|
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
|
|
|
PACEMAKER EVIA DR 359 524
|
Facility
|
OP
|
$22,625.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,787.50 |
| Max. Negotiated Rate |
$21,720.00 |
| Rate for Payer: Aetna Commercial |
$17,421.25
|
| Rate for Payer: Anthem Medicaid |
$7,780.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,647.50
|
| Rate for Payer: Cash Price |
$11,312.50
|
| Rate for Payer: Cigna Commercial |
$18,778.75
|
| Rate for Payer: First Health Commercial |
$21,493.75
|
| Rate for Payer: Humana Commercial |
$19,231.25
|
| Rate for Payer: Humana KY Medicaid |
$7,780.74
|
| Rate for Payer: Kentucky WC Medicaid |
$7,859.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,552.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,697.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,936.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,910.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,968.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,683.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,611.25
|
| Rate for Payer: PHCS Commercial |
$21,720.00
|
| Rate for Payer: United Healthcare All Payer |
$19,910.00
|
|
|
PACEMAKER EVIA DR 359 524
|
Facility
|
IP
|
$22,625.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,787.50 |
| Max. Negotiated Rate |
$21,720.00 |
| Rate for Payer: Aetna Commercial |
$17,421.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,647.50
|
| Rate for Payer: Cash Price |
$11,312.50
|
| Rate for Payer: Cigna Commercial |
$18,778.75
|
| Rate for Payer: First Health Commercial |
$21,493.75
|
| Rate for Payer: Humana Commercial |
$19,231.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,552.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,697.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,910.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,968.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,683.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,611.25
|
| Rate for Payer: PHCS Commercial |
$21,720.00
|
| Rate for Payer: United Healthcare All Payer |
$19,910.00
|
|
|
PACEMAKER EVIA DR-T 359 529
|
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 EVIA DR-T 359 529
|
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 EVIA SR 359531
|
Facility
|
IP
|
$20,937.50
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,281.25 |
| Max. Negotiated Rate |
$20,100.00 |
| Rate for Payer: Aetna Commercial |
$16,121.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,331.25
|
| Rate for Payer: Cash Price |
$10,468.75
|
| Rate for Payer: Cigna Commercial |
$17,378.12
|
| Rate for Payer: First Health Commercial |
$19,890.62
|
| Rate for Payer: Humana Commercial |
$17,796.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,168.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,451.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,281.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,425.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,703.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,750.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,215.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,446.88
|
| Rate for Payer: PHCS Commercial |
$20,100.00
|
| Rate for Payer: United Healthcare All Payer |
$18,425.00
|
|
|
PACEMAKER EVIA SR 359531
|
Facility
|
OP
|
$20,937.50
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,281.25 |
| Max. Negotiated Rate |
$20,100.00 |
| Rate for Payer: Aetna Commercial |
$16,121.88
|
| Rate for Payer: Anthem Medicaid |
$7,200.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,331.25
|
| Rate for Payer: Cash Price |
$10,468.75
|
| Rate for Payer: Cigna Commercial |
$17,378.12
|
| Rate for Payer: First Health Commercial |
$19,890.62
|
| Rate for Payer: Humana Commercial |
$17,796.88
|
| Rate for Payer: Humana KY Medicaid |
$7,200.41
|
| Rate for Payer: Kentucky WC Medicaid |
$7,273.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,168.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,451.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,281.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,344.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,425.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,703.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,750.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,215.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,446.88
|
| Rate for Payer: PHCS Commercial |
$20,100.00
|
| Rate for Payer: United Healthcare All Payer |
$18,425.00
|
|
|
PACEMAKER LEAD ACC KIT 6056M
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$581.35
|
| Rate for Payer: Anthem Medicaid |
$259.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$588.90
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$626.65
|
| Rate for Payer: First Health Commercial |
$717.25
|
| Rate for Payer: Humana Commercial |
$641.75
|
| Rate for Payer: Humana KY Medicaid |
$259.64
|
| Rate for Payer: Kentucky WC Medicaid |
$262.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$264.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.40
|
| Rate for Payer: Ohio Health Group HMO |
$566.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$604.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$520.95
|
| Rate for Payer: PHCS Commercial |
$724.80
|
| Rate for Payer: United Healthcare All Payer |
$664.40
|
|
|
PACEMAKER LEAD ACC KIT 6056M
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$581.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$588.90
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$626.65
|
| Rate for Payer: First Health Commercial |
$717.25
|
| Rate for Payer: Humana Commercial |
$641.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.40
|
| Rate for Payer: Ohio Health Group HMO |
$566.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$604.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$520.95
|
| Rate for Payer: PHCS Commercial |
$724.80
|
| Rate for Payer: United Healthcare All Payer |
$664.40
|
|
|
PACEMAKER PHILOS II DR 341826
|
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 PHILOS II DR 341826
|
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 PROTECTA D334DRG
|
Facility
|
OP
|
$84,600.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$25,380.00 |
| Max. Negotiated Rate |
$81,216.00 |
| Rate for Payer: Aetna Commercial |
$65,142.00
|
| Rate for Payer: Anthem Medicaid |
$29,093.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,988.00
|
| Rate for Payer: Cash Price |
$42,300.00
|
| Rate for Payer: Cigna Commercial |
$70,218.00
|
| Rate for Payer: First Health Commercial |
$80,370.00
|
| Rate for Payer: Humana Commercial |
$71,910.00
|
| Rate for Payer: Humana KY Medicaid |
$29,093.94
|
| Rate for Payer: Kentucky WC Medicaid |
$29,390.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69,372.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62,434.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,380.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,677.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$74,448.00
|
| Rate for Payer: Ohio Health Group HMO |
$63,450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73,602.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58,374.00
|
| Rate for Payer: PHCS Commercial |
$81,216.00
|
| Rate for Payer: United Healthcare All Payer |
$74,448.00
|
|
|
PACEMAKER PROTECTA D334DRG
|
Facility
|
IP
|
$84,600.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$25,380.00 |
| Max. Negotiated Rate |
$81,216.00 |
| Rate for Payer: Aetna Commercial |
$65,142.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,988.00
|
| Rate for Payer: Cash Price |
$42,300.00
|
| Rate for Payer: Cigna Commercial |
$70,218.00
|
| Rate for Payer: First Health Commercial |
$80,370.00
|
| Rate for Payer: Humana Commercial |
$71,910.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69,372.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62,434.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,380.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$74,448.00
|
| Rate for Payer: Ohio Health Group HMO |
$63,450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73,602.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58,374.00
|
| Rate for Payer: PHCS Commercial |
$81,216.00
|
| Rate for Payer: United Healthcare All Payer |
$74,448.00
|
|
|
PACEMAKER W/O PROGRAM SC
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 93288
|
| Hospital Charge Code |
48000083
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$29.10 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$75.66
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.93
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
PACEMAKER W/O PROGRAM SC
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 93288
|
| Hospital Charge Code |
48000083
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem Medicaid |
$33.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$75.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.52
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Humana KY Medicaid |
$33.36
|
| Rate for Payer: Humana Medicare Advantage |
$34.46
|
| Rate for Payer: Kentucky WC Medicaid |
$33.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$34.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.93
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
PACEMKR ADVANTIO DR IS-1 K063
|
Facility
|
IP
|
$15,685.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,705.50 |
| Max. Negotiated Rate |
$15,057.60 |
| Rate for Payer: Aetna Commercial |
$12,077.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,234.30
|
| Rate for Payer: Cash Price |
$7,842.50
|
| Rate for Payer: Cigna Commercial |
$13,018.55
|
| Rate for Payer: First Health Commercial |
$14,900.75
|
| Rate for Payer: Humana Commercial |
$13,332.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,861.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,575.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,705.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,802.80
|
| Rate for Payer: Ohio Health Group HMO |
$11,763.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,548.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,645.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,822.65
|
| Rate for Payer: PHCS Commercial |
$15,057.60
|
| Rate for Payer: United Healthcare All Payer |
$13,802.80
|
|
|
PACEMKR ADVANTIO DR IS-1 K063
|
Facility
|
OP
|
$15,685.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,705.50 |
| Max. Negotiated Rate |
$15,057.60 |
| Rate for Payer: Aetna Commercial |
$12,077.45
|
| Rate for Payer: Anthem Medicaid |
$5,394.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,234.30
|
| Rate for Payer: Cash Price |
$7,842.50
|
| Rate for Payer: Cigna Commercial |
$13,018.55
|
| Rate for Payer: First Health Commercial |
$14,900.75
|
| Rate for Payer: Humana Commercial |
$13,332.25
|
| Rate for Payer: Humana KY Medicaid |
$5,394.07
|
| Rate for Payer: Kentucky WC Medicaid |
$5,448.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,861.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,575.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,705.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,502.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,802.80
|
| Rate for Payer: Ohio Health Group HMO |
$11,763.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,548.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,645.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,822.65
|
| Rate for Payer: PHCS Commercial |
$15,057.60
|
| Rate for Payer: United Healthcare All Payer |
$13,802.80
|
|
|
PACEMKR ANTHEM CRT-P RF PM3210
|
Facility
|
IP
|
$23,750.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,125.00 |
| Max. Negotiated Rate |
$22,800.00 |
| Rate for Payer: Aetna Commercial |
$18,287.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,525.00
|
| Rate for Payer: Cash Price |
$11,875.00
|
| Rate for Payer: Cigna Commercial |
$19,712.50
|
| Rate for Payer: First Health Commercial |
$22,562.50
|
| Rate for Payer: Humana Commercial |
$20,187.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,475.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,527.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,125.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,900.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,812.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,662.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,387.50
|
| Rate for Payer: PHCS Commercial |
$22,800.00
|
| Rate for Payer: United Healthcare All Payer |
$20,900.00
|
|
|
PACEMKR ANTHEM CRT-P RF PM3210
|
Facility
|
OP
|
$23,750.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,125.00 |
| Max. Negotiated Rate |
$22,800.00 |
| Rate for Payer: Aetna Commercial |
$18,287.50
|
| Rate for Payer: Anthem Medicaid |
$8,167.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,525.00
|
| Rate for Payer: Cash Price |
$11,875.00
|
| Rate for Payer: Cigna Commercial |
$19,712.50
|
| Rate for Payer: First Health Commercial |
$22,562.50
|
| Rate for Payer: Humana Commercial |
$20,187.50
|
| Rate for Payer: Humana KY Medicaid |
$8,167.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8,250.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,475.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,527.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,125.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,331.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,900.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,812.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,662.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,387.50
|
| Rate for Payer: PHCS Commercial |
$22,800.00
|
| Rate for Payer: United Healthcare All Payer |
$20,900.00
|
|
|
PACEMKR ASSURTY SR PM1272 CELL
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
PACEMKR ASSURTY SR PM1272 CELL
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
PACIFIC PLUS BALLOON 5*20*180
|
Facility
|
IP
|
$2,136.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$2,050.56 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,708.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,858.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.84
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
PACIFIC PLUS BALLOON 5*20*180
|
Facility
|
OP
|
$2,136.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$2,050.56 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem Medicaid |
$734.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Humana KY Medicaid |
$734.57
|
| Rate for Payer: Kentucky WC Medicaid |
$742.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$749.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,708.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,858.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.84
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
PACIFIC PLUS BALLOON 5*40*180
|
Facility
|
IP
|
$2,136.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$2,050.56 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,708.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,858.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.84
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
PACIFIC PLUS BALLOON 5*40*180
|
Facility
|
OP
|
$2,136.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$2,050.56 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem Medicaid |
$734.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Humana KY Medicaid |
$734.57
|
| Rate for Payer: Kentucky WC Medicaid |
$742.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$749.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,708.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,858.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.84
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
