|
RMVL OF SUBQ DEFIBRILLATOR(T
|
Facility
|
IP
|
$6,165.00
|
|
|
Service Code
|
HCPCS 33272
|
| Hospital Charge Code |
761T1278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$801.45 |
| Max. Negotiated Rate |
$5,918.40 |
| Rate for Payer: Aetna Commercial |
$4,747.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,808.70
|
| Rate for Payer: Cash Price |
$3,082.50
|
| Rate for Payer: Cigna Commercial |
$5,116.95
|
| Rate for Payer: First Health Commercial |
$5,856.75
|
| Rate for Payer: Humana Commercial |
$5,240.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,055.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,549.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,849.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,425.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,623.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$801.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,911.15
|
| Rate for Payer: PHCS Commercial |
$5,918.40
|
| Rate for Payer: United Healthcare All Payer |
$5,425.20
|
|
|
RMVL OF SUBQ DEFIBRILLATOR(T
|
Facility
|
OP
|
$6,165.00
|
|
|
Service Code
|
HCPCS 33272
|
| Hospital Charge Code |
761T1278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$801.45 |
| Max. Negotiated Rate |
$5,918.40 |
| Rate for Payer: Aetna Commercial |
$4,747.05
|
| Rate for Payer: Anthem Medicaid |
$2,120.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,395.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,808.70
|
| 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 |
$3,082.50
|
| Rate for Payer: Cash Price |
$3,082.50
|
| Rate for Payer: Cigna Commercial |
$5,116.95
|
| Rate for Payer: First Health Commercial |
$5,856.75
|
| Rate for Payer: Humana Commercial |
$5,240.25
|
| Rate for Payer: Humana KY Medicaid |
$2,120.14
|
| Rate for Payer: Humana Medicare Advantage |
$3,395.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,141.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,055.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,549.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,162.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,425.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,623.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$801.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,911.15
|
| Rate for Payer: PHCS Commercial |
$5,918.40
|
| Rate for Payer: United Healthcare All Payer |
$5,425.20
|
|
|
RMVL& REPLC PULSE GEN 1 LEAD
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 33262
|
| Hospital Charge Code |
76101273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
RMVL& REPLC PULSE GEN 1 LEAD
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 33262
|
| Hospital Charge Code |
76101273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.16 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Anthem Medicaid |
$295.16
|
| 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: Cigna Commercial |
$684.41
|
| Rate for Payer: Healthspan PPO |
$459.94
|
| Rate for Payer: Humana Medicaid |
$295.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$492.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$301.06
|
| Rate for Payer: Molina Healthcare Passport |
$295.16
|
| 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 |
$298.11
|
|
|
RMVL& REPLC PULSE GEN 1 LEAD
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 33262
|
| Hospital Charge Code |
76101273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$28,536.86 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20,383.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28,536.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$27,517.68
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$20,383.47
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,460.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
RMVL& REPLC PULSE GEN 1 LEA(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 33262
|
| Hospital Charge Code |
761P1273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.16 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Anthem Medicaid |
$295.16
|
| 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: Cigna Commercial |
$684.41
|
| Rate for Payer: Healthspan PPO |
$459.94
|
| Rate for Payer: Humana Medicaid |
$295.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$492.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$301.06
|
| Rate for Payer: Molina Healthcare Passport |
$295.16
|
| 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 |
$298.11
|
|
|
RMVL & RPLCMT DFB GEN 2 LEAD
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 33263
|
| Hospital Charge Code |
76101274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$306.86 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Anthem Medicaid |
$306.86
|
| 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: Cigna Commercial |
$711.53
|
| Rate for Payer: Healthspan PPO |
$478.24
|
| Rate for Payer: Humana Medicaid |
$306.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$512.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$313.00
|
| Rate for Payer: Molina Healthcare Passport |
$306.86
|
| 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 |
$309.93
|
|
|
RMVL & RPLCMT DFB GEN 2 LEAD
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 33263
|
| Hospital Charge Code |
76101274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$28,536.86 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20,383.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28,536.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$27,517.68
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$20,383.47
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,460.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
RMVL & RPLCMT DFB GEN 2 LEAD
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 33263
|
| Hospital Charge Code |
76101274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
RMVL & RPLCMT DFB GEN 2 LEA(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 33263
|
| Hospital Charge Code |
761P1274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$306.86 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Anthem Medicaid |
$306.86
|
| 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: Cigna Commercial |
$711.53
|
| Rate for Payer: Healthspan PPO |
$478.24
|
| Rate for Payer: Humana Medicaid |
$306.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$512.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$313.00
|
| Rate for Payer: Molina Healthcare Passport |
$306.86
|
| 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 |
$309.93
|
|
|
RMVL & RPLCMT DFB GEN MLT LD
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 33264
|
| Hospital Charge Code |
76101275
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.56 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Anthem Medicaid |
$318.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$738.65
|
| Rate for Payer: Healthspan PPO |
$496.55
|
| Rate for Payer: Humana Medicaid |
$318.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$532.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$324.93
|
| Rate for Payer: Molina Healthcare Passport |
$318.56
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$321.75
|
|
|
RMVL & RPLCMT DFB GEN MLT LD
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 33264
|
| Hospital Charge Code |
76101275
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$39,829.45 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$28,449.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$39,829.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$38,406.97
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Humana KY Medicaid |
$928.53
|
| Rate for Payer: Humana Medicare Advantage |
$28,449.61
|
| Rate for Payer: Kentucky WC Medicaid |
$937.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34,139.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
RMVL & RPLCMT DFB GEN MLT LD
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 33264
|
| Hospital Charge Code |
76101275
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
RMVL & RPLCMT DFB GEN MLT L(P
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 33264
|
| Hospital Charge Code |
761P1275
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.56 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Anthem Medicaid |
$318.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$738.65
|
| Rate for Payer: Healthspan PPO |
$496.55
|
| Rate for Payer: Humana Medicaid |
$318.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$532.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$324.93
|
| Rate for Payer: Molina Healthcare Passport |
$318.56
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$321.75
|
|
|
RMVL RUPTURED BREAST IMPLANT
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 19330
|
| Hospital Charge Code |
76100310
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.98 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna Commercial |
$906.93
|
| Rate for Payer: Anthem Medicaid |
$332.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$975.00
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$854.08
|
| Rate for Payer: Healthspan PPO |
$725.17
|
| Rate for Payer: Humana Medicaid |
$332.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$806.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$339.64
|
| Rate for Payer: Molina Healthcare Passport |
$332.98
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$682.50
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$336.31
|
|
|
RMVL RUPTURED BREAST IMPLANT
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS 19330
|
| Hospital Charge Code |
76100310
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$4,614.69 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem Medicaid |
$335.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Humana KY Medicaid |
$335.30
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Kentucky WC Medicaid |
$338.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$342.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.25
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
RMVL RUPTURED BREAST IMPLANT
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS 19330
|
| Hospital Charge Code |
76100310
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$292.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.25
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
RMVL RUPTURED BREAST IMPLANT(P
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 19330
|
| Hospital Charge Code |
761P0310
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.98 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna Commercial |
$906.93
|
| Rate for Payer: Anthem Medicaid |
$332.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$975.00
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$854.08
|
| Rate for Payer: Healthspan PPO |
$725.17
|
| Rate for Payer: Humana Medicaid |
$332.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$806.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$339.64
|
| Rate for Payer: Molina Healthcare Passport |
$332.98
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$682.50
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$336.31
|
|
|
RMVL SUBQ CAR RHYTHM MNTR
|
Facility
|
IP
|
$3,041.00
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
76101280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.33 |
| Max. Negotiated Rate |
$2,919.36 |
| Rate for Payer: Aetna Commercial |
$2,341.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,371.98
|
| Rate for Payer: Cash Price |
$1,520.50
|
| Rate for Payer: Cigna Commercial |
$2,524.03
|
| Rate for Payer: First Health Commercial |
$2,888.95
|
| Rate for Payer: Humana Commercial |
$2,584.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,493.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,244.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$912.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,676.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,280.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$608.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$395.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$942.71
|
| Rate for Payer: PHCS Commercial |
$2,919.36
|
| Rate for Payer: United Healthcare All Payer |
$2,676.08
|
|
|
RMVL SUBQ CAR RHYTHM MNTR
|
Professional
|
Both
|
$3,041.00
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
76101280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.03 |
| Max. Negotiated Rate |
$3,041.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.63
|
| Rate for Payer: Anthem Medicaid |
$71.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,041.00
|
| Rate for Payer: Cash Price |
$1,520.50
|
| Rate for Payer: Cash Price |
$1,520.50
|
| Rate for Payer: Cigna Commercial |
$160.18
|
| Rate for Payer: Humana Medicaid |
$71.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$120.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.45
|
| Rate for Payer: Molina Healthcare Passport |
$71.03
|
| Rate for Payer: Multiplan PHCS |
$1,824.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,128.70
|
| Rate for Payer: UHCCP Medicaid |
$75.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.74
|
|
|
RMVL SUBQ CAR RHYTHM MNTR
|
Facility
|
OP
|
$3,041.00
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
76101280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.33 |
| Max. Negotiated Rate |
$2,919.36 |
| Rate for Payer: Aetna Commercial |
$2,341.57
|
| Rate for Payer: Anthem Medicaid |
$1,045.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,371.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,520.50
|
| Rate for Payer: Cash Price |
$1,520.50
|
| Rate for Payer: Cigna Commercial |
$2,524.03
|
| Rate for Payer: First Health Commercial |
$2,888.95
|
| Rate for Payer: Humana Commercial |
$2,584.85
|
| Rate for Payer: Humana KY Medicaid |
$1,045.80
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,056.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,493.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,244.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,066.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,676.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,280.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$608.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$395.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$942.71
|
| Rate for Payer: PHCS Commercial |
$2,919.36
|
| Rate for Payer: United Healthcare All Payer |
$2,676.08
|
|
|
RMVL SUBQ CAR RHYTHM MNTR(P
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
761P1280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.03 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.63
|
| Rate for Payer: Anthem Medicaid |
$71.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$290.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$160.18
|
| Rate for Payer: Humana Medicaid |
$71.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$120.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.45
|
| Rate for Payer: Molina Healthcare Passport |
$71.03
|
| Rate for Payer: Multiplan PHCS |
$174.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$203.00
|
| Rate for Payer: UHCCP Medicaid |
$75.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.74
|
|
|
RMVL SUBQ CAR RHYTHM MNTR(T
|
Facility
|
IP
|
$2,751.00
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
761T1280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$357.63 |
| Max. Negotiated Rate |
$2,640.96 |
| Rate for Payer: Aetna Commercial |
$2,118.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,145.78
|
| Rate for Payer: Cash Price |
$1,375.50
|
| Rate for Payer: Cigna Commercial |
$2,283.33
|
| Rate for Payer: First Health Commercial |
$2,613.45
|
| Rate for Payer: Humana Commercial |
$2,338.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,255.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,030.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$825.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,420.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,063.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$550.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$357.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$852.81
|
| Rate for Payer: PHCS Commercial |
$2,640.96
|
| Rate for Payer: United Healthcare All Payer |
$2,420.88
|
|
|
RMVL SUBQ CAR RHYTHM MNTR(T
|
Facility
|
OP
|
$2,751.00
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
761T1280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$357.63 |
| Max. Negotiated Rate |
$2,640.96 |
| Rate for Payer: Aetna Commercial |
$2,118.27
|
| Rate for Payer: Anthem Medicaid |
$946.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,145.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,375.50
|
| Rate for Payer: Cash Price |
$1,375.50
|
| Rate for Payer: Cigna Commercial |
$2,283.33
|
| Rate for Payer: First Health Commercial |
$2,613.45
|
| Rate for Payer: Humana Commercial |
$2,338.35
|
| Rate for Payer: Humana KY Medicaid |
$946.07
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$955.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,255.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,030.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$965.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,420.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,063.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$550.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$357.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$852.81
|
| Rate for Payer: PHCS Commercial |
$2,640.96
|
| Rate for Payer: United Healthcare All Payer |
$2,420.88
|
|
|
ROBAXINMETHOCARB 1000MG/10MLVL
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS J2800
|
| Hospital Charge Code |
25002355
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.26
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.27
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
