|
R/L HC W/INJ ART& L VENT IMG(T
|
Facility
|
OP
|
$15,755.00
|
|
|
Service Code
|
HCPCS 93460
|
| Hospital Charge Code |
761T2484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$15,124.80 |
| Rate for Payer: Aetna Commercial |
$12,131.35
|
| Rate for Payer: Anthem Medicaid |
$5,418.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,288.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$7,877.50
|
| Rate for Payer: Cash Price |
$7,877.50
|
| Rate for Payer: Cigna Commercial |
$13,076.65
|
| Rate for Payer: First Health Commercial |
$14,967.25
|
| Rate for Payer: Humana Commercial |
$13,391.75
|
| Rate for Payer: Humana KY Medicaid |
$5,418.14
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$5,473.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,919.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,627.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,526.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,864.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,816.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,604.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,706.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,870.95
|
| Rate for Payer: PHCS Commercial |
$15,124.80
|
| Rate for Payer: United Healthcare All Payer |
$13,864.40
|
|
|
R&L HRT CATH W/VENTRICLGRPH(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
761P2477
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$1,906.32 |
| Rate for Payer: Aetna Commercial |
$1,740.44
|
| Rate for Payer: Ambetter Exchange |
$986.93
|
| Rate for Payer: Anthem Medicaid |
$968.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$986.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$986.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,184.32
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$1,906.32
|
| Rate for Payer: Healthspan PPO |
$1,293.72
|
| Rate for Payer: Humana Medicaid |
$968.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$464.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$986.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$986.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$988.10
|
| Rate for Payer: Molina Healthcare Passport |
$968.73
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,283.01
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$978.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$986.93
|
|
|
R&L HRT CATH W/VENTRICLGRPH(T
|
Facility
|
IP
|
$15,606.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
761T2477
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,681.80 |
| Max. Negotiated Rate |
$14,981.76 |
| Rate for Payer: Aetna Commercial |
$12,016.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,172.68
|
| Rate for Payer: Cash Price |
$7,803.00
|
| Rate for Payer: Cigna Commercial |
$12,952.98
|
| Rate for Payer: First Health Commercial |
$14,825.70
|
| Rate for Payer: Humana Commercial |
$13,265.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,796.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,517.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,681.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,733.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,704.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,484.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,577.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,768.14
|
| Rate for Payer: PHCS Commercial |
$14,981.76
|
| Rate for Payer: United Healthcare All Payer |
$13,733.28
|
|
|
R&L HRT CATH W/VENTRICLGRPH(T
|
Facility
|
OP
|
$15,606.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
761T2477
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$14,981.76 |
| Rate for Payer: Aetna Commercial |
$12,016.62
|
| Rate for Payer: Anthem Medicaid |
$5,366.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,172.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$7,803.00
|
| Rate for Payer: Cash Price |
$7,803.00
|
| Rate for Payer: Cigna Commercial |
$12,952.98
|
| Rate for Payer: First Health Commercial |
$14,825.70
|
| Rate for Payer: Humana Commercial |
$13,265.10
|
| Rate for Payer: Humana KY Medicaid |
$5,366.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$5,421.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,796.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,517.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,474.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,733.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,704.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,484.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,577.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,768.14
|
| Rate for Payer: PHCS Commercial |
$14,981.76
|
| Rate for Payer: United Healthcare All Payer |
$13,733.28
|
|
|
R&L HRT CATH W/VENTRICLGRPHY
|
Facility
|
IP
|
$16,620.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
48100064
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,986.00 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,986.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,296.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,459.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,467.80
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
R&L HRT CATH W/VENTRICLGRPHY
|
Facility
|
OP
|
$16,156.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
76102477
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$15,509.76 |
| Rate for Payer: Aetna Commercial |
$12,440.12
|
| Rate for Payer: Anthem Medicaid |
$5,556.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,601.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$8,078.00
|
| Rate for Payer: Cash Price |
$8,078.00
|
| Rate for Payer: Cigna Commercial |
$13,409.48
|
| Rate for Payer: First Health Commercial |
$15,348.20
|
| Rate for Payer: Humana Commercial |
$13,732.60
|
| Rate for Payer: Humana KY Medicaid |
$5,556.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$5,612.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,247.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,923.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,667.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,217.28
|
| Rate for Payer: Ohio Health Group HMO |
$12,117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,924.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,055.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,147.64
|
| Rate for Payer: PHCS Commercial |
$15,509.76
|
| Rate for Payer: United Healthcare All Payer |
$14,217.28
|
|
|
R&L HRT CATH W/VENTRICLGRPHY
|
Facility
|
OP
|
$16,620.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
48100064
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem Medicaid |
$5,715.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Humana KY Medicaid |
$5,715.62
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$5,773.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,830.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,296.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,459.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,467.80
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
R&L HRT CATH W/VENTRICLGRPHY
|
Facility
|
IP
|
$16,156.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
76102477
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,846.80 |
| Max. Negotiated Rate |
$15,509.76 |
| Rate for Payer: Aetna Commercial |
$12,440.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,601.68
|
| Rate for Payer: Cash Price |
$8,078.00
|
| Rate for Payer: Cigna Commercial |
$13,409.48
|
| Rate for Payer: First Health Commercial |
$15,348.20
|
| Rate for Payer: Humana Commercial |
$13,732.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,247.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,923.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,846.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,217.28
|
| Rate for Payer: Ohio Health Group HMO |
$12,117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,924.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,055.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,147.64
|
| Rate for Payer: PHCS Commercial |
$15,509.76
|
| Rate for Payer: United Healthcare All Payer |
$14,217.28
|
|
|
R&L HRT CATH W/VENTRICLGRPHY
|
Professional
|
Both
|
$16,156.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
76102477
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$464.69 |
| Max. Negotiated Rate |
$9,693.60 |
| Rate for Payer: Aetna Commercial |
$1,740.44
|
| Rate for Payer: Ambetter Exchange |
$986.93
|
| Rate for Payer: Anthem Medicaid |
$968.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$986.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$986.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,184.32
|
| Rate for Payer: Cash Price |
$8,078.00
|
| Rate for Payer: Cash Price |
$8,078.00
|
| Rate for Payer: Cigna Commercial |
$1,906.32
|
| Rate for Payer: Healthspan PPO |
$1,293.72
|
| Rate for Payer: Humana Medicaid |
$968.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$464.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$986.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$986.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$988.10
|
| Rate for Payer: Molina Healthcare Passport |
$968.73
|
| Rate for Payer: Multiplan PHCS |
$9,693.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,283.01
|
| Rate for Payer: UHCCP Medicaid |
$5,654.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$978.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$986.93
|
|
|
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 |
$337.80 |
| 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 |
$900.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$979.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$776.94
|
| 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 |
$387.23 |
| Max. Negotiated Rate |
$1,212.81 |
| Rate for Payer: Aetna Commercial |
$867.02
|
| Rate for Payer: Anthem Medicaid |
$387.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$878.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| 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 |
$866.29
|
| 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 |
$1,039.55
|
| 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 |
$900.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$979.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$776.94
|
| 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 |
$1,400.00 |
| Rate for Payer: Anthem Medicaid |
$325.00
|
| 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 |
$325.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$331.50
|
| Rate for Payer: Molina Healthcare Passport |
$325.00
|
| 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 |
$328.25
|
|
|
RMV INTRAUTERINE DEVICE (IUD)
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
76102221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$339.90 |
| Max. Negotiated Rate |
$1,087.68 |
| Rate for Payer: Aetna Commercial |
$872.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$883.74
|
| Rate for Payer: Cash Price |
$566.50
|
| Rate for Payer: Cigna Commercial |
$940.39
|
| Rate for Payer: First Health Commercial |
$1,076.35
|
| Rate for Payer: Humana Commercial |
$963.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$929.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$836.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$997.04
|
| Rate for Payer: Ohio Health Group HMO |
$849.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$906.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$985.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$781.77
|
| Rate for Payer: PHCS Commercial |
$1,087.68
|
| Rate for Payer: United Healthcare All Payer |
$997.04
|
|
|
RMV INTRAUTERINE DEVICE (IUD)
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
76102221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.07 |
| Max. Negotiated Rate |
$1,087.68 |
| Rate for Payer: Aetna Commercial |
$872.41
|
| Rate for Payer: Anthem Medicaid |
$389.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$281.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$883.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$393.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.44
|
| Rate for Payer: Cash Price |
$566.50
|
| Rate for Payer: Cash Price |
$566.50
|
| Rate for Payer: Cigna Commercial |
$940.39
|
| Rate for Payer: First Health Commercial |
$1,076.35
|
| Rate for Payer: Humana Commercial |
$963.05
|
| Rate for Payer: Humana KY Medicaid |
$389.64
|
| Rate for Payer: Humana Medicare Advantage |
$281.07
|
| Rate for Payer: Kentucky WC Medicaid |
$393.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$929.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$836.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$397.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$997.04
|
| Rate for Payer: Ohio Health Group HMO |
$849.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$906.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$985.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$781.77
|
| Rate for Payer: PHCS Commercial |
$1,087.68
|
| Rate for Payer: United Healthcare All Payer |
$997.04
|
|
|
RMV INTRAUTERINE DEVICE (IUD)
|
Professional
|
Both
|
$1,133.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
76102221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$679.80 |
| Rate for Payer: Aetna Commercial |
$105.40
|
| Rate for Payer: Ambetter Exchange |
$62.83
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.04
|
| Rate for Payer: Anthem Medicaid |
$35.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$62.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$62.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$75.40
|
| Rate for Payer: Cash Price |
$566.50
|
| Rate for Payer: Cash Price |
$566.50
|
| Rate for Payer: Cigna Commercial |
$148.53
|
| Rate for Payer: Healthspan PPO |
$139.38
|
| Rate for Payer: Humana Medicaid |
$35.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$62.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.14
|
| Rate for Payer: Molina Healthcare Passport |
$35.43
|
| Rate for Payer: Multiplan PHCS |
$679.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$81.68
|
| Rate for Payer: UHCCP Medicaid |
$36.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$62.83
|
|
|
RMV INTRAUTERINE DEVICE (IUD(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
761P2221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$105.40
|
| Rate for Payer: Ambetter Exchange |
$62.83
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.04
|
| Rate for Payer: Anthem Medicaid |
$35.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$62.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$62.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$75.40
|
| 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 |
$35.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$62.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.14
|
| Rate for Payer: Molina Healthcare Passport |
$35.43
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$81.68
|
| Rate for Payer: UHCCP Medicaid |
$36.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$62.83
|
|
|
RMV INTRAUTERINE DEVICE (IUD(T
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
761T2221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$799.68 |
| Rate for Payer: Aetna Commercial |
$641.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$649.74
|
| Rate for Payer: Cash Price |
$416.50
|
| Rate for Payer: Cigna Commercial |
$691.39
|
| Rate for Payer: First Health Commercial |
$791.35
|
| Rate for Payer: Humana Commercial |
$708.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$683.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$614.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$733.04
|
| Rate for Payer: Ohio Health Group HMO |
$624.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$666.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$574.77
|
| Rate for Payer: PHCS Commercial |
$799.68
|
| Rate for Payer: United Healthcare All Payer |
$733.04
|
|
|
RMV INTRAUTERINE DEVICE (IUD(T
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
761T2221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.07 |
| Max. Negotiated Rate |
$799.68 |
| Rate for Payer: Aetna Commercial |
$641.41
|
| Rate for Payer: Anthem Medicaid |
$286.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$281.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$649.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$393.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.44
|
| Rate for Payer: Cash Price |
$416.50
|
| Rate for Payer: Cash Price |
$416.50
|
| Rate for Payer: Cigna Commercial |
$691.39
|
| Rate for Payer: First Health Commercial |
$791.35
|
| Rate for Payer: Humana Commercial |
$708.05
|
| Rate for Payer: Humana KY Medicaid |
$286.47
|
| Rate for Payer: Humana Medicare Advantage |
$281.07
|
| Rate for Payer: Kentucky WC Medicaid |
$289.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$683.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$614.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$292.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$733.04
|
| Rate for Payer: Ohio Health Group HMO |
$624.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$666.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$574.77
|
| Rate for Payer: PHCS Commercial |
$799.68
|
| Rate for Payer: United Healthcare All Payer |
$733.04
|
|
|
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 |
$45.00 |
| 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 |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.50
|
| 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: Ambetter Exchange |
$117.55
|
| Rate for Payer: Anthem Medicaid |
$96.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$117.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$117.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$141.06
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$117.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$98.69
|
| Rate for Payer: Molina Healthcare Passport |
$96.75
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$152.81
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$97.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$117.55
|
|
|
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 |
$45.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem Medicaid |
$51.59
|
| 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 |
$51.59
|
| 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 |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
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 |
$201.00 |
| 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 |
$536.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$462.30
|
| 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 |
$272.40 |
| 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 |
$726.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$789.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$626.52
|
| Rate for Payer: PHCS Commercial |
$871.68
|
| Rate for Payer: United Healthcare All Payer |
$799.04
|
|
|
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 |
$201.00 |
| 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 |
$536.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$462.30
|
| Rate for Payer: PHCS Commercial |
$643.20
|
| Rate for Payer: United Healthcare All Payer |
$589.60
|
|
|
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 |
$402.00 |
| Rate for Payer: Ambetter Exchange |
$175.78
|
| Rate for Payer: Anthem Medicaid |
$167.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$175.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$210.94
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$175.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.78
|
| 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 |
$228.51
|
| Rate for Payer: UHCCP Medicaid |
$234.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.78
|
|
