|
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 |
$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
|
|
|
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 |
$272.40 |
| 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 |
$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 NINFCT MESH HERNIA RPR
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 49623
|
| Hospital Charge Code |
76102844
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.00 |
| 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 |
$176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.80
|
| 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 |
$251.62 |
| Rate for Payer: Ambetter Exchange |
$193.55
|
| Rate for Payer: Anthem Medicaid |
$166.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$193.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$193.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.26
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Humana Medicaid |
$166.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$193.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$193.55
|
| 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 |
$251.62
|
| Rate for Payer: UHCCP Medicaid |
$77.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$168.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$193.55
|
|
|
RMVL NINFCT MESH HERNIA RPR
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 49623
|
| Hospital Charge Code |
76102844
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.00 |
| 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 |
$176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.80
|
| Rate for Payer: PHCS Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Payer |
$193.60
|
|
|
RMVL OF SUBQ DEFIBRILLATOR
|
Facility
|
IP
|
$7,205.00
|
|
|
Service Code
|
HCPCS 33272
|
| Hospital Charge Code |
76101278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,161.50 |
| 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 |
$5,764.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,268.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,971.45
|
| 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 |
$4,323.00 |
| Rate for Payer: Ambetter Exchange |
$325.19
|
| Rate for Payer: Anthem Medicaid |
$290.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$325.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$325.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$390.23
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$325.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.19
|
| 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 |
$422.75
|
| Rate for Payer: UHCCP Medicaid |
$2,521.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$293.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$325.19
|
|
|
RMVL OF SUBQ DEFIBRILLATOR
|
Facility
|
OP
|
$7,205.00
|
|
|
Service Code
|
HCPCS 33272
|
| Hospital Charge Code |
76101278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,477.80 |
| 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 |
$3,362.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,619.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,707.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,539.56
|
| 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 |
$3,362.64
|
| 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 |
$4,035.17
|
| 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 |
$5,764.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,268.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,971.45
|
| 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 |
$662.14 |
| Rate for Payer: Ambetter Exchange |
$325.19
|
| Rate for Payer: Anthem Medicaid |
$290.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$325.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$325.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$390.23
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$325.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.19
|
| 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 |
$422.75
|
| Rate for Payer: UHCCP Medicaid |
$364.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$293.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$325.19
|
|
|
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 |
$1,849.50 |
| 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 |
$4,932.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,363.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,253.85
|
| 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 |
$2,120.14 |
| 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 |
$3,362.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,808.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,707.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,539.56
|
| 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 |
$3,362.64
|
| 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 |
$4,035.17
|
| 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 |
$4,932.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,363.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,253.85
|
| 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
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 33262
|
| Hospital Charge Code |
76101273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.80 |
| Max. Negotiated Rate |
$29,035.76 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20,739.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29,035.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$27,998.77
|
| 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 |
$20,739.83
|
| 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 |
$24,887.80
|
| 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 |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
RMVL& REPLC PULSE GEN 1 LEAD
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 33262
|
| Hospital Charge Code |
76101273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| 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 |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| 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 |
$1,200.00 |
| Rate for Payer: Ambetter Exchange |
$346.59
|
| Rate for Payer: Anthem Medicaid |
$295.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$346.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$346.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$415.91
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$346.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.59
|
| 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 |
$450.57
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$298.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$346.59
|
|
|
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 |
$1,200.00 |
| Rate for Payer: Ambetter Exchange |
$346.59
|
| Rate for Payer: Anthem Medicaid |
$295.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$346.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$346.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$415.91
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$346.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.59
|
| 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 |
$450.57
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$298.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$346.59
|
|
|
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 |
$1,200.00 |
| Rate for Payer: Ambetter Exchange |
$360.65
|
| Rate for Payer: Anthem Medicaid |
$306.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$360.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$360.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$432.78
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$360.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.65
|
| 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 |
$468.85
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$309.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$360.65
|
|
|
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 |
$687.80 |
| Max. Negotiated Rate |
$29,035.76 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20,739.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29,035.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$27,998.77
|
| 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 |
$20,739.83
|
| 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 |
$24,887.80
|
| 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 |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| 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 |
$600.00 |
| 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 |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| 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 |
$1,200.00 |
| Rate for Payer: Ambetter Exchange |
$360.65
|
| Rate for Payer: Anthem Medicaid |
$306.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$360.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$360.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$432.78
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$360.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.65
|
| 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 |
$468.85
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$309.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$360.65
|
|
|
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 |
$1,620.00 |
| Rate for Payer: Ambetter Exchange |
$375.85
|
| Rate for Payer: Anthem Medicaid |
$318.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$375.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$375.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$451.02
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$375.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.85
|
| 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 |
$488.61
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$321.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$375.85
|
|
|
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 |
$928.53 |
| Max. Negotiated Rate |
$41,473.96 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29,624.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41,473.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$39,992.75
|
| 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 |
$29,624.26
|
| 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 |
$35,549.11
|
| 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 |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| 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 |
$810.00 |
| 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 |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| 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 |
$1,620.00 |
| Rate for Payer: Ambetter Exchange |
$375.85
|
| Rate for Payer: Anthem Medicaid |
$318.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$375.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$375.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$451.02
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$375.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.85
|
| 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 |
$488.61
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$321.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$375.85
|
|
|
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 |
$906.93 |
| Rate for Payer: Aetna Commercial |
$906.93
|
| Rate for Payer: Ambetter Exchange |
$611.66
|
| Rate for Payer: Anthem Medicaid |
$332.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$611.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$611.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.99
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$611.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.66
|
| 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 |
$795.16
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$336.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$611.66
|
|
|
RMVL RUPTURED BREAST IMPLANT
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS 19330
|
| Hospital Charge Code |
76100310
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.50 |
| 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 |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$672.75
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
