|
ART BYP GRFT AXILL-BRACHIAL(P
|
Professional
|
Both
|
$1,440.00
|
|
|
Service Code
|
HCPCS 35522
|
| Hospital Charge Code |
761P1392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$2,085.31 |
| Rate for Payer: Aetna Commercial |
$2,085.31
|
| Rate for Payer: Anthem Medicaid |
$928.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,440.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$2,011.15
|
| Rate for Payer: Healthspan PPO |
$2,050.27
|
| Rate for Payer: Humana Medicaid |
$928.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,682.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$947.17
|
| Rate for Payer: Molina Healthcare Passport |
$928.60
|
| Rate for Payer: Multiplan PHCS |
$864.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,008.00
|
| Rate for Payer: UHCCP Medicaid |
$504.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$937.89
|
|
|
ART BYP GRFT BRACHIAL-BRCHL
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 35525
|
| Hospital Charge Code |
76101394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$886.32 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$1,961.89
|
| Rate for Payer: Anthem Medicaid |
$886.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,600.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$1,904.90
|
| Rate for Payer: Healthspan PPO |
$1,928.92
|
| Rate for Payer: Humana Medicaid |
$886.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,565.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$904.05
|
| Rate for Payer: Molina Healthcare Passport |
$886.32
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,820.00
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$895.18
|
|
|
ART BYP GRFT BRACHIAL-BRCHL
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 35525
|
| Hospital Charge Code |
76101394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem Medicaid |
$894.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Humana KY Medicaid |
$894.14
|
| Rate for Payer: Kentucky WC Medicaid |
$903.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$912.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
ART BYP GRFT BRACHIAL-BRCHL
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 35525
|
| Hospital Charge Code |
76101394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
ART BYP GRFT BRACHIAL-BRCHL(P
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 35525
|
| Hospital Charge Code |
761P1394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$886.32 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$1,961.89
|
| Rate for Payer: Anthem Medicaid |
$886.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,600.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$1,904.90
|
| Rate for Payer: Healthspan PPO |
$1,928.92
|
| Rate for Payer: Humana Medicaid |
$886.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,565.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$904.05
|
| Rate for Payer: Molina Healthcare Passport |
$886.32
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,820.00
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$895.18
|
|
|
ART BYP GRFT BRCHL-ULNR-RDL
|
Facility
|
OP
|
$1,515.00
|
|
|
Service Code
|
HCPCS 35523
|
| Hospital Charge Code |
76101393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.95 |
| Max. Negotiated Rate |
$1,454.40 |
| Rate for Payer: Aetna Commercial |
$1,166.55
|
| Rate for Payer: Anthem Medicaid |
$521.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,181.70
|
| Rate for Payer: Cash Price |
$757.50
|
| Rate for Payer: Cigna Commercial |
$1,257.45
|
| Rate for Payer: First Health Commercial |
$1,439.25
|
| Rate for Payer: Humana Commercial |
$1,287.75
|
| Rate for Payer: Humana KY Medicaid |
$521.01
|
| Rate for Payer: Kentucky WC Medicaid |
$526.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,242.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,118.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$531.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,333.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,136.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.65
|
| Rate for Payer: PHCS Commercial |
$1,454.40
|
| Rate for Payer: United Healthcare All Payer |
$1,333.20
|
|
|
ART BYP GRFT BRCHL-ULNR-RDL
|
Professional
|
Both
|
$1,515.00
|
|
|
Service Code
|
HCPCS 35523
|
| Hospital Charge Code |
76101393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$530.25 |
| Max. Negotiated Rate |
$2,202.75 |
| Rate for Payer: Aetna Commercial |
$2,202.75
|
| Rate for Payer: Anthem Medicaid |
$1,049.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,515.00
|
| Rate for Payer: Cash Price |
$757.50
|
| Rate for Payer: Cash Price |
$757.50
|
| Rate for Payer: Cigna Commercial |
$2,040.43
|
| Rate for Payer: Healthspan PPO |
$2,165.73
|
| Rate for Payer: Humana Medicaid |
$1,049.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,762.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,070.11
|
| Rate for Payer: Molina Healthcare Passport |
$1,049.13
|
| Rate for Payer: Multiplan PHCS |
$909.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,060.50
|
| Rate for Payer: UHCCP Medicaid |
$530.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,059.62
|
|
|
ART BYP GRFT BRCHL-ULNR-RDL
|
Facility
|
IP
|
$1,515.00
|
|
|
Service Code
|
HCPCS 35523
|
| Hospital Charge Code |
76101393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.95 |
| Max. Negotiated Rate |
$1,454.40 |
| Rate for Payer: Aetna Commercial |
$1,166.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,181.70
|
| Rate for Payer: Cash Price |
$757.50
|
| Rate for Payer: Cigna Commercial |
$1,257.45
|
| Rate for Payer: First Health Commercial |
$1,439.25
|
| Rate for Payer: Humana Commercial |
$1,287.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,242.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,118.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,333.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,136.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.65
|
| Rate for Payer: PHCS Commercial |
$1,454.40
|
| Rate for Payer: United Healthcare All Payer |
$1,333.20
|
|
|
ART BYP GRFT BRCHL-ULNR-RDL(P
|
Professional
|
Both
|
$1,515.00
|
|
|
Service Code
|
HCPCS 35523
|
| Hospital Charge Code |
761P1393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$530.25 |
| Max. Negotiated Rate |
$2,202.75 |
| Rate for Payer: Aetna Commercial |
$2,202.75
|
| Rate for Payer: Anthem Medicaid |
$1,049.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,515.00
|
| Rate for Payer: Cash Price |
$757.50
|
| Rate for Payer: Cash Price |
$757.50
|
| Rate for Payer: Cigna Commercial |
$2,040.43
|
| Rate for Payer: Healthspan PPO |
$2,165.73
|
| Rate for Payer: Humana Medicaid |
$1,049.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,762.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,070.11
|
| Rate for Payer: Molina Healthcare Passport |
$1,049.13
|
| Rate for Payer: Multiplan PHCS |
$909.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,060.50
|
| Rate for Payer: UHCCP Medicaid |
$530.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,059.62
|
|
|
ART BYP GRFT FEM-FEMORAL
|
Professional
|
Both
|
$3,405.00
|
|
|
Service Code
|
HCPCS 35558
|
| Hospital Charge Code |
76101397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$894.82 |
| Max. Negotiated Rate |
$3,405.00 |
| Rate for Payer: Aetna Commercial |
$2,161.37
|
| Rate for Payer: Anthem Medicaid |
$894.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,405.00
|
| Rate for Payer: Cash Price |
$1,702.50
|
| Rate for Payer: Cash Price |
$1,702.50
|
| Rate for Payer: Cigna Commercial |
$2,062.18
|
| Rate for Payer: Healthspan PPO |
$2,125.05
|
| Rate for Payer: Humana Medicaid |
$894.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,693.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$912.72
|
| Rate for Payer: Molina Healthcare Passport |
$894.82
|
| Rate for Payer: Multiplan PHCS |
$2,043.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,383.50
|
| Rate for Payer: UHCCP Medicaid |
$1,191.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$903.77
|
|
|
ART BYP GRFT FEM-FEMORAL
|
Facility
|
IP
|
$3,405.00
|
|
|
Service Code
|
HCPCS 35558
|
| Hospital Charge Code |
76101397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$442.65 |
| Max. Negotiated Rate |
$3,268.80 |
| Rate for Payer: Aetna Commercial |
$2,621.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,655.90
|
| Rate for Payer: Cash Price |
$1,702.50
|
| Rate for Payer: Cigna Commercial |
$2,826.15
|
| Rate for Payer: First Health Commercial |
$3,234.75
|
| Rate for Payer: Humana Commercial |
$2,894.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,792.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,512.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,996.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,553.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.55
|
| Rate for Payer: PHCS Commercial |
$3,268.80
|
| Rate for Payer: United Healthcare All Payer |
$2,996.40
|
|
|
ART BYP GRFT FEM-FEMORAL
|
Facility
|
OP
|
$3,405.00
|
|
|
Service Code
|
HCPCS 35558
|
| Hospital Charge Code |
76101397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$442.65 |
| Max. Negotiated Rate |
$3,268.80 |
| Rate for Payer: Aetna Commercial |
$2,621.85
|
| Rate for Payer: Anthem Medicaid |
$1,170.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,655.90
|
| Rate for Payer: Cash Price |
$1,702.50
|
| Rate for Payer: Cigna Commercial |
$2,826.15
|
| Rate for Payer: First Health Commercial |
$3,234.75
|
| Rate for Payer: Humana Commercial |
$2,894.25
|
| Rate for Payer: Humana KY Medicaid |
$1,170.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,182.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,792.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,512.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,194.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,996.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,553.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.55
|
| Rate for Payer: PHCS Commercial |
$3,268.80
|
| Rate for Payer: United Healthcare All Payer |
$2,996.40
|
|
|
ART BYP GRFT FEM-FEMORAL(P
|
Professional
|
Both
|
$3,405.00
|
|
|
Service Code
|
HCPCS 35558
|
| Hospital Charge Code |
761P1397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$894.82 |
| Max. Negotiated Rate |
$3,405.00 |
| Rate for Payer: Aetna Commercial |
$2,161.37
|
| Rate for Payer: Anthem Medicaid |
$894.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,405.00
|
| Rate for Payer: Cash Price |
$1,702.50
|
| Rate for Payer: Cash Price |
$1,702.50
|
| Rate for Payer: Cigna Commercial |
$2,062.18
|
| Rate for Payer: Healthspan PPO |
$2,125.05
|
| Rate for Payer: Humana Medicaid |
$894.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,693.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$912.72
|
| Rate for Payer: Molina Healthcare Passport |
$894.82
|
| Rate for Payer: Multiplan PHCS |
$2,043.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,383.50
|
| Rate for Payer: UHCCP Medicaid |
$1,191.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$903.77
|
|
|
ART BYP POP-TIBL-PRL-OTHER
|
Facility
|
IP
|
$1,355.00
|
|
|
Service Code
|
HCPCS 35671
|
| Hospital Charge Code |
76101415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.15 |
| Max. Negotiated Rate |
$1,300.80 |
| Rate for Payer: Aetna Commercial |
$1,043.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,056.90
|
| Rate for Payer: Cash Price |
$677.50
|
| Rate for Payer: Cigna Commercial |
$1,124.65
|
| Rate for Payer: First Health Commercial |
$1,287.25
|
| Rate for Payer: Humana Commercial |
$1,151.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,111.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$999.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$406.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,192.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,016.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$271.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$420.05
|
| Rate for Payer: PHCS Commercial |
$1,300.80
|
| Rate for Payer: United Healthcare All Payer |
$1,192.40
|
|
|
ART BYP POP-TIBL-PRL-OTHER
|
Facility
|
IP
|
$3,800.00
|
|
|
Service Code
|
HCPCS 35571
|
| Hospital Charge Code |
76101401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$494.00 |
| Max. Negotiated Rate |
$3,648.00 |
| Rate for Payer: Aetna Commercial |
$2,926.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,964.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$3,154.00
|
| Rate for Payer: First Health Commercial |
$3,610.00
|
| Rate for Payer: Humana Commercial |
$3,230.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,116.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,804.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,344.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.00
|
| Rate for Payer: PHCS Commercial |
$3,648.00
|
| Rate for Payer: United Healthcare All Payer |
$3,344.00
|
|
|
ART BYP POP-TIBL-PRL-OTHER
|
Professional
|
Both
|
$1,355.00
|
|
|
Service Code
|
HCPCS 35671
|
| Hospital Charge Code |
76101415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$474.25 |
| Max. Negotiated Rate |
$1,980.53 |
| Rate for Payer: Aetna Commercial |
$1,980.53
|
| Rate for Payer: Anthem Medicaid |
$874.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,355.00
|
| Rate for Payer: Cash Price |
$677.50
|
| Rate for Payer: Cash Price |
$677.50
|
| Rate for Payer: Cigna Commercial |
$1,902.36
|
| Rate for Payer: Healthspan PPO |
$1,947.25
|
| Rate for Payer: Humana Medicaid |
$874.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,539.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$892.47
|
| Rate for Payer: Molina Healthcare Passport |
$874.97
|
| Rate for Payer: Multiplan PHCS |
$813.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$948.50
|
| Rate for Payer: UHCCP Medicaid |
$474.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$883.72
|
|
|
ART BYP POP-TIBL-PRL-OTHER
|
Facility
|
OP
|
$1,355.00
|
|
|
Service Code
|
HCPCS 35671
|
| Hospital Charge Code |
76101415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.15 |
| Max. Negotiated Rate |
$1,300.80 |
| Rate for Payer: Aetna Commercial |
$1,043.35
|
| Rate for Payer: Anthem Medicaid |
$465.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,056.90
|
| Rate for Payer: Cash Price |
$677.50
|
| Rate for Payer: Cigna Commercial |
$1,124.65
|
| Rate for Payer: First Health Commercial |
$1,287.25
|
| Rate for Payer: Humana Commercial |
$1,151.75
|
| Rate for Payer: Humana KY Medicaid |
$465.98
|
| Rate for Payer: Kentucky WC Medicaid |
$470.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,111.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$999.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$406.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$475.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,192.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,016.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$271.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$420.05
|
| Rate for Payer: PHCS Commercial |
$1,300.80
|
| Rate for Payer: United Healthcare All Payer |
$1,192.40
|
|
|
ART BYP POP-TIBL-PRL-OTHER
|
Professional
|
Both
|
$3,800.00
|
|
|
Service Code
|
HCPCS 35571
|
| Hospital Charge Code |
76101401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,102.17 |
| Max. Negotiated Rate |
$3,800.00 |
| Rate for Payer: Aetna Commercial |
$2,374.67
|
| Rate for Payer: Anthem Medicaid |
$1,102.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,800.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$2,290.19
|
| Rate for Payer: Healthspan PPO |
$2,334.76
|
| Rate for Payer: Humana Medicaid |
$1,102.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,839.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,124.21
|
| Rate for Payer: Molina Healthcare Passport |
$1,102.17
|
| Rate for Payer: Multiplan PHCS |
$2,280.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,660.00
|
| Rate for Payer: UHCCP Medicaid |
$1,330.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,113.19
|
|
|
ART BYP POP-TIBL-PRL-OTHER
|
Facility
|
OP
|
$3,800.00
|
|
|
Service Code
|
HCPCS 35571
|
| Hospital Charge Code |
76101401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$494.00 |
| Max. Negotiated Rate |
$3,648.00 |
| Rate for Payer: Aetna Commercial |
$2,926.00
|
| Rate for Payer: Anthem Medicaid |
$1,306.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,964.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$3,154.00
|
| Rate for Payer: First Health Commercial |
$3,610.00
|
| Rate for Payer: Humana Commercial |
$3,230.00
|
| Rate for Payer: Humana KY Medicaid |
$1,306.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,320.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,116.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,804.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,333.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,344.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.00
|
| Rate for Payer: PHCS Commercial |
$3,648.00
|
| Rate for Payer: United Healthcare All Payer |
$3,344.00
|
|
|
ART BYP POP-TIBL-PRL-OTHER(P
|
Professional
|
Both
|
$1,355.00
|
|
|
Service Code
|
HCPCS 35671
|
| Hospital Charge Code |
761P1415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$474.25 |
| Max. Negotiated Rate |
$1,980.53 |
| Rate for Payer: Aetna Commercial |
$1,980.53
|
| Rate for Payer: Anthem Medicaid |
$874.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,355.00
|
| Rate for Payer: Cash Price |
$677.50
|
| Rate for Payer: Cash Price |
$677.50
|
| Rate for Payer: Cigna Commercial |
$1,902.36
|
| Rate for Payer: Healthspan PPO |
$1,947.25
|
| Rate for Payer: Humana Medicaid |
$874.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,539.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$892.47
|
| Rate for Payer: Molina Healthcare Passport |
$874.97
|
| Rate for Payer: Multiplan PHCS |
$813.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$948.50
|
| Rate for Payer: UHCCP Medicaid |
$474.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$883.72
|
|
|
ART BYP POP-TIBL-PRL-OTHER(P
|
Professional
|
Both
|
$3,800.00
|
|
|
Service Code
|
HCPCS 35571
|
| Hospital Charge Code |
761P1401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,102.17 |
| Max. Negotiated Rate |
$3,800.00 |
| Rate for Payer: Aetna Commercial |
$2,374.67
|
| Rate for Payer: Anthem Medicaid |
$1,102.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,800.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$2,290.19
|
| Rate for Payer: Healthspan PPO |
$2,334.76
|
| Rate for Payer: Humana Medicaid |
$1,102.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,839.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,124.21
|
| Rate for Payer: Molina Healthcare Passport |
$1,102.17
|
| Rate for Payer: Multiplan PHCS |
$2,280.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,660.00
|
| Rate for Payer: UHCCP Medicaid |
$1,330.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,113.19
|
|
|
ARTCM 40M .1875 PST 10.0*10.0
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
ARTCM 40M .1875 PST 10.0*10.0
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
ARTCM 40M .1875 PST 10.0*11.0
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
ARTCM 40M .1875 PST 10.0*11.0
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
