Negotiated Rate |
$18,254.40 |
| Rate for Payer: Aetna Commercial |
$14,641.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,831.70
|
| Rate for Payer: Cash Price |
$9,507.50
|
| Rate for Payer: Cigna Commercial |
$15,782.45
|
| Rate for Payer: First Health Commercial |
$18,064.25
|
| Rate for Payer: Humana Commercial |
$16,162.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,592.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,033.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,704.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,733.20
|
| Rate for Payer: Ohio Health Group HMO |
$14,261.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,212.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,543.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,120.35
|
| Rate for Payer: PHCS Commercial |
$18,254.40
|
| Rate for Payer: United Healthcare All Payer |
$16,733.20
|
|
|
PACEMAKER ASSURITY SR PM1240
|
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 ASSURITY SR PM1240
|
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 ASSURITY SR PM1272
|
Facility
|
IP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
PACEMAKER ASSURITY SR PM1272
|
Facility
|
OP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem Medicaid |
$3,040.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Humana KY Medicaid |
$3,040.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
PACEMAKER ATLAS II VR V-168
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PACEMAKER ATLAS II VR V-168
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PACEMAKER AZURE DR MRI W1DR01
|
Facility
|
OP
|
$13,259.04
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,977.71 |
| Max. Negotiated Rate |
$12,728.68 |
| Rate for Payer: Aetna Commercial |
$10,209.46
|
| Rate for Payer: Anthem Medicaid |
$4,559.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,342.05
|
| Rate for Payer: Cash Price |
$6,629.52
|
| Rate for Payer: Cigna Commercial |
$11,005.00
|
| Rate for Payer: First Health Commercial |
$12,596.09
|
| Rate for Payer: Humana Commercial |
$11,270.18
|
| Rate for Payer: Humana KY Medicaid |
$4,559.78
|
| Rate for Payer: Kentucky WC Medicaid |
$4,606.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,872.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,785.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,977.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,651.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,667.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,944.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,607.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,535.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,148.74
|
| Rate for Payer: PHCS Commercial |
$12,728.68
|
| Rate for Payer: United Healthcare All Payer |
$11,667.96
|
|
|
PACEMAKER AZURE DR MRI W1DR01
|
Facility
|
IP
|
$13,259.04
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,977.71 |
| Max. Negotiated Rate |
$12,728.68 |
| Rate for Payer: Aetna Commercial |
$10,209.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,342.05
|
| Rate for Payer: Cash Price |
$6,629.52
|
| Rate for Payer: Cigna Commercial |
$11,005.00
|
| Rate for Payer: First Health Commercial |
$12,596.09
|
| Rate for Payer: Humana Commercial |
$11,270.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,872.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,785.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,977.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,667.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,944.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,607.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,535.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,148.74
|
| Rate for Payer: PHCS Commercial |
$12,728.68
|
| Rate for Payer: United Healthcare All Payer |
$11,667.96
|
|
