|
PACEMAKER AZURE DR MRI W3DR01
|
Facility
|
IP
|
$17,816.20
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,344.86 |
| Max. Negotiated Rate |
$17,103.55 |
| Rate for Payer: Aetna Commercial |
$13,718.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,896.64
|
| Rate for Payer: Cash Price |
$8,908.10
|
| Rate for Payer: Cigna Commercial |
$14,787.45
|
| Rate for Payer: First Health Commercial |
$16,925.39
|
| Rate for Payer: Humana Commercial |
$15,143.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,609.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,148.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,344.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,678.26
|
| Rate for Payer: Ohio Health Group HMO |
$13,362.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,252.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,500.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,293.18
|
| Rate for Payer: PHCS Commercial |
$17,103.55
|
| Rate for Payer: United Healthcare All Payer |
$15,678.26
|
|
|
PACEMAKER AZURE DR MRI W3DR01
|
Facility
|
OP
|
$17,816.20
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,344.86 |
| Max. Negotiated Rate |
$17,103.55 |
| Rate for Payer: Aetna Commercial |
$13,718.47
|
| Rate for Payer: Anthem Medicaid |
$6,126.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,896.64
|
| Rate for Payer: Cash Price |
$8,908.10
|
| Rate for Payer: Cigna Commercial |
$14,787.45
|
| Rate for Payer: First Health Commercial |
$16,925.39
|
| Rate for Payer: Humana Commercial |
$15,143.77
|
| Rate for Payer: Humana KY Medicaid |
$6,126.99
|
| Rate for Payer: Kentucky WC Medicaid |
$6,189.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,609.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,148.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,344.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,249.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,678.26
|
| Rate for Payer: Ohio Health Group HMO |
$13,362.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,252.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,500.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,293.18
|
| Rate for Payer: PHCS Commercial |
$17,103.55
|
| Rate for Payer: United Healthcare All Payer |
$15,678.26
|
|
|
PACEMAKER AZURE SR MRI W1SR01
|
Facility
|
IP
|
$11,493.26
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,447.98 |
| Max. Negotiated Rate |
$11,033.53 |
| Rate for Payer: Aetna Commercial |
$8,849.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,964.74
|
| Rate for Payer: Cash Price |
$5,746.63
|
| Rate for Payer: Cigna Commercial |
$9,539.41
|
| Rate for Payer: First Health Commercial |
$10,918.60
|
| Rate for Payer: Humana Commercial |
$9,769.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,424.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,482.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,447.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,114.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,619.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,194.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,999.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,930.35
|
| Rate for Payer: PHCS Commercial |
$11,033.53
|
| Rate for Payer: United Healthcare All Payer |
$10,114.07
|
|
|
PACEMAKER AZURE SR MRI W1SR01
|
Facility
|
OP
|
$11,493.26
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,447.98 |
| Max. Negotiated Rate |
$11,033.53 |
| Rate for Payer: Aetna Commercial |
$8,849.81
|
| Rate for Payer: Anthem Medicaid |
$3,952.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,964.74
|
| Rate for Payer: Cash Price |
$5,746.63
|
| Rate for Payer: Cigna Commercial |
$9,539.41
|
| Rate for Payer: First Health Commercial |
$10,918.60
|
| Rate for Payer: Humana Commercial |
$9,769.27
|
| Rate for Payer: Humana KY Medicaid |
$3,952.53
|
| Rate for Payer: Kentucky WC Medicaid |
$3,992.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,424.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,482.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,447.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,031.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,114.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,619.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,194.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,999.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,930.35
|
| Rate for Payer: PHCS Commercial |
$11,033.53
|
| Rate for Payer: United Healthcare All Payer |
$10,114.07
|
|
|
PACEMAKER CYLOS DR 349799
|
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 CYLOS DR 349799
|
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 DCCR ADAPTA ADDR01
|
Facility
|
IP
|
$16,240.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,872.00 |
| Max. Negotiated Rate |
$15,590.40 |
| Rate for Payer: Aetna Commercial |
$12,504.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,667.20
|
| Rate for Payer: Cash Price |
$8,120.00
|
| Rate for Payer: Cigna Commercial |
$13,479.20
|
| Rate for Payer: First Health Commercial |
$15,428.00
|
| Rate for Payer: Humana Commercial |
$13,804.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,316.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,985.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,872.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,205.60
|
| Rate for Payer: PHCS Commercial |
$15,590.40
|
| Rate for Payer: United Healthcare All Payer |
$14,291.20
|
|
|
PACEMAKER DCCR ADAPTA ADDR01
|
Facility
|
OP
|
$16,240.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,872.00 |
| Max. Negotiated Rate |
$15,590.40 |
| Rate for Payer: Aetna Commercial |
$12,504.80
|
| Rate for Payer: Anthem Medicaid |
$5,584.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,667.20
|
| Rate for Payer: Cash Price |
$8,120.00
|
| Rate for Payer: Cigna Commercial |
$13,479.20
|
| Rate for Payer: First Health Commercial |
$15,428.00
|
| Rate for Payer: Humana Commercial |
$13,804.00
|
| Rate for Payer: Humana KY Medicaid |
$5,584.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,641.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,316.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,985.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,872.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,696.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,205.60
|
| Rate for Payer: PHCS Commercial |
$15,590.40
|
| Rate for Payer: United Healthcare All Payer |
$14,291.20
|
|
|
PACEMAKER DCCR ADAPTA ADDR06
|
Facility
|
IP
|
$13,776.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
PACEMAKER DCCR ADAPTA ADDR06
|
Facility
|
OP
|
$13,776.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem Medicaid |
$4,737.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Humana KY Medicaid |
$4,737.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,785.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,832.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
PACEMAKER DCCR ADAPTA ADDRS1
|
Facility
|
IP
|
$13,776.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
PACEMAKER DCCR ADAPTA ADDRS1
|
Facility
|
OP
|
$13,776.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem Medicaid |
$4,737.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Humana KY Medicaid |
$4,737.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,785.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,832.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
PACEMAKER DCRR ACCOLADE L311
|
Facility
|
OP
|
$16,813.50
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,044.05 |
| Max. Negotiated Rate |
$16,140.96 |
| Rate for Payer: Aetna Commercial |
$12,946.40
|
| Rate for Payer: Anthem Medicaid |
$5,782.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,114.53
|
| Rate for Payer: Cash Price |
$8,406.75
|
| Rate for Payer: Cigna Commercial |
$13,955.20
|
| Rate for Payer: First Health Commercial |
$15,972.83
|
| Rate for Payer: Humana Commercial |
$14,291.48
|
| Rate for Payer: Humana KY Medicaid |
$5,782.16
|
| Rate for Payer: Kentucky WC Medicaid |
$5,841.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,787.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,408.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,044.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,898.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,795.88
|
| Rate for Payer: Ohio Health Group HMO |
$12,610.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,450.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,627.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,601.32
|
| Rate for Payer: PHCS Commercial |
$16,140.96
|
| Rate for Payer: United Healthcare All Payer |
$14,795.88
|
|
|
PACEMAKER DCRR ACCOLADE L311
|
Facility
|
IP
|
$16,813.50
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,044.05 |
| Max. Negotiated Rate |
$16,140.96 |
| Rate for Payer: Aetna Commercial |
$12,946.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,114.53
|
| Rate for Payer: Cash Price |
$8,406.75
|
| Rate for Payer: Cigna Commercial |
$13,955.20
|
| Rate for Payer: First Health Commercial |
$15,972.83
|
| Rate for Payer: Humana Commercial |
$14,291.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,787.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,408.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,044.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,795.88
|
| Rate for Payer: Ohio Health Group HMO |
$12,610.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,450.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,627.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,601.32
|
| Rate for Payer: PHCS Commercial |
$16,140.96
|
| Rate for Payer: United Healthcare All Payer |
$14,795.88
|
|
|
PACEMAKER DCRR ADAPTA ADDRL1
|
Facility
|
OP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,205.00 |
| Max. Negotiated Rate |
$16,656.00 |
| Rate for Payer: Aetna Commercial |
$13,359.50
|
| Rate for Payer: Anthem Medicaid |
$5,966.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,533.00
|
| Rate for Payer: Cash Price |
$8,675.00
|
| Rate for Payer: Cigna Commercial |
$14,400.50
|
| Rate for Payer: First Health Commercial |
$16,482.50
|
| Rate for Payer: Humana Commercial |
$14,747.50
|
| Rate for Payer: Humana KY Medicaid |
$5,966.66
|
| Rate for Payer: Kentucky WC Medicaid |
$6,027.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,227.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,804.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,205.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,086.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,094.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,971.50
|
| Rate for Payer: PHCS Commercial |
$16,656.00
|
| Rate for Payer: United Healthcare All Payer |
$15,268.00
|
|
|
PACEMAKER DCRR ADAPTA ADDRL1
|
Facility
|
IP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,205.00 |
| Max. Negotiated Rate |
$16,656.00 |
| Rate for Payer: Aetna Commercial |
$13,359.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,533.00
|
| Rate for Payer: Cash Price |
$8,675.00
|
| Rate for Payer: Cigna Commercial |
$14,400.50
|
| Rate for Payer: First Health Commercial |
$16,482.50
|
| Rate for Payer: Humana Commercial |
$14,747.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,227.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,804.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,205.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,094.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,971.50
|
| Rate for Payer: PHCS Commercial |
$16,656.00
|
| Rate for Payer: United Healthcare All Payer |
$15,268.00
|
|
|
PACEMAKER DCRR ENTOVIS DR-T
|
Facility
|
OP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,687.50 |
| Max. Negotiated Rate |
$24,600.00 |
| Rate for Payer: Aetna Commercial |
$19,731.25
|
| Rate for Payer: Anthem Medicaid |
$8,812.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,987.50
|
| Rate for Payer: Cash Price |
$12,812.50
|
| Rate for Payer: Cigna Commercial |
$21,268.75
|
| Rate for Payer: First Health Commercial |
$24,343.75
|
| Rate for Payer: Humana Commercial |
$21,781.25
|
| Rate for Payer: Humana KY Medicaid |
$8,812.44
|
| Rate for Payer: Kentucky WC Medicaid |
$8,902.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,012.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,911.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,687.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,989.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,550.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,293.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,681.25
|
| Rate for Payer: PHCS Commercial |
$24,600.00
|
| Rate for Payer: United Healthcare All Payer |
$22,550.00
|
|
|
PACEMAKER DCRR ENTOVIS DR-T
|
Facility
|
IP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,687.50 |
| Max. Negotiated Rate |
$24,600.00 |
| Rate for Payer: Aetna Commercial |
$19,731.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,987.50
|
| Rate for Payer: Cash Price |
$12,812.50
|
| Rate for Payer: Cigna Commercial |
$21,268.75
|
| Rate for Payer: First Health Commercial |
$24,343.75
|
| Rate for Payer: Humana Commercial |
$21,781.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,012.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,911.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,687.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,550.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,293.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,681.25
|
| Rate for Payer: PHCS Commercial |
$24,600.00
|
| Rate for Payer: United Healthcare All Payer |
$22,550.00
|
|
|
PACEMAKER DCRR MRI RVDR01
|
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 DCRR MRI RVDR01
|
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 ELUNA 8 DR-T 394969
|
Facility
|
IP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,687.50 |
| Max. Negotiated Rate |
$24,600.00 |
| Rate for Payer: Aetna Commercial |
$19,731.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,987.50
|
| Rate for Payer: Cash Price |
$12,812.50
|
| Rate for Payer: Cigna Commercial |
$21,268.75
|
| Rate for Payer: First Health Commercial |
$24,343.75
|
| Rate for Payer: Humana Commercial |
$21,781.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,012.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,911.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,687.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,550.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,293.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,681.25
|
| Rate for Payer: PHCS Commercial |
$24,600.00
|
| Rate for Payer: United Healthcare All Payer |
$22,550.00
|
|
|
PACEMAKER ELUNA 8 DR-T 394969
|
Facility
|
OP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,687.50 |
| Max. Negotiated Rate |
$24,600.00 |
| Rate for Payer: Aetna Commercial |
$19,731.25
|
| Rate for Payer: Anthem Medicaid |
$8,812.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,987.50
|
| Rate for Payer: Cash Price |
$12,812.50
|
| Rate for Payer: Cigna Commercial |
$21,268.75
|
| Rate for Payer: First Health Commercial |
$24,343.75
|
| Rate for Payer: Humana Commercial |
$21,781.25
|
| Rate for Payer: Humana KY Medicaid |
$8,812.44
|
| Rate for Payer: Kentucky WC Medicaid |
$8,902.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,012.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,911.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,687.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,989.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,550.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,293.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,681.25
|
| Rate for Payer: PHCS Commercial |
$24,600.00
|
| Rate for Payer: United Healthcare All Payer |
$22,550.00
|
|
|
PACEMAKER ENDURITY U US PM2160
|
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 ENDURITY U US PM2160
|
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 ETRINSA 8 DR-T 39493
|
Facility
|
IP
|
$16,036.50
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,810.95 |
| Max. Negotiated Rate |
$15,395.04 |
| Rate for Payer: Aetna Commercial |
$12,348.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,508.47
|
| Rate for Payer: Cash Price |
$8,018.25
|
| Rate for Payer: Cigna Commercial |
$13,310.30
|
| Rate for Payer: First Health Commercial |
$15,234.67
|
| Rate for Payer: Humana Commercial |
$13,631.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,149.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,834.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,810.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,112.12
|
| Rate for Payer: Ohio Health Group HMO |
$12,027.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,829.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,951.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,065.18
|
| Rate for Payer: PHCS Commercial |
$15,395.04
|
| Rate for Payer: United Healthcare All Payer |
$14,112.12
|
|
