|
LGN POROUS CR HA FEM SZ 4 RT
|
Facility
|
IP
|
$20,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,168.75 |
| Max. Negotiated Rate |
$19,740.00 |
| Rate for Payer: Aetna Commercial |
$15,833.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,038.75
|
| Rate for Payer: Cash Price |
$10,281.25
|
| Rate for Payer: Cigna Commercial |
$17,066.88
|
| Rate for Payer: First Health Commercial |
$19,534.38
|
| Rate for Payer: Humana Commercial |
$17,478.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,861.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,175.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,168.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,095.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,889.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,188.12
|
| Rate for Payer: PHCS Commercial |
$19,740.00
|
| Rate for Payer: United Healthcare All Payer |
$18,095.00
|
|
|
LGN POROUS CR HA FEM SZ 5 RT
|
Facility
|
IP
|
$20,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,168.75 |
| Max. Negotiated Rate |
$19,740.00 |
| Rate for Payer: Aetna Commercial |
$15,833.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,038.75
|
| Rate for Payer: Cash Price |
$10,281.25
|
| Rate for Payer: Cigna Commercial |
$17,066.88
|
| Rate for Payer: First Health Commercial |
$19,534.38
|
| Rate for Payer: Humana Commercial |
$17,478.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,861.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,175.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,168.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,095.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,889.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,188.12
|
| Rate for Payer: PHCS Commercial |
$19,740.00
|
| Rate for Payer: United Healthcare All Payer |
$18,095.00
|
|
|
LGN POROUS CR HA FEM SZ 5 RT
|
Facility
|
OP
|
$20,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,168.75 |
| Max. Negotiated Rate |
$19,740.00 |
| Rate for Payer: Aetna Commercial |
$15,833.12
|
| Rate for Payer: Anthem Medicaid |
$7,071.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,038.75
|
| Rate for Payer: Cash Price |
$10,281.25
|
| Rate for Payer: Cigna Commercial |
$17,066.88
|
| Rate for Payer: First Health Commercial |
$19,534.38
|
| Rate for Payer: Humana Commercial |
$17,478.12
|
| Rate for Payer: Humana KY Medicaid |
$7,071.44
|
| Rate for Payer: Kentucky WC Medicaid |
$7,143.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,861.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,175.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,168.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,213.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,095.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,889.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,188.12
|
| Rate for Payer: PHCS Commercial |
$19,740.00
|
| Rate for Payer: United Healthcare All Payer |
$18,095.00
|
|
|
LGN POROUS CR HA FEM SZ 6 RT
|
Facility
|
IP
|
$20,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,168.75 |
| Max. Negotiated Rate |
$19,740.00 |
| Rate for Payer: Aetna Commercial |
$15,833.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,038.75
|
| Rate for Payer: Cash Price |
$10,281.25
|
| Rate for Payer: Cigna Commercial |
$17,066.88
|
| Rate for Payer: First Health Commercial |
$19,534.38
|
| Rate for Payer: Humana Commercial |
$17,478.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,861.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,175.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,168.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,095.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,889.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,188.12
|
| Rate for Payer: PHCS Commercial |
$19,740.00
|
| Rate for Payer: United Healthcare All Payer |
$18,095.00
|
|
|
LGN POROUS CR HA FEM SZ 6 RT
|
Facility
|
OP
|
$20,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,168.75 |
| Max. Negotiated Rate |
$19,740.00 |
| Rate for Payer: Aetna Commercial |
$15,833.12
|
| Rate for Payer: Anthem Medicaid |
$7,071.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,038.75
|
| Rate for Payer: Cash Price |
$10,281.25
|
| Rate for Payer: Cigna Commercial |
$17,066.88
|
| Rate for Payer: First Health Commercial |
$19,534.38
|
| Rate for Payer: Humana Commercial |
$17,478.12
|
| Rate for Payer: Humana KY Medicaid |
$7,071.44
|
| Rate for Payer: Kentucky WC Medicaid |
$7,143.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,861.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,175.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,168.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,213.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,095.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,889.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,188.12
|
| Rate for Payer: PHCS Commercial |
$19,740.00
|
| Rate for Payer: United Healthcare All Payer |
$18,095.00
|
|
|
LGN POROUS CR HA FEM SZ 7 RT
|
Facility
|
OP
|
$20,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,168.75 |
| Max. Negotiated Rate |
$19,740.00 |
| Rate for Payer: Aetna Commercial |
$15,833.12
|
| Rate for Payer: Anthem Medicaid |
$7,071.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,038.75
|
| Rate for Payer: Cash Price |
$10,281.25
|
| Rate for Payer: Cigna Commercial |
$17,066.88
|
| Rate for Payer: First Health Commercial |
$19,534.38
|
| Rate for Payer: Humana Commercial |
$17,478.12
|
| Rate for Payer: Humana KY Medicaid |
$7,071.44
|
| Rate for Payer: Kentucky WC Medicaid |
$7,143.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,861.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,175.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,168.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,213.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,095.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,889.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,188.12
|
| Rate for Payer: PHCS Commercial |
$19,740.00
|
| Rate for Payer: United Healthcare All Payer |
$18,095.00
|
|
|
LGN POROUS CR HA FEM SZ 7 RT
|
Facility
|
IP
|
$20,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,168.75 |
| Max. Negotiated Rate |
$19,740.00 |
| Rate for Payer: Aetna Commercial |
$15,833.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,038.75
|
| Rate for Payer: Cash Price |
$10,281.25
|
| Rate for Payer: Cigna Commercial |
$17,066.88
|
| Rate for Payer: First Health Commercial |
$19,534.38
|
| Rate for Payer: Humana Commercial |
$17,478.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,861.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,175.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,168.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,095.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,889.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,188.12
|
| Rate for Payer: PHCS Commercial |
$19,740.00
|
| Rate for Payer: United Healthcare All Payer |
$18,095.00
|
|
|
LGN POROUS CR HA FEM SZ 8 RT
|
Facility
|
IP
|
$20,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,168.75 |
| Max. Negotiated Rate |
$19,740.00 |
| Rate for Payer: Aetna Commercial |
$15,833.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,038.75
|
| Rate for Payer: Cash Price |
$10,281.25
|
| Rate for Payer: Cigna Commercial |
$17,066.88
|
| Rate for Payer: First Health Commercial |
$19,534.38
|
| Rate for Payer: Humana Commercial |
$17,478.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,861.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,175.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,168.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,095.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,889.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,188.12
|
| Rate for Payer: PHCS Commercial |
$19,740.00
|
| Rate for Payer: United Healthcare All Payer |
$18,095.00
|
|
|
LGN POROUS CR HA FEM SZ 8 RT
|
Facility
|
OP
|
$20,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,168.75 |
| Max. Negotiated Rate |
$19,740.00 |
| Rate for Payer: Aetna Commercial |
$15,833.12
|
| Rate for Payer: Anthem Medicaid |
$7,071.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,038.75
|
| Rate for Payer: Cash Price |
$10,281.25
|
| Rate for Payer: Cigna Commercial |
$17,066.88
|
| Rate for Payer: First Health Commercial |
$19,534.38
|
| Rate for Payer: Humana Commercial |
$17,478.12
|
| Rate for Payer: Humana KY Medicaid |
$7,071.44
|
| Rate for Payer: Kentucky WC Medicaid |
$7,143.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,861.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,175.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,168.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,213.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,095.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,889.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,188.12
|
| Rate for Payer: PHCS Commercial |
$19,740.00
|
| Rate for Payer: United Healthcare All Payer |
$18,095.00
|
|
|
LGN PS HG FLX XLPE SZ 3-4X9MM
|
Facility
|
OP
|
$10,910.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,273.01 |
| Max. Negotiated Rate |
$10,473.62 |
| Rate for Payer: Aetna Commercial |
$8,400.72
|
| Rate for Payer: Anthem Medicaid |
$3,751.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,509.82
|
| Rate for Payer: Cash Price |
$5,455.01
|
| Rate for Payer: Cigna Commercial |
$9,055.32
|
| Rate for Payer: First Health Commercial |
$10,364.52
|
| Rate for Payer: Humana Commercial |
$9,273.52
|
| Rate for Payer: Humana KY Medicaid |
$3,751.96
|
| Rate for Payer: Kentucky WC Medicaid |
$3,790.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,946.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,051.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,273.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,827.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,600.82
|
| Rate for Payer: Ohio Health Group HMO |
$8,182.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,728.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,491.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,527.91
|
| Rate for Payer: PHCS Commercial |
$10,473.62
|
| Rate for Payer: United Healthcare All Payer |
$9,600.82
|
|
|
LGN PS HG FLX XLPE SZ 3-4X9MM
|
Facility
|
IP
|
$10,910.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,273.01 |
| Max. Negotiated Rate |
$10,473.62 |
| Rate for Payer: Aetna Commercial |
$8,400.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,509.82
|
| Rate for Payer: Cash Price |
$5,455.01
|
| Rate for Payer: Cigna Commercial |
$9,055.32
|
| Rate for Payer: First Health Commercial |
$10,364.52
|
| Rate for Payer: Humana Commercial |
$9,273.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,946.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,051.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,273.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,600.82
|
| Rate for Payer: Ohio Health Group HMO |
$8,182.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,728.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,491.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,527.91
|
| Rate for Payer: PHCS Commercial |
$10,473.62
|
| Rate for Payer: United Healthcare All Payer |
$9,600.82
|
|
|
LGN PS HG FLX XLP SZ5-6 X 13MM
|
Facility
|
OP
|
$7,913.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,373.94 |
| Max. Negotiated Rate |
$7,596.60 |
| Rate for Payer: Aetna Commercial |
$6,093.10
|
| Rate for Payer: Anthem Medicaid |
$2,721.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,172.23
|
| Rate for Payer: Cash Price |
$3,956.56
|
| Rate for Payer: Cigna Commercial |
$6,567.89
|
| Rate for Payer: First Health Commercial |
$7,517.46
|
| Rate for Payer: Humana Commercial |
$6,726.15
|
| Rate for Payer: Humana KY Medicaid |
$2,721.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,749.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,488.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,839.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,775.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,963.55
|
| Rate for Payer: Ohio Health Group HMO |
$5,934.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,330.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,884.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,460.05
|
| Rate for Payer: PHCS Commercial |
$7,596.60
|
| Rate for Payer: United Healthcare All Payer |
$6,963.55
|
|
|
LGN PS HG FLX XLP SZ5-6 X 13MM
|
Facility
|
IP
|
$7,913.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,373.94 |
| Max. Negotiated Rate |
$7,596.60 |
| Rate for Payer: Aetna Commercial |
$6,093.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,172.23
|
| Rate for Payer: Cash Price |
$3,956.56
|
| Rate for Payer: Cigna Commercial |
$6,567.89
|
| Rate for Payer: First Health Commercial |
$7,517.46
|
| Rate for Payer: Humana Commercial |
$6,726.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,488.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,839.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,963.55
|
| Rate for Payer: Ohio Health Group HMO |
$5,934.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,330.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,884.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,460.05
|
| Rate for Payer: PHCS Commercial |
$7,596.60
|
| Rate for Payer: United Healthcare All Payer |
$6,963.55
|
|
|
L HRT ARTERY/VENTRICLE ANGIO
|
Facility
|
OP
|
$18,754.00
|
|
|
Service Code
|
HCPCS 93458
|
| Hospital Charge Code |
48100069
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$18,003.84 |
| Rate for Payer: Aetna Commercial |
$14,440.58
|
| Rate for Payer: Anthem Medicaid |
$6,449.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,628.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$9,377.00
|
| Rate for Payer: Cash Price |
$9,377.00
|
| Rate for Payer: Cigna Commercial |
$15,565.82
|
| Rate for Payer: First Health Commercial |
$17,816.30
|
| Rate for Payer: Humana Commercial |
$15,940.90
|
| Rate for Payer: Humana KY Medicaid |
$6,449.50
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$6,515.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,378.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,840.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,578.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,503.52
|
| Rate for Payer: Ohio Health Group HMO |
$14,065.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,003.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,315.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,940.26
|
| Rate for Payer: PHCS Commercial |
$18,003.84
|
| Rate for Payer: United Healthcare All Payer |
$16,503.52
|
|
|
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 |
$5,441.70 |
| 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 |
$14,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,780.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,515.91
|
| Rate for Payer: PHCS Commercial |
$17,413.44
|
| Rate for Payer: United Healthcare All Payer |
$15,962.32
|
|
|
L HRT ARTERY/VENTRICLE ANGIO
|
Facility
|
IP
|
$18,754.00
|
|
|
Service Code
|
HCPCS 93458
|
| Hospital Charge Code |
48100069
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,626.20 |
| Max. Negotiated Rate |
$18,003.84 |
| Rate for Payer: Aetna Commercial |
$14,440.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,628.12
|
| Rate for Payer: Cash Price |
$9,377.00
|
| Rate for Payer: Cigna Commercial |
$15,565.82
|
| Rate for Payer: First Health Commercial |
$17,816.30
|
| Rate for Payer: Humana Commercial |
$15,940.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,378.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,840.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,626.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,503.52
|
| Rate for Payer: Ohio Health Group HMO |
$14,065.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,003.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,315.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,940.26
|
| Rate for Payer: PHCS Commercial |
$18,003.84
|
| Rate for Payer: United Healthcare All Payer |
$16,503.52
|
|
|
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 |
$10,883.40 |
| Rate for Payer: Aetna Commercial |
$1,654.81
|
| Rate for Payer: Ambetter Exchange |
$897.68
|
| Rate for Payer: Anthem Medicaid |
$921.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$897.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$897.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,077.22
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$897.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$939.67
|
| 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 |
$1,166.98
|
| Rate for Payer: UHCCP Medicaid |
$6,348.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$930.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$897.68
|
|
|
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 |
$2,971.90 |
| 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 |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,148.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$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 |
$2,971.90
|
| 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 |
$3,566.28
|
| 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 |
$14,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,780.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,515.91
|
| 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: Ambetter Exchange |
$897.68
|
| Rate for Payer: Anthem Medicaid |
$921.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$897.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$897.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,077.22
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$897.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$939.67
|
| Rate for Payer: Molina Healthcare Passport |
$921.25
|
| Rate for Payer: Multiplan PHCS |
$318.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,166.98
|
| Rate for Payer: UHCCP Medicaid |
$185.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$930.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$897.68
|
|
|
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 |
$5,282.70 |
| 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 |
$14,087.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,319.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,150.21
|
| 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 |
$2,971.90 |
| 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 |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,735.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$8,804.50
|
| 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 |
$2,971.90
|
| 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 |
$3,566.28
|
| 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 |
$14,087.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,319.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,150.21
|
| 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
|
$19,238.00
|
|
|
Service Code
|
HCPCS 93459
|
| Hospital Charge Code |
76102483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$18,468.48 |
| Rate for Payer: Aetna Commercial |
$14,813.26
|
| Rate for Payer: Anthem Medicaid |
$6,615.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,005.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$9,619.00
|
| Rate for Payer: Cash Price |
$9,619.00
|
| Rate for Payer: Cigna Commercial |
$15,967.54
|
| Rate for Payer: First Health Commercial |
$18,276.10
|
| Rate for Payer: Humana Commercial |
$16,352.30
|
| Rate for Payer: Humana KY Medicaid |
$6,615.95
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$6,683.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,775.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,197.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,748.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,929.44
|
| Rate for Payer: Ohio Health Group HMO |
$14,428.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,737.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,274.22
|
| Rate for Payer: PHCS Commercial |
$18,468.48
|
| Rate for Payer: United Healthcare All Payer |
$16,929.44
|
|
|
L HRT ART/GRFT ANGIO
|
Facility
|
IP
|
$19,238.00
|
|
|
Service Code
|
HCPCS 93459
|
| Hospital Charge Code |
76102483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,771.40 |
| Max. Negotiated Rate |
$18,468.48 |
| Rate for Payer: Aetna Commercial |
$14,813.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,005.64
|
| Rate for Payer: Cash Price |
$9,619.00
|
| Rate for Payer: Cigna Commercial |
$15,967.54
|
| Rate for Payer: First Health Commercial |
$18,276.10
|
| Rate for Payer: Humana Commercial |
$16,352.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,775.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,197.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,771.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,929.44
|
| Rate for Payer: Ohio Health Group HMO |
$14,428.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,737.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,274.22
|
| Rate for Payer: PHCS Commercial |
$18,468.48
|
| Rate for Payer: United Healthcare All Payer |
$16,929.44
|
|
|
L HRT ART/GRFT ANGIO
|
Professional
|
Both
|
$19,238.00
|
|
|
Service Code
|
HCPCS 93459
|
| Hospital Charge Code |
76102483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.43 |
| Max. Negotiated Rate |
$11,542.80 |
| Rate for Payer: Aetna Commercial |
$1,827.80
|
| Rate for Payer: Ambetter Exchange |
$967.57
|
| Rate for Payer: Anthem Medicaid |
$1,017.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$967.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$967.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,161.08
|
| Rate for Payer: Cash Price |
$9,619.00
|
| Rate for Payer: Cash Price |
$9,619.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$967.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$967.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,037.73
|
| Rate for Payer: Molina Healthcare Passport |
$1,017.38
|
| Rate for Payer: Multiplan PHCS |
$11,542.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,257.84
|
| Rate for Payer: UHCCP Medicaid |
$6,733.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,027.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$967.57
|
|
|
L HRT ART/GRFT ANGIO
|
Facility
|
OP
|
$19,291.00
|
|
|
Service Code
|
HCPCS 93459
|
| Hospital Charge Code |
48100070
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$18,519.36 |
| Rate for Payer: Aetna Commercial |
$14,854.07
|
| Rate for Payer: Anthem Medicaid |
$6,634.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,046.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$9,645.50
|
| Rate for Payer: Cash Price |
$9,645.50
|
| Rate for Payer: Cigna Commercial |
$16,011.53
|
| Rate for Payer: First Health Commercial |
$18,326.45
|
| Rate for Payer: Humana Commercial |
$16,397.35
|
| Rate for Payer: Humana KY Medicaid |
$6,634.17
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$6,701.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,818.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,236.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,767.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,976.08
|
| Rate for Payer: Ohio Health Group HMO |
$14,468.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,432.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,783.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,310.79
|
| Rate for Payer: PHCS Commercial |
$18,519.36
|
| Rate for Payer: United Healthcare All Payer |
$16,976.08
|
|
