|
LGN POROUS CR HA FEM SZ 4 RT
|
Facility
|
OP
|
$19,947.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,593.18 |
| Max. Negotiated Rate |
$19,149.60 |
| Rate for Payer: Aetna Commercial |
$15,359.58
|
| Rate for Payer: Anthem Medicaid |
$6,859.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,559.05
|
| Rate for Payer: Cash Price |
$9,973.75
|
| Rate for Payer: Cigna Commercial |
$16,556.42
|
| Rate for Payer: First Health Commercial |
$18,950.12
|
| Rate for Payer: Humana Commercial |
$16,955.38
|
| Rate for Payer: Humana KY Medicaid |
$6,859.95
|
| Rate for Payer: Kentucky WC Medicaid |
$6,929.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,356.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,721.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,984.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,997.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,553.80
|
| Rate for Payer: Ohio Health Group HMO |
$14,960.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,989.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,593.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,183.72
|
| Rate for Payer: PHCS Commercial |
$19,149.60
|
| Rate for Payer: United Healthcare All Payer |
$17,553.80
|
|
|
LGN POROUS CR HA FEM SZ 5 RT
|
Facility
|
OP
|
$19,947.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,593.18 |
| Max. Negotiated Rate |
$19,149.60 |
| Rate for Payer: Aetna Commercial |
$15,359.58
|
| Rate for Payer: Anthem Medicaid |
$6,859.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,559.05
|
| Rate for Payer: Cash Price |
$9,973.75
|
| Rate for Payer: Cigna Commercial |
$16,556.42
|
| Rate for Payer: First Health Commercial |
$18,950.12
|
| Rate for Payer: Humana Commercial |
$16,955.38
|
| Rate for Payer: Humana KY Medicaid |
$6,859.95
|
| Rate for Payer: Kentucky WC Medicaid |
$6,929.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,356.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,721.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,984.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,997.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,553.80
|
| Rate for Payer: Ohio Health Group HMO |
$14,960.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,989.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,593.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,183.72
|
| Rate for Payer: PHCS Commercial |
$19,149.60
|
| Rate for Payer: United Healthcare All Payer |
$17,553.80
|
|
|
LGN POROUS CR HA FEM SZ 5 RT
|
Facility
|
IP
|
$19,947.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,593.18 |
| Max. Negotiated Rate |
$19,149.60 |
| Rate for Payer: Aetna Commercial |
$15,359.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,559.05
|
| Rate for Payer: Cash Price |
$9,973.75
|
| Rate for Payer: Cigna Commercial |
$16,556.42
|
| Rate for Payer: First Health Commercial |
$18,950.12
|
| Rate for Payer: Humana Commercial |
$16,955.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,356.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,721.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,984.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,553.80
|
| Rate for Payer: Ohio Health Group HMO |
$14,960.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,989.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,593.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,183.72
|
| Rate for Payer: PHCS Commercial |
$19,149.60
|
| Rate for Payer: United Healthcare All Payer |
$17,553.80
|
|
|
LGN POROUS CR HA FEM SZ 6 RT
|
Facility
|
IP
|
$19,947.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,593.18 |
| Max. Negotiated Rate |
$19,149.60 |
| Rate for Payer: Aetna Commercial |
$15,359.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,559.05
|
| Rate for Payer: Cash Price |
$9,973.75
|
| Rate for Payer: Cigna Commercial |
$16,556.42
|
| Rate for Payer: First Health Commercial |
$18,950.12
|
| Rate for Payer: Humana Commercial |
$16,955.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,356.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,721.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,984.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,553.80
|
| Rate for Payer: Ohio Health Group HMO |
$14,960.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,989.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,593.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,183.72
|
| Rate for Payer: PHCS Commercial |
$19,149.60
|
| Rate for Payer: United Healthcare All Payer |
$17,553.80
|
|
|
LGN POROUS CR HA FEM SZ 6 RT
|
Facility
|
OP
|
$19,947.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,593.18 |
| Max. Negotiated Rate |
$19,149.60 |
| Rate for Payer: Aetna Commercial |
$15,359.58
|
| Rate for Payer: Anthem Medicaid |
$6,859.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,559.05
|
| Rate for Payer: Cash Price |
$9,973.75
|
| Rate for Payer: Cigna Commercial |
$16,556.42
|
| Rate for Payer: First Health Commercial |
$18,950.12
|
| Rate for Payer: Humana Commercial |
$16,955.38
|
| Rate for Payer: Humana KY Medicaid |
$6,859.95
|
| Rate for Payer: Kentucky WC Medicaid |
$6,929.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,356.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,721.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,984.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,997.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,553.80
|
| Rate for Payer: Ohio Health Group HMO |
$14,960.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,989.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,593.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,183.72
|
| Rate for Payer: PHCS Commercial |
$19,149.60
|
| Rate for Payer: United Healthcare All Payer |
$17,553.80
|
|
|
LGN POROUS CR HA FEM SZ 7 RT
|
Facility
|
OP
|
$19,947.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,593.18 |
| Max. Negotiated Rate |
$19,149.60 |
| Rate for Payer: Aetna Commercial |
$15,359.58
|
| Rate for Payer: Anthem Medicaid |
$6,859.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,559.05
|
| Rate for Payer: Cash Price |
$9,973.75
|
| Rate for Payer: Cigna Commercial |
$16,556.42
|
| Rate for Payer: First Health Commercial |
$18,950.12
|
| Rate for Payer: Humana Commercial |
$16,955.38
|
| Rate for Payer: Humana KY Medicaid |
$6,859.95
|
| Rate for Payer: Kentucky WC Medicaid |
$6,929.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,356.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,721.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,984.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,997.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,553.80
|
| Rate for Payer: Ohio Health Group HMO |
$14,960.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,989.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,593.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,183.72
|
| Rate for Payer: PHCS Commercial |
$19,149.60
|
| Rate for Payer: United Healthcare All Payer |
$17,553.80
|
|
|
LGN POROUS CR HA FEM SZ 7 RT
|
Facility
|
IP
|
$19,947.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,593.18 |
| Max. Negotiated Rate |
$19,149.60 |
| Rate for Payer: Aetna Commercial |
$15,359.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,559.05
|
| Rate for Payer: Cash Price |
$9,973.75
|
| Rate for Payer: Cigna Commercial |
$16,556.42
|
| Rate for Payer: First Health Commercial |
$18,950.12
|
| Rate for Payer: Humana Commercial |
$16,955.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,356.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,721.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,984.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,553.80
|
| Rate for Payer: Ohio Health Group HMO |
$14,960.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,989.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,593.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,183.72
|
| Rate for Payer: PHCS Commercial |
$19,149.60
|
| Rate for Payer: United Healthcare All Payer |
$17,553.80
|
|
|
LGN POROUS CR HA FEM SZ 8 RT
|
Facility
|
OP
|
$19,947.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,593.18 |
| Max. Negotiated Rate |
$19,149.60 |
| Rate for Payer: Aetna Commercial |
$15,359.58
|
| Rate for Payer: Anthem Medicaid |
$6,859.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,559.05
|
| Rate for Payer: Cash Price |
$9,973.75
|
| Rate for Payer: Cigna Commercial |
$16,556.42
|
| Rate for Payer: First Health Commercial |
$18,950.12
|
| Rate for Payer: Humana Commercial |
$16,955.38
|
| Rate for Payer: Humana KY Medicaid |
$6,859.95
|
| Rate for Payer: Kentucky WC Medicaid |
$6,929.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,356.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,721.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,984.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,997.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,553.80
|
| Rate for Payer: Ohio Health Group HMO |
$14,960.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,989.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,593.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,183.72
|
| Rate for Payer: PHCS Commercial |
$19,149.60
|
| Rate for Payer: United Healthcare All Payer |
$17,553.80
|
|
|
LGN POROUS CR HA FEM SZ 8 RT
|
Facility
|
IP
|
$19,947.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,593.18 |
| Max. Negotiated Rate |
$19,149.60 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,356.95
|
| Rate for Payer: Aetna Commercial |
$15,359.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,559.05
|
| Rate for Payer: Cash Price |
$9,973.75
|
| Rate for Payer: Cigna Commercial |
$16,556.42
|
| Rate for Payer: First Health Commercial |
$18,950.12
|
| Rate for Payer: Humana Commercial |
$16,955.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,721.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,984.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,553.80
|
| Rate for Payer: Ohio Health Group HMO |
$14,960.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,989.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,593.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,183.72
|
| Rate for Payer: PHCS Commercial |
$19,149.60
|
| Rate for Payer: United Healthcare All Payer |
$17,553.80
|
|
|
LGN PS HG FLX XLPE SZ 3-4X9MM
|
Facility
|
IP
|
$10,669.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.05 |
| Max. Negotiated Rate |
$10,242.85 |
| Rate for Payer: Aetna Commercial |
$8,215.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,322.32
|
| Rate for Payer: Cash Price |
$5,334.82
|
| Rate for Payer: Cigna Commercial |
$8,855.80
|
| Rate for Payer: First Health Commercial |
$10,136.16
|
| Rate for Payer: Humana Commercial |
$9,069.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,749.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,874.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,200.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,389.28
|
| Rate for Payer: Ohio Health Group HMO |
$8,002.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,133.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,387.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,307.59
|
| Rate for Payer: PHCS Commercial |
$10,242.85
|
| Rate for Payer: United Healthcare All Payer |
$9,389.28
|
|
|
LGN PS HG FLX XLPE SZ 3-4X9MM
|
Facility
|
OP
|
$10,669.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.05 |
| Max. Negotiated Rate |
$10,242.85 |
| Rate for Payer: Aetna Commercial |
$8,215.62
|
| Rate for Payer: Anthem Medicaid |
$3,669.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,322.32
|
| Rate for Payer: Cash Price |
$5,334.82
|
| Rate for Payer: Cigna Commercial |
$8,855.80
|
| Rate for Payer: First Health Commercial |
$10,136.16
|
| Rate for Payer: Humana Commercial |
$9,069.19
|
| Rate for Payer: Humana KY Medicaid |
$3,669.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,706.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,749.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,874.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,200.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,742.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,389.28
|
| Rate for Payer: Ohio Health Group HMO |
$8,002.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,133.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,387.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,307.59
|
| Rate for Payer: PHCS Commercial |
$10,242.85
|
| Rate for Payer: United Healthcare All Payer |
$9,389.28
|
|
|
LGN PS HG FLX XLP SZ5-6 X 13MM
|
Facility
|
OP
|
$7,713.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.71 |
| Max. Negotiated Rate |
$7,404.60 |
| Rate for Payer: Aetna Commercial |
$5,939.10
|
| Rate for Payer: Anthem Medicaid |
$2,652.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,016.23
|
| Rate for Payer: Cash Price |
$3,856.56
|
| Rate for Payer: Cigna Commercial |
$6,401.89
|
| Rate for Payer: First Health Commercial |
$7,327.46
|
| Rate for Payer: Humana Commercial |
$6,556.15
|
| Rate for Payer: Humana KY Medicaid |
$2,652.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,679.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,324.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,692.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,313.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,705.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,787.55
|
| Rate for Payer: Ohio Health Group HMO |
$5,784.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,542.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,002.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,391.07
|
| Rate for Payer: PHCS Commercial |
$7,404.60
|
| Rate for Payer: United Healthcare All Payer |
$6,787.55
|
|
|
LGN PS HG FLX XLP SZ5-6 X 13MM
|
Facility
|
IP
|
$7,713.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.71 |
| Max. Negotiated Rate |
$7,404.60 |
| Rate for Payer: Aetna Commercial |
$5,939.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,016.23
|
| Rate for Payer: Cash Price |
$3,856.56
|
| Rate for Payer: Cigna Commercial |
$6,401.89
|
| Rate for Payer: First Health Commercial |
$7,327.46
|
| Rate for Payer: Humana Commercial |
$6,556.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,324.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,692.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,313.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,787.55
|
| Rate for Payer: Ohio Health Group HMO |
$5,784.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,542.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,002.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,391.07
|
| Rate for Payer: PHCS Commercial |
$7,404.60
|
| Rate for Payer: United Healthcare All Payer |
$6,787.55
|
|
|
L HRT ARTERY/VENTRICLE ANGIO
|
Facility
|
OP
|
$18,139.00
|
|
|
Service Code
|
HCPCS 93458
|
| Hospital Charge Code |
76102482
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,358.07 |
| Max. Negotiated Rate |
$17,413.44 |
| Rate for Payer: Aetna Commercial |
$13,967.03
|
| Rate for Payer: Anthem Medicaid |
$6,238.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,148.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$9,069.50
|
| Rate for Payer: Cash Price |
$9,069.50
|
| Rate for Payer: Cigna Commercial |
$15,055.37
|
| Rate for Payer: First Health Commercial |
$17,232.05
|
| Rate for Payer: Humana Commercial |
$15,418.15
|
| Rate for Payer: Humana KY Medicaid |
$6,238.00
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$6,301.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,873.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,386.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,363.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,962.32
|
| Rate for Payer: Ohio Health Group HMO |
$13,604.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,627.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,623.09
|
| Rate for Payer: PHCS Commercial |
$17,413.44
|
| Rate for Payer: United Healthcare All Payer |
$15,962.32
|
|
|
L HRT ARTERY/VENTRICLE ANGIO
|
Professional
|
Both
|
$18,139.00
|
|
|
Service Code
|
HCPCS 93458
|
| Hospital Charge Code |
76102482
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$436.05 |
| Max. Negotiated Rate |
$18,139.00 |
| Rate for Payer: Aetna Commercial |
$1,654.81
|
| Rate for Payer: Anthem Medicaid |
$921.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$18,139.00
|
| Rate for Payer: Cash Price |
$9,069.50
|
| Rate for Payer: Cash Price |
$9,069.50
|
| Rate for Payer: Cigna Commercial |
$1,812.55
|
| Rate for Payer: Healthspan PPO |
$1,229.79
|
| Rate for Payer: Humana Medicaid |
$921.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$436.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$939.68
|
| Rate for Payer: Molina Healthcare Passport |
$921.25
|
| Rate for Payer: Multiplan PHCS |
$10,883.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$12,697.30
|
| Rate for Payer: UHCCP Medicaid |
$6,348.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$930.46
|
|
|
L HRT ARTERY/VENTRICLE ANGIO
|
Facility
|
OP
|
$17,609.00
|
|
|
Service Code
|
HCPCS 93458
|
| Hospital Charge Code |
48100069
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,289.17 |
| Max. Negotiated Rate |
$16,904.64 |
| Rate for Payer: Aetna Commercial |
$13,558.93
|
| Rate for Payer: Anthem Medicaid |
$6,055.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,735.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$8,804.50
|
| Rate for Payer: Cash Price |
$8,804.50
|
| Rate for Payer: Cigna Commercial |
$14,615.47
|
| Rate for Payer: First Health Commercial |
$16,728.55
|
| Rate for Payer: Humana Commercial |
$14,967.65
|
| Rate for Payer: Humana KY Medicaid |
$6,055.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$6,117.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,439.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,995.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,177.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,495.92
|
| Rate for Payer: Ohio Health Group HMO |
$13,206.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,521.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,289.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,458.79
|
| Rate for Payer: PHCS Commercial |
$16,904.64
|
| Rate for Payer: United Healthcare All Payer |
$15,495.92
|
|
|
L HRT ARTERY/VENTRICLE ANGIO
|
Facility
|
IP
|
$17,609.00
|
|
|
Service Code
|
HCPCS 93458
|
| Hospital Charge Code |
48100069
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,289.17 |
| Max. Negotiated Rate |
$16,904.64 |
| Rate for Payer: Aetna Commercial |
$13,558.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,735.02
|
| Rate for Payer: Cash Price |
$8,804.50
|
| Rate for Payer: Cigna Commercial |
$14,615.47
|
| Rate for Payer: First Health Commercial |
$16,728.55
|
| Rate for Payer: Humana Commercial |
$14,967.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,439.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,995.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,282.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,495.92
|
| Rate for Payer: Ohio Health Group HMO |
$13,206.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,521.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,289.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,458.79
|
| Rate for Payer: PHCS Commercial |
$16,904.64
|
| Rate for Payer: United Healthcare All Payer |
$15,495.92
|
|
|
L HRT ARTERY/VENTRICLE ANGIO
|
Facility
|
IP
|
$18,139.00
|
|
|
Service Code
|
HCPCS 93458
|
| Hospital Charge Code |
76102482
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,358.07 |
| Max. Negotiated Rate |
$17,413.44 |
| Rate for Payer: Aetna Commercial |
$13,967.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,148.42
|
| Rate for Payer: Cash Price |
$9,069.50
|
| Rate for Payer: Cigna Commercial |
$15,055.37
|
| Rate for Payer: First Health Commercial |
$17,232.05
|
| Rate for Payer: Humana Commercial |
$15,418.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,873.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,386.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,441.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,962.32
|
| Rate for Payer: Ohio Health Group HMO |
$13,604.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,627.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,623.09
|
| Rate for Payer: PHCS Commercial |
$17,413.44
|
| Rate for Payer: United Healthcare All Payer |
$15,962.32
|
|
|
L HRT ARTERY/VENTRICLE ANGI(P
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 93458
|
| Hospital Charge Code |
761P2482
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.50 |
| Max. Negotiated Rate |
$1,812.55 |
| Rate for Payer: Aetna Commercial |
$1,654.81
|
| Rate for Payer: Anthem Medicaid |
$921.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$530.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$1,812.55
|
| Rate for Payer: Healthspan PPO |
$1,229.79
|
| Rate for Payer: Humana Medicaid |
$921.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$436.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$939.68
|
| Rate for Payer: Molina Healthcare Passport |
$921.25
|
| Rate for Payer: Multiplan PHCS |
$318.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$371.00
|
| Rate for Payer: UHCCP Medicaid |
$185.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$930.46
|
|
|
L HRT ARTERY/VENTRICLE ANGI(T
|
Facility
|
IP
|
$17,609.00
|
|
|
Service Code
|
HCPCS 93458
|
| Hospital Charge Code |
761T2482
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,289.17 |
| Max. Negotiated Rate |
$16,904.64 |
| Rate for Payer: Aetna Commercial |
$13,558.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,735.02
|
| Rate for Payer: Cash Price |
$8,804.50
|
| Rate for Payer: Cigna Commercial |
$14,615.47
|
| Rate for Payer: First Health Commercial |
$16,728.55
|
| Rate for Payer: Humana Commercial |
$14,967.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,439.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,995.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,282.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,495.92
|
| Rate for Payer: Ohio Health Group HMO |
$13,206.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,521.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,289.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,458.79
|
| Rate for Payer: PHCS Commercial |
$16,904.64
|
| Rate for Payer: United Healthcare All Payer |
$15,495.92
|
|
|
L HRT ARTERY/VENTRICLE ANGI(T
|
Facility
|
OP
|
$17,609.00
|
|
|
Service Code
|
HCPCS 93458
|
| Hospital Charge Code |
761T2482
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,289.17 |
| Max. Negotiated Rate |
$16,904.64 |
| Rate for Payer: Aetna Commercial |
$13,558.93
|
| Rate for Payer: Anthem Medicaid |
$6,055.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,735.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$8,804.50
|
| Rate for Payer: Cash Price |
$8,804.50
|
| Rate for Payer: Cigna Commercial |
$14,615.47
|
| Rate for Payer: First Health Commercial |
$16,728.55
|
| Rate for Payer: Humana Commercial |
$14,967.65
|
| Rate for Payer: Humana KY Medicaid |
$6,055.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$6,117.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,439.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,995.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,177.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,495.92
|
| Rate for Payer: Ohio Health Group HMO |
$13,206.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,521.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,289.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,458.79
|
| Rate for Payer: PHCS Commercial |
$16,904.64
|
| Rate for Payer: United Healthcare All Payer |
$15,495.92
|
|
|
L HRT ART/GRFT ANGIO
|
Facility
|
OP
|
$18,713.00
|
|
|
Service Code
|
HCPCS 93459
|
| Hospital Charge Code |
76102483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,432.69 |
| Max. Negotiated Rate |
$17,964.48 |
| Rate for Payer: Aetna Commercial |
$14,409.01
|
| Rate for Payer: Anthem Medicaid |
$6,435.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,596.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$9,356.50
|
| Rate for Payer: Cash Price |
$9,356.50
|
| Rate for Payer: Cigna Commercial |
$15,531.79
|
| Rate for Payer: First Health Commercial |
$17,777.35
|
| Rate for Payer: Humana Commercial |
$15,906.05
|
| Rate for Payer: Humana KY Medicaid |
$6,435.40
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$6,500.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,344.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,810.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,564.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,467.44
|
| Rate for Payer: Ohio Health Group HMO |
$14,034.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,432.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,801.03
|
| Rate for Payer: PHCS Commercial |
$17,964.48
|
| Rate for Payer: United Healthcare All Payer |
$16,467.44
|
|
|
L HRT ART/GRFT ANGIO
|
Professional
|
Both
|
$18,713.00
|
|
|
Service Code
|
HCPCS 93459
|
| Hospital Charge Code |
76102483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.43 |
| Max. Negotiated Rate |
$18,713.00 |
| Rate for Payer: Aetna Commercial |
$1,827.80
|
| Rate for Payer: Anthem Medicaid |
$1,017.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$18,713.00
|
| Rate for Payer: Cash Price |
$9,356.50
|
| Rate for Payer: Cash Price |
$9,356.50
|
| Rate for Payer: Cigna Commercial |
$2,002.24
|
| Rate for Payer: Healthspan PPO |
$1,358.82
|
| Rate for Payer: Humana Medicaid |
$1,017.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$490.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,037.73
|
| Rate for Payer: Molina Healthcare Passport |
$1,017.38
|
| Rate for Payer: Multiplan PHCS |
$11,227.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$13,099.10
|
| Rate for Payer: UHCCP Medicaid |
$6,549.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,027.55
|
|
|
L HRT ART/GRFT ANGIO
|
Facility
|
OP
|
$18,113.00
|
|
|
Service Code
|
HCPCS 93459
|
| Hospital Charge Code |
48100070
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,354.69 |
| Max. Negotiated Rate |
$17,388.48 |
| Rate for Payer: Aetna Commercial |
$13,947.01
|
| Rate for Payer: Anthem Medicaid |
$6,229.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,128.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$9,056.50
|
| Rate for Payer: Cash Price |
$9,056.50
|
| Rate for Payer: Cigna Commercial |
$15,033.79
|
| Rate for Payer: First Health Commercial |
$17,207.35
|
| Rate for Payer: Humana Commercial |
$15,396.05
|
| Rate for Payer: Humana KY Medicaid |
$6,229.06
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$6,292.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,852.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,367.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,354.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,939.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,584.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,622.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,354.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,615.03
|
| Rate for Payer: PHCS Commercial |
$17,388.48
|
| Rate for Payer: United Healthcare All Payer |
$15,939.44
|
|
|
L HRT ART/GRFT ANGIO
|
Facility
|
IP
|
$18,113.00
|
|
|
Service Code
|
HCPCS 93459
|
| Hospital Charge Code |
48100070
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,354.69 |
| Max. Negotiated Rate |
$17,388.48 |
| Rate for Payer: Aetna Commercial |
$13,947.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,128.14
|
| Rate for Payer: Cash Price |
$9,056.50
|
| Rate for Payer: Cigna Commercial |
$15,033.79
|
| Rate for Payer: First Health Commercial |
$17,207.35
|
| Rate for Payer: Humana Commercial |
$15,396.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,852.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,367.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,433.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,939.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,584.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,622.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,354.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,615.03
|
| Rate for Payer: PHCS Commercial |
$17,388.48
|
| Rate for Payer: United Healthcare All Payer |
$15,939.44
|
|
