|
INSERT PLACE HEART CATH
|
Facility
|
OP
|
$9,871.00
|
|
|
Service Code
|
HCPCS 93503
|
| Hospital Charge Code |
76102486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,283.23 |
| Max. Negotiated Rate |
$9,476.16 |
| Rate for Payer: Aetna Commercial |
$7,600.67
|
| Rate for Payer: Anthem Medicaid |
$3,394.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,699.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$4,935.50
|
| Rate for Payer: Cash Price |
$4,935.50
|
| Rate for Payer: Cigna Commercial |
$8,192.93
|
| Rate for Payer: First Health Commercial |
$9,377.45
|
| Rate for Payer: Humana Commercial |
$8,390.35
|
| Rate for Payer: Humana KY Medicaid |
$3,394.64
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$3,429.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,094.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,284.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,462.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,686.48
|
| Rate for Payer: Ohio Health Group HMO |
$7,403.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,974.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,283.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,060.01
|
| Rate for Payer: PHCS Commercial |
$9,476.16
|
| Rate for Payer: United Healthcare All Payer |
$8,686.48
|
|
|
INSERT PLACE HEART CATH
|
Facility
|
OP
|
$4,871.00
|
|
|
Service Code
|
HCPCS 93503
|
| Hospital Charge Code |
48100073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$633.23 |
| Max. Negotiated Rate |
$4,676.16 |
| Rate for Payer: Aetna Commercial |
$3,750.67
|
| Rate for Payer: Anthem Medicaid |
$1,675.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,799.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$2,435.50
|
| Rate for Payer: Cash Price |
$2,435.50
|
| Rate for Payer: Cigna Commercial |
$4,042.93
|
| Rate for Payer: First Health Commercial |
$4,627.45
|
| Rate for Payer: Humana Commercial |
$4,140.35
|
| Rate for Payer: Humana KY Medicaid |
$1,675.14
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,692.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,994.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,594.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,708.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,286.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,653.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$974.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$633.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,510.01
|
| Rate for Payer: PHCS Commercial |
$4,676.16
|
| Rate for Payer: United Healthcare All Payer |
$4,286.48
|
|
|
INSERT PLACE HEART CATH
|
Professional
|
Both
|
$9,871.00
|
|
|
Service Code
|
HCPCS 93503
|
| Hospital Charge Code |
76102486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.62 |
| Max. Negotiated Rate |
$9,871.00 |
| Rate for Payer: Aetna Commercial |
$176.41
|
| Rate for Payer: Anthem Medicaid |
$143.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,871.00
|
| Rate for Payer: Cash Price |
$4,935.50
|
| Rate for Payer: Cash Price |
$4,935.50
|
| Rate for Payer: Cigna Commercial |
$209.50
|
| Rate for Payer: Healthspan PPO |
$179.87
|
| Rate for Payer: Humana Medicaid |
$143.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$180.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.49
|
| Rate for Payer: Molina Healthcare Passport |
$143.62
|
| Rate for Payer: Multiplan PHCS |
$5,922.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,909.70
|
| Rate for Payer: UHCCP Medicaid |
$3,454.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$145.06
|
|
|
INSERT PLACE HEART CATH
|
Facility
|
IP
|
$4,871.00
|
|
|
Service Code
|
HCPCS 93503
|
| Hospital Charge Code |
48100073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$633.23 |
| Max. Negotiated Rate |
$4,676.16 |
| Rate for Payer: Aetna Commercial |
$3,750.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,799.38
|
| Rate for Payer: Cash Price |
$2,435.50
|
| Rate for Payer: Cigna Commercial |
$4,042.93
|
| Rate for Payer: First Health Commercial |
$4,627.45
|
| Rate for Payer: Humana Commercial |
$4,140.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,994.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,594.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,461.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,286.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,653.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$974.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$633.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,510.01
|
| Rate for Payer: PHCS Commercial |
$4,676.16
|
| Rate for Payer: United Healthcare All Payer |
$4,286.48
|
|
|
INSERT PLACE HEART CATH (P
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 93503
|
| Hospital Charge Code |
761P2486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.62 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna Commercial |
$176.41
|
| Rate for Payer: Anthem Medicaid |
$143.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,000.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$209.50
|
| Rate for Payer: Healthspan PPO |
$179.87
|
| Rate for Payer: Humana Medicaid |
$143.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$180.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.49
|
| Rate for Payer: Molina Healthcare Passport |
$143.62
|
| Rate for Payer: Multiplan PHCS |
$3,000.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,500.00
|
| Rate for Payer: UHCCP Medicaid |
$1,750.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$145.06
|
|
|
INSERT PLACE HEART CATH (T
|
Facility
|
IP
|
$4,871.00
|
|
|
Service Code
|
HCPCS 93503
|
| Hospital Charge Code |
761T2486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$633.23 |
| Max. Negotiated Rate |
$4,676.16 |
| Rate for Payer: Aetna Commercial |
$3,750.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,799.38
|
| Rate for Payer: Cash Price |
$2,435.50
|
| Rate for Payer: Cigna Commercial |
$4,042.93
|
| Rate for Payer: First Health Commercial |
$4,627.45
|
| Rate for Payer: Humana Commercial |
$4,140.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,994.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,594.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,461.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,286.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,653.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$974.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$633.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,510.01
|
| Rate for Payer: PHCS Commercial |
$4,676.16
|
| Rate for Payer: United Healthcare All Payer |
$4,286.48
|
|
|
INSERT PLACE HEART CATH (T
|
Facility
|
OP
|
$4,871.00
|
|
|
Service Code
|
HCPCS 93503
|
| Hospital Charge Code |
761T2486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$633.23 |
| Max. Negotiated Rate |
$4,676.16 |
| Rate for Payer: Aetna Commercial |
$3,750.67
|
| Rate for Payer: Anthem Medicaid |
$1,675.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,799.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$2,435.50
|
| Rate for Payer: Cash Price |
$2,435.50
|
| Rate for Payer: Cigna Commercial |
$4,042.93
|
| Rate for Payer: First Health Commercial |
$4,627.45
|
| Rate for Payer: Humana Commercial |
$4,140.35
|
| Rate for Payer: Humana KY Medicaid |
$1,675.14
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,692.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,994.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,594.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,708.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,286.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,653.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$974.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$633.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,510.01
|
| Rate for Payer: PHCS Commercial |
$4,676.16
|
| Rate for Payer: United Healthcare All Payer |
$4,286.48
|
|
|
INSERT POLCUP PE NON-CEM 43/22
|
Facility
|
OP
|
$4,861.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.03 |
| Max. Negotiated Rate |
$4,667.28 |
| Rate for Payer: Aetna Commercial |
$3,743.55
|
| Rate for Payer: Anthem Medicaid |
$1,671.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,792.16
|
| Rate for Payer: Cash Price |
$2,430.88
|
| Rate for Payer: Cigna Commercial |
$4,035.25
|
| Rate for Payer: First Health Commercial |
$4,618.66
|
| Rate for Payer: Humana Commercial |
$4,132.49
|
| Rate for Payer: Humana KY Medicaid |
$1,671.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,688.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,986.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,587.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,705.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,278.34
|
| Rate for Payer: Ohio Health Group HMO |
$3,646.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$632.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,507.14
|
| Rate for Payer: PHCS Commercial |
$4,667.28
|
| Rate for Payer: United Healthcare All Payer |
$4,278.34
|
|
|
INSERT POLCUP PE NON-CEM 43/22
|
Facility
|
IP
|
$4,861.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.03 |
| Max. Negotiated Rate |
$4,667.28 |
| Rate for Payer: Aetna Commercial |
$3,743.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,792.16
|
| Rate for Payer: Cash Price |
$2,430.88
|
| Rate for Payer: Cigna Commercial |
$4,035.25
|
| Rate for Payer: First Health Commercial |
$4,618.66
|
| Rate for Payer: Humana Commercial |
$4,132.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,986.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,587.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,278.34
|
| Rate for Payer: Ohio Health Group HMO |
$3,646.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$632.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,507.14
|
| Rate for Payer: PHCS Commercial |
$4,667.28
|
| Rate for Payer: United Healthcare All Payer |
$4,278.34
|
|
|
INSERT POLCUP PE NON-CEM 45/22
|
Facility
|
IP
|
$4,861.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.03 |
| Max. Negotiated Rate |
$4,667.28 |
| Rate for Payer: Aetna Commercial |
$3,743.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,792.16
|
| Rate for Payer: Cash Price |
$2,430.88
|
| Rate for Payer: Cigna Commercial |
$4,035.25
|
| Rate for Payer: First Health Commercial |
$4,618.66
|
| Rate for Payer: Humana Commercial |
$4,132.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,986.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,587.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,278.34
|
| Rate for Payer: Ohio Health Group HMO |
$3,646.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$632.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,507.14
|
| Rate for Payer: PHCS Commercial |
$4,667.28
|
| Rate for Payer: United Healthcare All Payer |
$4,278.34
|
|
|
INSERT POLCUP PE NON-CEM 45/22
|
Facility
|
OP
|
$4,861.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.03 |
| Max. Negotiated Rate |
$4,667.28 |
| Rate for Payer: Aetna Commercial |
$3,743.55
|
| Rate for Payer: Anthem Medicaid |
$1,671.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,792.16
|
| Rate for Payer: Cash Price |
$2,430.88
|
| Rate for Payer: Cigna Commercial |
$4,035.25
|
| Rate for Payer: First Health Commercial |
$4,618.66
|
| Rate for Payer: Humana Commercial |
$4,132.49
|
| Rate for Payer: Humana KY Medicaid |
$1,671.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,688.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,986.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,587.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,705.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,278.34
|
| Rate for Payer: Ohio Health Group HMO |
$3,646.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$632.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,507.14
|
| Rate for Payer: PHCS Commercial |
$4,667.28
|
| Rate for Payer: United Healthcare All Payer |
$4,278.34
|
|
|
INSERT POLCUP PE NON-CEM 47/28
|
Facility
|
OP
|
$6,524.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$848.23 |
| Max. Negotiated Rate |
$6,263.83 |
| Rate for Payer: Aetna Commercial |
$5,024.11
|
| Rate for Payer: Anthem Medicaid |
$2,243.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,089.36
|
| Rate for Payer: Cash Price |
$3,262.41
|
| Rate for Payer: Cigna Commercial |
$5,415.60
|
| Rate for Payer: First Health Commercial |
$6,198.58
|
| Rate for Payer: Humana Commercial |
$5,546.10
|
| Rate for Payer: Humana KY Medicaid |
$2,243.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,266.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,350.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,815.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,957.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,288.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,741.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,893.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,304.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,022.69
|
| Rate for Payer: PHCS Commercial |
$6,263.83
|
| Rate for Payer: United Healthcare All Payer |
$5,741.84
|
|
|
INSERT POLCUP PE NON-CEM 47/28
|
Facility
|
IP
|
$6,524.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$848.23 |
| Max. Negotiated Rate |
$6,263.83 |
| Rate for Payer: Aetna Commercial |
$5,024.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,089.36
|
| Rate for Payer: Cash Price |
$3,262.41
|
| Rate for Payer: Cigna Commercial |
$5,415.60
|
| Rate for Payer: First Health Commercial |
$6,198.58
|
| Rate for Payer: Humana Commercial |
$5,546.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,350.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,815.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,957.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,741.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,893.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,304.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,022.69
|
| Rate for Payer: PHCS Commercial |
$6,263.83
|
| Rate for Payer: United Healthcare All Payer |
$5,741.84
|
|
|
INSERT POLCUP PE NON-CEM 49/28
|
Facility
|
OP
|
$6,524.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$848.23 |
| Max. Negotiated Rate |
$6,263.83 |
| Rate for Payer: Aetna Commercial |
$5,024.11
|
| Rate for Payer: Anthem Medicaid |
$2,243.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,089.36
|
| Rate for Payer: Cash Price |
$3,262.41
|
| Rate for Payer: Cigna Commercial |
$5,415.60
|
| Rate for Payer: First Health Commercial |
$6,198.58
|
| Rate for Payer: Humana Commercial |
$5,546.10
|
| Rate for Payer: Humana KY Medicaid |
$2,243.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,266.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,350.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,815.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,957.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,288.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,741.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,893.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,304.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,022.69
|
| Rate for Payer: PHCS Commercial |
$6,263.83
|
| Rate for Payer: United Healthcare All Payer |
$5,741.84
|
|
|
INSERT POLCUP PE NON-CEM 49/28
|
Facility
|
IP
|
$6,524.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$848.23 |
| Max. Negotiated Rate |
$6,263.83 |
| Rate for Payer: Aetna Commercial |
$5,024.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,089.36
|
| Rate for Payer: Cash Price |
$3,262.41
|
| Rate for Payer: Cigna Commercial |
$5,415.60
|
| Rate for Payer: First Health Commercial |
$6,198.58
|
| Rate for Payer: Humana Commercial |
$5,546.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,350.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,815.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,957.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,741.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,893.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,304.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,022.69
|
| Rate for Payer: PHCS Commercial |
$6,263.83
|
| Rate for Payer: United Healthcare All Payer |
$5,741.84
|
|
|
INSERT POLCUP PE NON-CEM 51/28
|
Facility
|
OP
|
$5,601.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$728.15 |
| Max. Negotiated Rate |
$5,377.08 |
| Rate for Payer: Aetna Commercial |
$4,312.86
|
| Rate for Payer: Anthem Medicaid |
$1,926.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,368.87
|
| Rate for Payer: Cash Price |
$2,800.56
|
| Rate for Payer: Cigna Commercial |
$4,648.93
|
| Rate for Payer: First Health Commercial |
$5,321.06
|
| Rate for Payer: Humana Commercial |
$4,760.95
|
| Rate for Payer: Humana KY Medicaid |
$1,926.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,945.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,592.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,133.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,680.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,964.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,928.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,200.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$728.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,736.35
|
| Rate for Payer: PHCS Commercial |
$5,377.08
|
| Rate for Payer: United Healthcare All Payer |
$4,928.99
|
|
|
INSERT POLCUP PE NON-CEM 51/28
|
Facility
|
IP
|
$5,601.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$728.15 |
| Max. Negotiated Rate |
$5,377.08 |
| Rate for Payer: Aetna Commercial |
$4,312.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,368.87
|
| Rate for Payer: Cash Price |
$2,800.56
|
| Rate for Payer: Cigna Commercial |
$4,648.93
|
| Rate for Payer: First Health Commercial |
$5,321.06
|
| Rate for Payer: Humana Commercial |
$4,760.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,592.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,133.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,680.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,928.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,200.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$728.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,736.35
|
| Rate for Payer: PHCS Commercial |
$5,377.08
|
| Rate for Payer: United Healthcare All Payer |
$4,928.99
|
|
|
INSERT POLCUP PE NON-CEM 53/28
|
Facility
|
OP
|
$6,524.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$848.23 |
| Max. Negotiated Rate |
$6,263.83 |
| Rate for Payer: Aetna Commercial |
$5,024.11
|
| Rate for Payer: Anthem Medicaid |
$2,243.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,089.36
|
| Rate for Payer: Cash Price |
$3,262.41
|
| Rate for Payer: Cigna Commercial |
$5,415.60
|
| Rate for Payer: First Health Commercial |
$6,198.58
|
| Rate for Payer: Humana Commercial |
$5,546.10
|
| Rate for Payer: Humana KY Medicaid |
$2,243.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,266.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,350.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,815.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,957.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,288.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,741.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,893.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,304.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,022.69
|
| Rate for Payer: PHCS Commercial |
$6,263.83
|
| Rate for Payer: United Healthcare All Payer |
$5,741.84
|
|
|
INSERT POLCUP PE NON-CEM 53/28
|
Facility
|
IP
|
$6,524.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$848.23 |
| Max. Negotiated Rate |
$6,263.83 |
| Rate for Payer: Aetna Commercial |
$5,024.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,089.36
|
| Rate for Payer: Cash Price |
$3,262.41
|
| Rate for Payer: Cigna Commercial |
$5,415.60
|
| Rate for Payer: First Health Commercial |
$6,198.58
|
| Rate for Payer: Humana Commercial |
$5,546.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,350.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,815.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,957.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,741.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,893.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,304.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,022.69
|
| Rate for Payer: PHCS Commercial |
$6,263.83
|
| Rate for Payer: United Healthcare All Payer |
$5,741.84
|
|
|
INSERT POLCUP PE NON-CEM 55/28
|
Facility
|
IP
|
$5,601.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$728.15 |
| Max. Negotiated Rate |
$5,377.08 |
| Rate for Payer: Aetna Commercial |
$4,312.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,368.87
|
| Rate for Payer: Cash Price |
$2,800.56
|
| Rate for Payer: Cigna Commercial |
$4,648.93
|
| Rate for Payer: First Health Commercial |
$5,321.06
|
| Rate for Payer: Humana Commercial |
$4,760.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,592.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,133.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,680.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,928.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,200.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$728.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,736.35
|
| Rate for Payer: PHCS Commercial |
$5,377.08
|
| Rate for Payer: United Healthcare All Payer |
$4,928.99
|
|
|
INSERT POLCUP PE NON-CEM 55/28
|
Facility
|
OP
|
$5,601.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$728.15 |
| Max. Negotiated Rate |
$5,377.08 |
| Rate for Payer: Aetna Commercial |
$4,312.86
|
| Rate for Payer: Anthem Medicaid |
$1,926.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,368.87
|
| Rate for Payer: Cash Price |
$2,800.56
|
| Rate for Payer: Cigna Commercial |
$4,648.93
|
| Rate for Payer: First Health Commercial |
$5,321.06
|
| Rate for Payer: Humana Commercial |
$4,760.95
|
| Rate for Payer: Humana KY Medicaid |
$1,926.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,945.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,592.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,133.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,680.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,964.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,928.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,200.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$728.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,736.35
|
| Rate for Payer: PHCS Commercial |
$5,377.08
|
| Rate for Payer: United Healthcare All Payer |
$4,928.99
|
|
|
INSERT POLCUP PE NON-CEM 57/28
|
Facility
|
IP
|
$5,601.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$728.15 |
| Max. Negotiated Rate |
$5,377.08 |
| Rate for Payer: Aetna Commercial |
$4,312.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,368.87
|
| Rate for Payer: Cash Price |
$2,800.56
|
| Rate for Payer: Cigna Commercial |
$4,648.93
|
| Rate for Payer: First Health Commercial |
$5,321.06
|
| Rate for Payer: Humana Commercial |
$4,760.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,592.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,133.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,680.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,928.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,200.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$728.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,736.35
|
| Rate for Payer: PHCS Commercial |
$5,377.08
|
| Rate for Payer: United Healthcare All Payer |
$4,928.99
|
|
|
INSERT POLCUP PE NON-CEM 57/28
|
Facility
|
OP
|
$5,601.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$728.15 |
| Max. Negotiated Rate |
$5,377.08 |
| Rate for Payer: Aetna Commercial |
$4,312.86
|
| Rate for Payer: Anthem Medicaid |
$1,926.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,368.87
|
| Rate for Payer: Cash Price |
$2,800.56
|
| Rate for Payer: Cigna Commercial |
$4,648.93
|
| Rate for Payer: First Health Commercial |
$5,321.06
|
| Rate for Payer: Humana Commercial |
$4,760.95
|
| Rate for Payer: Humana KY Medicaid |
$1,926.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,945.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,592.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,133.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,680.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,964.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,928.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,200.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$728.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,736.35
|
| Rate for Payer: PHCS Commercial |
$5,377.08
|
| Rate for Payer: United Healthcare All Payer |
$4,928.99
|
|
|
INSERT POLCUP PE NON-CEM 59/28
|
Facility
|
OP
|
$6,524.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$848.23 |
| Max. Negotiated Rate |
$6,263.83 |
| Rate for Payer: Aetna Commercial |
$5,024.11
|
| Rate for Payer: Anthem Medicaid |
$2,243.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,089.36
|
| Rate for Payer: Cash Price |
$3,262.41
|
| Rate for Payer: Cigna Commercial |
$5,415.60
|
| Rate for Payer: First Health Commercial |
$6,198.58
|
| Rate for Payer: Humana Commercial |
$5,546.10
|
| Rate for Payer: Humana KY Medicaid |
$2,243.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,266.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,350.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,815.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,957.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,288.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,741.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,893.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,304.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,022.69
|
| Rate for Payer: PHCS Commercial |
$6,263.83
|
| Rate for Payer: United Healthcare All Payer |
$5,741.84
|
|
|
INSERT POLCUP PE NON-CEM 59/28
|
Facility
|
IP
|
$6,524.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$848.23 |
| Max. Negotiated Rate |
$6,263.83 |
| Rate for Payer: Aetna Commercial |
$5,024.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,089.36
|
| Rate for Payer: Cash Price |
$3,262.41
|
| Rate for Payer: Cigna Commercial |
$5,415.60
|
| Rate for Payer: First Health Commercial |
$6,198.58
|
| Rate for Payer: Humana Commercial |
$5,546.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,350.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,815.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,957.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,741.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,893.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,304.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,022.69
|
| Rate for Payer: PHCS Commercial |
$6,263.83
|
| Rate for Payer: United Healthcare All Payer |
$5,741.84
|
|
