Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

CARCINOEMBRYONICANTIGEN/CEA

Facility

$213.00

Service Code	HCPCS 82378
Hospital Charge Code	30000266
Hospital Revenue Code	300
Min. Negotiated Rate	$27.69
Max. Negotiated Rate	$204.48
Rate for Payer: Aetna Commercial	$164.01
Rate for Payer: Anthem POS/PPO/Traditional	$171.04
Rate for Payer: Cash Price	$106.50
Rate for Payer: Cigna Commercial	$176.79
Rate for Payer: First Health Commercial	$202.35
Rate for Payer: Humana Commercial	$181.05
Rate for Payer: Medical Mutual Of Ohio HMO	$174.66
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$157.19
Rate for Payer: Molina Healthcare Benefit Exchange	$63.90
Rate for Payer: Ohio Health Choice Commercial	$187.44
Rate for Payer: Ohio Health Group HMO	$159.75
Rate for Payer: Ohio Health Group PPO Differential	$42.60
Rate for Payer: Ohio Health Group PPO No Differential	$27.69
Rate for Payer: Ohio Health Group PPO SOMC Employees	$66.03
Rate for Payer: PHCS Commercial	$204.48
Rate for Payer: United Healthcare All Payer	$187.44

CARDENE 20MG/200ML PREMIX BAG

Facility

$219.32

Service Code	NDC 143963410
Hospital Charge Code	25002926
Hospital Revenue Code	250
Min. Negotiated Rate	$28.51
Max. Negotiated Rate	$210.55
Rate for Payer: Aetna Commercial	$168.88
Rate for Payer: Anthem Medicaid	$75.42
Rate for Payer: Anthem POS/PPO/Traditional	$171.07
Rate for Payer: Cash Price	$109.66
Rate for Payer: Cigna Commercial	$182.04
Rate for Payer: First Health Commercial	$208.35
Rate for Payer: Humana Commercial	$186.42
Rate for Payer: Humana KY Medicaid	$75.42
Rate for Payer: Kentucky WC Medicaid	$76.19
Rate for Payer: Medical Mutual Of Ohio HMO	$179.84
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$161.86
Rate for Payer: Molina Healthcare Benefit Exchange	$65.80
Rate for Payer: Molina Healthcare Medicaid	$76.94
Rate for Payer: Ohio Health Choice Commercial	$193.00
Rate for Payer: Ohio Health Group HMO	$164.49
Rate for Payer: Ohio Health Group PPO Differential	$43.86
Rate for Payer: Ohio Health Group PPO No Differential	$28.51
Rate for Payer: Ohio Health Group PPO SOMC Employees	$67.99
Rate for Payer: PHCS Commercial	$210.55
Rate for Payer: United Healthcare All Payer	$193.00

CARDENE 20MG/200ML PREMIX BAG

Facility

$319.00

Service Code	NDC 43066000910
Hospital Charge Code	25002926
Hospital Revenue Code	250
Min. Negotiated Rate	$41.47
Max. Negotiated Rate	$306.24
Rate for Payer: Aetna Commercial	$245.63
Rate for Payer: Anthem Medicaid	$109.70
Rate for Payer: Anthem POS/PPO/Traditional	$248.82
Rate for Payer: Cash Price	$159.50
Rate for Payer: Cigna Commercial	$264.77
Rate for Payer: First Health Commercial	$303.05
Rate for Payer: Humana Commercial	$271.15
Rate for Payer: Humana KY Medicaid	$109.70
Rate for Payer: Kentucky WC Medicaid	$110.82
Rate for Payer: Medical Mutual Of Ohio HMO	$261.58
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$235.42
Rate for Payer: Molina Healthcare Benefit Exchange	$95.70
Rate for Payer: Molina Healthcare Medicaid	$111.91
Rate for Payer: Ohio Health Choice Commercial	$280.72
Rate for Payer: Ohio Health Group HMO	$239.25
Rate for Payer: Ohio Health Group PPO Differential	$63.80
Rate for Payer: Ohio Health Group PPO No Differential	$41.47
Rate for Payer: Ohio Health Group PPO SOMC Employees	$98.89
Rate for Payer: PHCS Commercial	$306.24
Rate for Payer: United Healthcare All Payer	$280.72

CARDENE 20MG/200ML PREMIX BAG

Facility

$219.32

Service Code	NDC 143963410
Hospital Charge Code	25002926
Hospital Revenue Code	250
Min. Negotiated Rate	$28.51
Max. Negotiated Rate	$210.55
Rate for Payer: Aetna Commercial	$168.88
Rate for Payer: Anthem POS/PPO/Traditional	$171.07
Rate for Payer: Cash Price	$109.66
Rate for Payer: Cigna Commercial	$182.04
Rate for Payer: First Health Commercial	$208.35
Rate for Payer: Humana Commercial	$186.42
Rate for Payer: Medical Mutual Of Ohio HMO	$179.84
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$161.86
Rate for Payer: Molina Healthcare Benefit Exchange	$65.80
Rate for Payer: Ohio Health Choice Commercial	$193.00
Rate for Payer: Ohio Health Group HMO	$164.49
Rate for Payer: Ohio Health Group PPO Differential	$43.86
Rate for Payer: Ohio Health Group PPO No Differential	$28.51
Rate for Payer: Ohio Health Group PPO SOMC Employees	$67.99
Rate for Payer: PHCS Commercial	$210.55
Rate for Payer: United Healthcare All Payer	$193.00

CARDENE 20MG/200ML PREMIX BAG

Facility

$319.00

Service Code	NDC 43066000910
Hospital Charge Code	25002926
Hospital Revenue Code	250
Min. Negotiated Rate	$41.47
Max. Negotiated Rate	$306.24
Rate for Payer: Aetna Commercial	$245.63
Rate for Payer: Anthem POS/PPO/Traditional	$248.82
Rate for Payer: Cash Price	$159.50
Rate for Payer: Cigna Commercial	$264.77
Rate for Payer: First Health Commercial	$303.05
Rate for Payer: Humana Commercial	$271.15
Rate for Payer: Medical Mutual Of Ohio HMO	$261.58
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$235.42
Rate for Payer: Molina Healthcare Benefit Exchange	$95.70
Rate for Payer: Ohio Health Choice Commercial	$280.72
Rate for Payer: Ohio Health Group HMO	$239.25
Rate for Payer: Ohio Health Group PPO Differential	$63.80
Rate for Payer: Ohio Health Group PPO No Differential	$41.47
Rate for Payer: Ohio Health Group PPO SOMC Employees	$98.89
Rate for Payer: PHCS Commercial	$306.24
Rate for Payer: United Healthcare All Payer	$280.72

CARDENE (NICARDIPINE 20MG/1CAP

Facility

$9.78

Service Code	NDC 378102077
Hospital Charge Code	25000377
Hospital Revenue Code	637
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$9.39
Rate for Payer: Humana Commercial	$8.31
Rate for Payer: Humana KY Medicaid	$3.36
Rate for Payer: Kentucky WC Medicaid	$3.40
Rate for Payer: Medical Mutual Of Ohio HMO	$8.02
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$7.22
Rate for Payer: Molina Healthcare Benefit Exchange	$2.93
Rate for Payer: Molina Healthcare Medicaid	$3.43
Rate for Payer: Ohio Health Choice Commercial	$8.61
Rate for Payer: Ohio Health Group HMO	$7.34
Rate for Payer: Ohio Health Group PPO Differential	$1.96
Rate for Payer: Ohio Health Group PPO No Differential	$1.27
Rate for Payer: Ohio Health Group PPO SOMC Employees	$3.03
Rate for Payer: PHCS Commercial	$9.39
Rate for Payer: United Healthcare All Payer	$8.61
Rate for Payer: Aetna Commercial	$7.53
Rate for Payer: Anthem Medicaid	$3.36
Rate for Payer: Anthem POS/PPO/Traditional	$7.63
Rate for Payer: Cash Price	$4.89
Rate for Payer: Cigna Commercial	$8.12
Rate for Payer: First Health Commercial	$9.29

CARDENE (NICARDIPINE 20MG/1CAP

Facility

$9.78

Service Code	NDC 378102077
Hospital Charge Code	25000377
Hospital Revenue Code	637
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$9.39
Rate for Payer: Aetna Commercial	$7.53
Rate for Payer: Anthem POS/PPO/Traditional	$7.63
Rate for Payer: Cash Price	$4.89
Rate for Payer: Cigna Commercial	$8.12
Rate for Payer: First Health Commercial	$9.29
Rate for Payer: Humana Commercial	$8.31
Rate for Payer: Medical Mutual Of Ohio HMO	$8.02
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$7.22
Rate for Payer: Molina Healthcare Benefit Exchange	$2.93
Rate for Payer: Ohio Health Choice Commercial	$8.61
Rate for Payer: Ohio Health Group HMO	$7.34
Rate for Payer: Ohio Health Group PPO Differential	$1.96
Rate for Payer: Ohio Health Group PPO No Differential	$1.27
Rate for Payer: Ohio Health Group PPO SOMC Employees	$3.03
Rate for Payer: PHCS Commercial	$9.39
Rate for Payer: United Healthcare All Payer	$8.61

CARDENE (NICARDIPINE 25MG/10ML

Facility

$181.52

Service Code	HCPCS J3490
Hospital Charge Code	25002925
Hospital Revenue Code	636
Min. Negotiated Rate	$23.60
Max. Negotiated Rate	$174.26
Rate for Payer: Aetna Commercial	$139.77
Rate for Payer: Anthem Medicaid	$62.42
Rate for Payer: Anthem POS/PPO/Traditional	$141.59
Rate for Payer: Cash Price	$90.76
Rate for Payer: Cigna Commercial	$150.66
Rate for Payer: First Health Commercial	$172.44
Rate for Payer: Humana Commercial	$154.29
Rate for Payer: Humana KY Medicaid	$62.42
Rate for Payer: Kentucky WC Medicaid	$63.06
Rate for Payer: Medical Mutual Of Ohio HMO	$148.85
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$133.96
Rate for Payer: Molina Healthcare Benefit Exchange	$54.46
Rate for Payer: Molina Healthcare Medicaid	$63.68
Rate for Payer: Ohio Health Choice Commercial	$159.74
Rate for Payer: Ohio Health Group HMO	$136.14
Rate for Payer: Ohio Health Group PPO Differential	$36.30
Rate for Payer: Ohio Health Group PPO No Differential	$23.60
Rate for Payer: Ohio Health Group PPO SOMC Employees	$56.27
Rate for Payer: PHCS Commercial	$174.26
Rate for Payer: United Healthcare All Payer	$159.74

CARDENE (NICARDIPINE 25MG/10ML

Facility

$181.52

Service Code	HCPCS J3490
Hospital Charge Code	25002925
Hospital Revenue Code	636
Min. Negotiated Rate	$23.60
Max. Negotiated Rate	$174.26
Rate for Payer: Aetna Commercial	$139.77
Rate for Payer: Anthem POS/PPO/Traditional	$141.59
Rate for Payer: Cash Price	$90.76
Rate for Payer: Cigna Commercial	$150.66
Rate for Payer: First Health Commercial	$172.44
Rate for Payer: Humana Commercial	$154.29
Rate for Payer: Medical Mutual Of Ohio HMO	$148.85
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$133.96
Rate for Payer: Molina Healthcare Benefit Exchange	$54.46
Rate for Payer: Ohio Health Choice Commercial	$159.74
Rate for Payer: Ohio Health Group HMO	$136.14
Rate for Payer: Ohio Health Group PPO Differential	$36.30
Rate for Payer: Ohio Health Group PPO No Differential	$23.60
Rate for Payer: Ohio Health Group PPO SOMC Employees	$56.27
Rate for Payer: PHCS Commercial	$174.26
Rate for Payer: United Healthcare All Payer	$159.74

CARDIAC ARREST, UNEXPLAINED WITH CC

Facility

$8,523.30

Service Code	MSDRG 297
Min. Negotiated Rate	$5,783.67
Max. Negotiated Rate	$8,523.30
Rate for Payer: Anthem Medicaid	$5,783.67
Rate for Payer: Anthem Medicare Advantage/PPO	$6,088.07
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,523.30
Rate for Payer: CareSource Just4Me Medicare	$8,218.89
Rate for Payer: Humana KY Medicaid	$5,783.67
Rate for Payer: Humana Medicare Advantage	$6,088.07
Rate for Payer: Kentucky WC Medicaid	$5,841.50
Rate for Payer: Molina Healthcare Benefit Exchange	$7,305.68
Rate for Payer: Molina Healthcare Medicaid	$5,899.34

CARDIAC ARREST, UNEXPLAINED WITH MCC

Facility

$18,754.57

Service Code	MSDRG 296
Min. Negotiated Rate	$12,726.31
Max. Negotiated Rate	$18,754.57
Rate for Payer: Anthem Medicaid	$12,726.31
Rate for Payer: Anthem Medicare Advantage/PPO	$13,396.12
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$18,754.57
Rate for Payer: CareSource Just4Me Medicare	$18,084.76
Rate for Payer: Humana KY Medicaid	$12,726.31
Rate for Payer: Humana Medicare Advantage	$13,396.12
Rate for Payer: Kentucky WC Medicaid	$12,853.58
Rate for Payer: Molina Healthcare Benefit Exchange	$16,075.34
Rate for Payer: Molina Healthcare Medicaid	$12,980.84

CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC

Facility

$5,143.73

Service Code	MSDRG 298
Min. Negotiated Rate	$3,490.39
Max. Negotiated Rate	$5,143.73
Rate for Payer: Anthem Medicaid	$3,490.39
Rate for Payer: Anthem Medicare Advantage/PPO	$3,674.09
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$5,143.73
Rate for Payer: CareSource Just4Me Medicare	$4,960.02
Rate for Payer: Humana KY Medicaid	$3,490.39
Rate for Payer: Humana Medicare Advantage	$3,674.09
Rate for Payer: Kentucky WC Medicaid	$3,525.29
Rate for Payer: Molina Healthcare Benefit Exchange	$4,408.91
Rate for Payer: Molina Healthcare Medicaid	$3,560.19

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC

Facility

$8,711.64

Service Code	MSDRG 309
Min. Negotiated Rate	$5,911.47
Max. Negotiated Rate	$8,711.64
Rate for Payer: Anthem Medicaid	$5,911.47
Rate for Payer: Anthem Medicare Advantage/PPO	$6,222.60
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,711.64
Rate for Payer: CareSource Just4Me Medicare	$8,400.51
Rate for Payer: Humana KY Medicaid	$5,911.47
Rate for Payer: Humana Medicare Advantage	$6,222.60
Rate for Payer: Kentucky WC Medicaid	$5,970.58
Rate for Payer: Molina Healthcare Benefit Exchange	$7,467.12
Rate for Payer: Molina Healthcare Medicaid	$6,029.70

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC

Facility

$14,063.59

Service Code	MSDRG 308
Min. Negotiated Rate	$9,543.15
Max. Negotiated Rate	$14,063.59
Rate for Payer: Anthem Medicaid	$9,543.15
Rate for Payer: Anthem Medicare Advantage/PPO	$10,045.42
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$14,063.59
Rate for Payer: CareSource Just4Me Medicare	$13,561.32
Rate for Payer: Humana KY Medicaid	$9,543.15
Rate for Payer: Humana Medicare Advantage	$10,045.42
Rate for Payer: Kentucky WC Medicaid	$9,638.58
Rate for Payer: Molina Healthcare Benefit Exchange	$12,054.50
Rate for Payer: Molina Healthcare Medicaid	$9,734.01

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC

Facility

$6,469.09

Service Code	MSDRG 310
Min. Negotiated Rate	$4,389.74
Max. Negotiated Rate	$6,469.09
Rate for Payer: Anthem Medicaid	$4,389.74
Rate for Payer: Anthem Medicare Advantage/PPO	$4,620.78
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$6,469.09
Rate for Payer: CareSource Just4Me Medicare	$6,238.05
Rate for Payer: Humana KY Medicaid	$4,389.74
Rate for Payer: Humana Medicare Advantage	$4,620.78
Rate for Payer: Kentucky WC Medicaid	$4,433.64
Rate for Payer: Molina Healthcare Benefit Exchange	$5,544.94
Rate for Payer: Molina Healthcare Medicaid	$4,477.54

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC

Facility

$17,977.81

Service Code	MSDRG 306
Min. Negotiated Rate	$12,199.23
Max. Negotiated Rate	$17,977.81
Rate for Payer: Anthem Medicaid	$12,199.23
Rate for Payer: Anthem Medicare Advantage/PPO	$12,841.29
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$17,977.81
Rate for Payer: CareSource Just4Me Medicare	$17,335.74
Rate for Payer: Humana KY Medicaid	$12,199.23
Rate for Payer: Humana Medicare Advantage	$12,841.29
Rate for Payer: Kentucky WC Medicaid	$12,321.22
Rate for Payer: Molina Healthcare Benefit Exchange	$15,409.55
Rate for Payer: Molina Healthcare Medicaid	$12,443.21

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC

Facility

$11,026.72

Service Code	MSDRG 307
Min. Negotiated Rate	$7,482.42
Max. Negotiated Rate	$11,026.72
Rate for Payer: Anthem Medicaid	$7,482.42
Rate for Payer: Anthem Medicare Advantage/PPO	$7,876.23
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,026.72
Rate for Payer: CareSource Just4Me Medicare	$10,632.91
Rate for Payer: Humana KY Medicaid	$7,482.42
Rate for Payer: Humana Medicare Advantage	$7,876.23
Rate for Payer: Kentucky WC Medicaid	$7,557.24
Rate for Payer: Molina Healthcare Benefit Exchange	$9,451.48
Rate for Payer: Molina Healthcare Medicaid	$7,632.07

CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC

Facility

$82,306.25

Service Code	MSDRG 275
Min. Negotiated Rate	$55,850.67
Max. Negotiated Rate	$82,306.25
Rate for Payer: Anthem Medicaid	$55,850.67
Rate for Payer: Anthem Medicare Advantage/PPO	$58,790.18
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$82,306.25
Rate for Payer: CareSource Just4Me Medicare	$79,366.74
Rate for Payer: Humana KY Medicaid	$55,850.67
Rate for Payer: Humana Medicare Advantage	$58,790.18
Rate for Payer: Kentucky WC Medicaid	$56,409.18
Rate for Payer: Molina Healthcare Benefit Exchange	$70,548.22
Rate for Payer: Molina Healthcare Medicaid	$56,967.68

CARDIAC DEFIBRILLATOR IMPLANT WITH MCC

Facility

$72,648.21

Service Code	MSDRG 276
Min. Negotiated Rate	$49,297.00
Max. Negotiated Rate	$72,648.21
Rate for Payer: Anthem Medicaid	$49,297.00
Rate for Payer: Anthem Medicare Advantage/PPO	$51,891.58
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$72,648.21
Rate for Payer: CareSource Just4Me Medicare	$70,053.63
Rate for Payer: Humana KY Medicaid	$49,297.00
Rate for Payer: Humana Medicare Advantage	$51,891.58
Rate for Payer: Kentucky WC Medicaid	$49,789.97
Rate for Payer: Molina Healthcare Benefit Exchange	$62,269.90
Rate for Payer: Molina Healthcare Medicaid	$50,282.94

CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC

Facility

$55,945.48

Service Code	MSDRG 277
Min. Negotiated Rate	$37,963.01
Max. Negotiated Rate	$55,945.48
Rate for Payer: Anthem Medicaid	$37,963.01
Rate for Payer: Anthem Medicare Advantage/PPO	$39,961.06
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$55,945.48
Rate for Payer: CareSource Just4Me Medicare	$53,947.43
Rate for Payer: Humana KY Medicaid	$37,963.01
Rate for Payer: Humana Medicare Advantage	$39,961.06
Rate for Payer: Kentucky WC Medicaid	$38,342.64
Rate for Payer: Molina Healthcare Benefit Exchange	$47,953.27
Rate for Payer: Molina Healthcare Medicaid	$38,722.27

CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC

Facility

$31,685.75

Service Code	MSDRG 258
Min. Negotiated Rate	$21,501.05
Max. Negotiated Rate	$31,685.75
Rate for Payer: Anthem Medicaid	$21,501.05
Rate for Payer: Anthem Medicare Advantage/PPO	$22,632.68
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$31,685.75
Rate for Payer: CareSource Just4Me Medicare	$30,554.12
Rate for Payer: Humana KY Medicaid	$21,501.05
Rate for Payer: Humana Medicare Advantage	$22,632.68
Rate for Payer: Kentucky WC Medicaid	$21,716.06
Rate for Payer: Molina Healthcare Benefit Exchange	$27,159.22
Rate for Payer: Molina Healthcare Medicaid	$21,931.07

CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC

Facility

$21,835.86

Service Code	MSDRG 259
Min. Negotiated Rate	$14,817.19
Max. Negotiated Rate	$21,835.86
Rate for Payer: Anthem Medicaid	$14,817.19
Rate for Payer: Anthem Medicare Advantage/PPO	$15,597.04
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,835.86
Rate for Payer: CareSource Just4Me Medicare	$21,056.00
Rate for Payer: Humana KY Medicaid	$14,817.19
Rate for Payer: Humana Medicare Advantage	$15,597.04
Rate for Payer: Kentucky WC Medicaid	$14,965.36
Rate for Payer: Molina Healthcare Benefit Exchange	$18,716.45
Rate for Payer: Molina Healthcare Medicaid	$15,113.53

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC

Facility

$22,013.68

Service Code	MSDRG 261
Min. Negotiated Rate	$14,937.86
Max. Negotiated Rate	$22,013.68
Rate for Payer: Anthem Medicaid	$14,937.86
Rate for Payer: Anthem Medicare Advantage/PPO	$15,724.06
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$22,013.68
Rate for Payer: CareSource Just4Me Medicare	$21,227.48
Rate for Payer: Humana KY Medicaid	$14,937.86
Rate for Payer: Humana Medicare Advantage	$15,724.06
Rate for Payer: Kentucky WC Medicaid	$15,087.24
Rate for Payer: Molina Healthcare Benefit Exchange	$18,868.87
Rate for Payer: Molina Healthcare Medicaid	$15,236.61

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC

Facility

$38,781.89

Service Code	MSDRG 260
Min. Negotiated Rate	$26,316.28
Max. Negotiated Rate	$38,781.89
Rate for Payer: Anthem Medicaid	$26,316.28
Rate for Payer: Anthem Medicare Advantage/PPO	$27,701.35
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$38,781.89
Rate for Payer: CareSource Just4Me Medicare	$37,396.82
Rate for Payer: Humana KY Medicaid	$26,316.28
Rate for Payer: Humana Medicare Advantage	$27,701.35
Rate for Payer: Kentucky WC Medicaid	$26,579.45
Rate for Payer: Molina Healthcare Benefit Exchange	$33,241.62
Rate for Payer: Molina Healthcare Medicaid	$26,842.61

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC

Facility

$19,247.06

Service Code	MSDRG 262
Min. Negotiated Rate	$13,060.50
Max. Negotiated Rate	$19,247.06
Rate for Payer: Anthem Medicaid	$13,060.50
Rate for Payer: Anthem Medicare Advantage/PPO	$13,747.90
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$19,247.06
Rate for Payer: CareSource Just4Me Medicare	$18,559.66
Rate for Payer: Humana KY Medicaid	$13,060.50
Rate for Payer: Humana Medicare Advantage	$13,747.90
Rate for Payer: Kentucky WC Medicaid	$13,191.11
Rate for Payer: Molina Healthcare Benefit Exchange	$16,497.48
Rate for Payer: Molina Healthcare Medicaid	$13,321.72

Know your out-of-pocket cost for care.

All Charges