|
RMV BILIARY DRAIN CATH PERC
|
Facility
|
IP
|
$1,126.00
|
|
|
Service Code
|
HCPCS 47537
|
| Hospital Charge Code |
76101961
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.38 |
| Max. Negotiated Rate |
$1,080.96 |
| Rate for Payer: Aetna Commercial |
$867.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$878.28
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cigna Commercial |
$934.58
|
| Rate for Payer: First Health Commercial |
$1,069.70
|
| Rate for Payer: Humana Commercial |
$957.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$923.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.88
|
| Rate for Payer: Ohio Health Group HMO |
$844.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.06
|
| Rate for Payer: PHCS Commercial |
$1,080.96
|
| Rate for Payer: United Healthcare All Payer |
$990.88
|
|
|
RMV BILIARY DRAIN CATH PERC
|
Facility
|
OP
|
$1,126.00
|
|
|
Service Code
|
HCPCS 47537
|
| Hospital Charge Code |
76101961
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.38 |
| Max. Negotiated Rate |
$1,097.45 |
| Rate for Payer: Aetna Commercial |
$867.02
|
| Rate for Payer: Anthem Medicaid |
$387.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$878.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cigna Commercial |
$934.58
|
| Rate for Payer: First Health Commercial |
$1,069.70
|
| Rate for Payer: Humana Commercial |
$957.10
|
| Rate for Payer: Humana KY Medicaid |
$387.23
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$391.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$923.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.88
|
| Rate for Payer: Ohio Health Group HMO |
$844.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.06
|
| Rate for Payer: PHCS Commercial |
$1,080.96
|
| Rate for Payer: United Healthcare All Payer |
$990.88
|
|
|
RMV EXP TISS EXPANDER W/RPLCMT
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 19499
|
| Hospital Charge Code |
76102683
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Anthem Medicaid |
$250.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$250.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$255.00
|
| Rate for Payer: Molina Healthcare Passport |
$250.00
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.50
|
|
|
RMV INTRAUTERINE DEVICE (IUD)
|
Facility
|
IP
|
$1,083.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
76102221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.79 |
| Max. Negotiated Rate |
$1,039.68 |
| Rate for Payer: Aetna Commercial |
$833.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$844.74
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$898.89
|
| Rate for Payer: First Health Commercial |
$1,028.85
|
| Rate for Payer: Humana Commercial |
$920.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$888.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$799.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$324.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$953.04
|
| Rate for Payer: Ohio Health Group HMO |
$812.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$335.73
|
| Rate for Payer: PHCS Commercial |
$1,039.68
|
| Rate for Payer: United Healthcare All Payer |
$953.04
|
|
|
RMV INTRAUTERINE DEVICE (IUD)
|
Facility
|
OP
|
$1,083.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
76102221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.79 |
| Max. Negotiated Rate |
$1,039.68 |
| Rate for Payer: Aetna Commercial |
$833.91
|
| Rate for Payer: Anthem Medicaid |
$372.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$844.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$388.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.52
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$898.89
|
| Rate for Payer: First Health Commercial |
$1,028.85
|
| Rate for Payer: Humana Commercial |
$920.55
|
| Rate for Payer: Humana KY Medicaid |
$372.44
|
| Rate for Payer: Humana Medicare Advantage |
$277.42
|
| Rate for Payer: Kentucky WC Medicaid |
$376.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$888.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$799.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$379.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$953.04
|
| Rate for Payer: Ohio Health Group HMO |
$812.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$335.73
|
| Rate for Payer: PHCS Commercial |
$1,039.68
|
| Rate for Payer: United Healthcare All Payer |
$953.04
|
|
|
RMV INTRAUTERINE DEVICE (IUD)
|
Professional
|
Both
|
$1,083.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
76102221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$1,083.00 |
| Rate for Payer: Aetna Commercial |
$105.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.04
|
| Rate for Payer: Anthem Medicaid |
$29.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,083.00
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$148.53
|
| Rate for Payer: Healthspan PPO |
$139.38
|
| Rate for Payer: Humana Medicaid |
$29.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.99
|
| Rate for Payer: Molina Healthcare Passport |
$29.40
|
| Rate for Payer: Multiplan PHCS |
$649.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$758.10
|
| Rate for Payer: UHCCP Medicaid |
$36.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.69
|
|
|
RMV INTRAUTERINE DEVICE (IUD(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
761P2221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$105.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.04
|
| Rate for Payer: Anthem Medicaid |
$29.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$148.53
|
| Rate for Payer: Healthspan PPO |
$139.38
|
| Rate for Payer: Humana Medicaid |
$29.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.99
|
| Rate for Payer: Molina Healthcare Passport |
$29.40
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$36.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.69
|
|
|
RMV INTRAUTERINE DEVICE (IUD(T
|
Facility
|
OP
|
$783.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
761T2221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$751.68 |
| Rate for Payer: Aetna Commercial |
$602.91
|
| Rate for Payer: Anthem Medicaid |
$269.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$610.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$388.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.52
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cigna Commercial |
$649.89
|
| Rate for Payer: First Health Commercial |
$743.85
|
| Rate for Payer: Humana Commercial |
$665.55
|
| Rate for Payer: Humana KY Medicaid |
$269.27
|
| Rate for Payer: Humana Medicare Advantage |
$277.42
|
| Rate for Payer: Kentucky WC Medicaid |
$272.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$642.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$577.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$274.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$689.04
|
| Rate for Payer: Ohio Health Group HMO |
$587.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$242.73
|
| Rate for Payer: PHCS Commercial |
$751.68
|
| Rate for Payer: United Healthcare All Payer |
$689.04
|
|
|
RMV INTRAUTERINE DEVICE (IUD(T
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
761T2221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$751.68 |
| Rate for Payer: Aetna Commercial |
$602.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$610.74
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cigna Commercial |
$649.89
|
| Rate for Payer: First Health Commercial |
$743.85
|
| Rate for Payer: Humana Commercial |
$665.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$642.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$577.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$689.04
|
| Rate for Payer: Ohio Health Group HMO |
$587.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$242.73
|
| Rate for Payer: PHCS Commercial |
$751.68
|
| Rate for Payer: United Healthcare All Payer |
$689.04
|
|
|
RMVL I-ARTIC RX DELIVERY DEV
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 20705
|
| Hospital Charge Code |
76102858
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
RMVL I-ARTIC RX DELIVERY DEV
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 20705
|
| Hospital Charge Code |
76102858
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem Medicaid |
$51.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Humana KY Medicaid |
$51.58
|
| Rate for Payer: Kentucky WC Medicaid |
$52.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
RMVL I-ARTIC RX DELIVERY DEV
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 20705
|
| Hospital Charge Code |
76102858
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$164.43 |
| Rate for Payer: Anthem Medicaid |
$96.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Humana Medicaid |
$96.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$164.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$98.68
|
| Rate for Payer: Molina Healthcare Passport |
$96.75
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$97.72
|
|
|
RMVL L HEART IMPELLA DEV PER
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 33992
|
| Hospital Charge Code |
76101333
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.66 |
| Max. Negotiated Rate |
$670.00 |
| Rate for Payer: Anthem Medicaid |
$167.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$670.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$389.49
|
| Rate for Payer: Healthspan PPO |
$266.22
|
| Rate for Payer: Humana Medicaid |
$167.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$281.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$171.01
|
| Rate for Payer: Molina Healthcare Passport |
$167.66
|
| Rate for Payer: Multiplan PHCS |
$402.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$469.00
|
| Rate for Payer: UHCCP Medicaid |
$234.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.34
|
|
|
RMVL L HEART IMPELLA DEV PER
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 33992
|
| Hospital Charge Code |
761P1333
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.66 |
| Max. Negotiated Rate |
$670.00 |
| Rate for Payer: Anthem Medicaid |
$167.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$670.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$389.49
|
| Rate for Payer: Healthspan PPO |
$266.22
|
| Rate for Payer: Humana Medicaid |
$167.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$281.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$171.01
|
| Rate for Payer: Molina Healthcare Passport |
$167.66
|
| Rate for Payer: Multiplan PHCS |
$402.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$469.00
|
| Rate for Payer: UHCCP Medicaid |
$234.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.34
|
|
|
RMVL L HEART IMPELLA DEV PER
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
HCPCS 33992
|
| Hospital Charge Code |
76101333
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.10 |
| Max. Negotiated Rate |
$643.20 |
| Rate for Payer: Aetna Commercial |
$515.90
|
| Rate for Payer: Anthem Medicaid |
$230.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$522.60
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$556.10
|
| Rate for Payer: First Health Commercial |
$636.50
|
| Rate for Payer: Humana Commercial |
$569.50
|
| Rate for Payer: Humana KY Medicaid |
$230.41
|
| Rate for Payer: Kentucky WC Medicaid |
$232.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$549.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$494.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$235.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$589.60
|
| Rate for Payer: Ohio Health Group HMO |
$502.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.70
|
| Rate for Payer: PHCS Commercial |
$643.20
|
| Rate for Payer: United Healthcare All Payer |
$589.60
|
|
|
RMVL L HEART IMPELLA DEV PER
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
HCPCS 33992
|
| Hospital Charge Code |
76101333
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.10 |
| Max. Negotiated Rate |
$643.20 |
| Rate for Payer: Aetna Commercial |
$515.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$522.60
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$556.10
|
| Rate for Payer: First Health Commercial |
$636.50
|
| Rate for Payer: Humana Commercial |
$569.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$549.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$494.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$589.60
|
| Rate for Payer: Ohio Health Group HMO |
$502.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.70
|
| Rate for Payer: PHCS Commercial |
$643.20
|
| Rate for Payer: United Healthcare All Payer |
$589.60
|
|
|
RMVL L HEART IMPELLA DEV PER
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
HCPCS 33992
|
| Hospital Charge Code |
48100008
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$118.04 |
| Max. Negotiated Rate |
$871.68 |
| Rate for Payer: Aetna Commercial |
$699.16
|
| Rate for Payer: Anthem Medicaid |
$312.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$708.24
|
| Rate for Payer: Cash Price |
$454.00
|
| Rate for Payer: Cigna Commercial |
$753.64
|
| Rate for Payer: First Health Commercial |
$862.60
|
| Rate for Payer: Humana Commercial |
$771.80
|
| Rate for Payer: Humana KY Medicaid |
$312.26
|
| Rate for Payer: Kentucky WC Medicaid |
$315.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$744.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$670.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$272.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$318.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$799.04
|
| Rate for Payer: Ohio Health Group HMO |
$681.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$281.48
|
| Rate for Payer: PHCS Commercial |
$871.68
|
| Rate for Payer: United Healthcare All Payer |
$799.04
|
|
|
RMVL L HEART IMPELLA DEV PER
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
HCPCS 33992
|
| Hospital Charge Code |
48100008
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$118.04 |
| Max. Negotiated Rate |
$871.68 |
| Rate for Payer: Aetna Commercial |
$699.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$708.24
|
| Rate for Payer: Cash Price |
$454.00
|
| Rate for Payer: Cigna Commercial |
$753.64
|
| Rate for Payer: First Health Commercial |
$862.60
|
| Rate for Payer: Humana Commercial |
$771.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$744.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$670.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$272.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$799.04
|
| Rate for Payer: Ohio Health Group HMO |
$681.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$281.48
|
| Rate for Payer: PHCS Commercial |
$871.68
|
| Rate for Payer: United Healthcare All Payer |
$799.04
|
|
|
RMVL NINFCT MESH HERNIA RPR
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 49623
|
| Hospital Charge Code |
76102844
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna Commercial |
$169.40
|
| Rate for Payer: Anthem Medicaid |
$75.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.60
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$182.60
|
| Rate for Payer: First Health Commercial |
$209.00
|
| Rate for Payer: Humana Commercial |
$187.00
|
| Rate for Payer: Humana KY Medicaid |
$75.66
|
| Rate for Payer: Kentucky WC Medicaid |
$76.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$180.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$162.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$77.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$193.60
|
| Rate for Payer: Ohio Health Group HMO |
$165.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68.20
|
| Rate for Payer: PHCS Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Payer |
$193.60
|
|
|
RMVL NINFCT MESH HERNIA RPR
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 49623
|
| Hospital Charge Code |
76102844
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna Commercial |
$169.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.60
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$182.60
|
| Rate for Payer: First Health Commercial |
$209.00
|
| Rate for Payer: Humana Commercial |
$187.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$180.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$162.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$193.60
|
| Rate for Payer: Ohio Health Group HMO |
$165.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68.20
|
| Rate for Payer: PHCS Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Payer |
$193.60
|
|
|
RMVL NINFCT MESH HERNIA RPR
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 49623
|
| Hospital Charge Code |
76102844
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Anthem Medicaid |
$166.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Humana Medicaid |
$166.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$169.69
|
| Rate for Payer: Molina Healthcare Passport |
$166.36
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.00
|
| Rate for Payer: UHCCP Medicaid |
$77.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$168.02
|
|
|
RMVL OF SUBQ DEFIBRILLATOR
|
Facility
|
IP
|
$7,205.00
|
|
|
Service Code
|
HCPCS 33272
|
| Hospital Charge Code |
76101278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$936.65 |
| Max. Negotiated Rate |
$6,916.80 |
| Rate for Payer: Aetna Commercial |
$5,547.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,619.90
|
| Rate for Payer: Cash Price |
$3,602.50
|
| Rate for Payer: Cigna Commercial |
$5,980.15
|
| Rate for Payer: First Health Commercial |
$6,844.75
|
| Rate for Payer: Humana Commercial |
$6,124.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,908.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,317.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,161.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,340.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,403.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$936.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,233.55
|
| Rate for Payer: PHCS Commercial |
$6,916.80
|
| Rate for Payer: United Healthcare All Payer |
$6,340.40
|
|
|
RMVL OF SUBQ DEFIBRILLATOR
|
Professional
|
Both
|
$7,205.00
|
|
|
Service Code
|
HCPCS 33272
|
| Hospital Charge Code |
76101278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.94 |
| Max. Negotiated Rate |
$7,205.00 |
| Rate for Payer: Anthem Medicaid |
$290.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,205.00
|
| Rate for Payer: Cash Price |
$3,602.50
|
| Rate for Payer: Cash Price |
$3,602.50
|
| Rate for Payer: Cigna Commercial |
$662.14
|
| Rate for Payer: Humana Medicaid |
$290.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$482.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$296.76
|
| Rate for Payer: Molina Healthcare Passport |
$290.94
|
| Rate for Payer: Multiplan PHCS |
$4,323.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,043.50
|
| Rate for Payer: UHCCP Medicaid |
$2,521.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$293.85
|
|
|
RMVL OF SUBQ DEFIBRILLATOR
|
Facility
|
OP
|
$7,205.00
|
|
|
Service Code
|
HCPCS 33272
|
| Hospital Charge Code |
76101278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$936.65 |
| Max. Negotiated Rate |
$6,916.80 |
| Rate for Payer: Aetna Commercial |
$5,547.85
|
| Rate for Payer: Anthem Medicaid |
$2,477.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,395.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,619.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,754.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,584.45
|
| Rate for Payer: Cash Price |
$3,602.50
|
| Rate for Payer: Cash Price |
$3,602.50
|
| Rate for Payer: Cigna Commercial |
$5,980.15
|
| Rate for Payer: First Health Commercial |
$6,844.75
|
| Rate for Payer: Humana Commercial |
$6,124.25
|
| Rate for Payer: Humana KY Medicaid |
$2,477.80
|
| Rate for Payer: Humana Medicare Advantage |
$3,395.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,503.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,908.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,317.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,527.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,340.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,403.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$936.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,233.55
|
| Rate for Payer: PHCS Commercial |
$6,916.80
|
| Rate for Payer: United Healthcare All Payer |
$6,340.40
|
|
|
RMVL OF SUBQ DEFIBRILLATOR(P
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 33272
|
| Hospital Charge Code |
761P1278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.94 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Anthem Medicaid |
$290.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,040.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$662.14
|
| Rate for Payer: Humana Medicaid |
$290.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$482.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$296.76
|
| Rate for Payer: Molina Healthcare Passport |
$290.94
|
| Rate for Payer: Multiplan PHCS |
$624.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$728.00
|
| Rate for Payer: UHCCP Medicaid |
$364.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$293.85
|
|
