|
PEPTO BISMOL TAB
|
Facility
|
IP
|
$4.34
|
|
|
Service Code
|
NDC 37000047709
|
| Hospital Charge Code |
25001172
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: First Health Commercial |
$4.12
|
| Rate for Payer: Humana Commercial |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.82
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Payer |
$3.82
|
|
|
PERC BIL DRAIN PLCMT EXTERNAL
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS 47533
|
| Hospital Charge Code |
76101957
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.75 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: First Health Commercial |
$451.25
|
| Rate for Payer: Humana Commercial |
$403.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$389.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$350.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.00
|
| Rate for Payer: Ohio Health Group HMO |
$356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.25
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
PERC BIL DRAIN PLCMT EXTERNAL
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 47533
|
| Hospital Charge Code |
76101957
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.30 |
| Max. Negotiated Rate |
$512.74 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$249.30
|
| Rate for Payer: Anthem Medicaid |
$250.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$475.00
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$512.74
|
| Rate for Payer: Humana Medicaid |
$250.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$432.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$255.91
|
| Rate for Payer: Molina Healthcare Passport |
$250.89
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$332.50
|
| Rate for Payer: UHCCP Medicaid |
$261.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$253.40
|
|
|
PERC BIL DRAIN PLCMT EXTERNAL
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS 47533
|
| Hospital Charge Code |
76101957
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.75 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem Medicaid |
$163.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: First Health Commercial |
$451.25
|
| Rate for Payer: Humana Commercial |
$403.75
|
| Rate for Payer: Humana KY Medicaid |
$163.35
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$165.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$389.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$350.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$166.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.00
|
| Rate for Payer: Ohio Health Group HMO |
$356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.25
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
PERC BIL DRAIN PLCMT EXTERNA(P
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 47533
|
| Hospital Charge Code |
761P1957
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.30 |
| Max. Negotiated Rate |
$512.74 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$249.30
|
| Rate for Payer: Anthem Medicaid |
$250.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$475.00
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$512.74
|
| Rate for Payer: Humana Medicaid |
$250.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$432.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$255.91
|
| Rate for Payer: Molina Healthcare Passport |
$250.89
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$332.50
|
| Rate for Payer: UHCCP Medicaid |
$261.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$253.40
|
|
|
PERC DE COR REVASC CHRO ADTL
|
Facility
|
IP
|
$14,052.00
|
|
|
Service Code
|
HCPCS C9608
|
| Hospital Charge Code |
76102532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,826.76 |
| Max. Negotiated Rate |
$13,489.92 |
| Rate for Payer: Aetna Commercial |
$10,820.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,960.56
|
| Rate for Payer: Cash Price |
$7,026.00
|
| Rate for Payer: Cigna Commercial |
$11,663.16
|
| Rate for Payer: First Health Commercial |
$13,349.40
|
| Rate for Payer: Humana Commercial |
$11,944.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,522.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,370.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,215.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,365.76
|
| Rate for Payer: Ohio Health Group HMO |
$10,539.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,810.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,826.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,356.12
|
| Rate for Payer: PHCS Commercial |
$13,489.92
|
| Rate for Payer: United Healthcare All Payer |
$12,365.76
|
|
|
PERC DE COR REVASC CHRO ADTL
|
Facility
|
IP
|
$14,052.00
|
|
|
Service Code
|
HCPCS C9608
|
| Hospital Charge Code |
48100091
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,826.76 |
| Max. Negotiated Rate |
$13,489.92 |
| Rate for Payer: Aetna Commercial |
$10,820.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,960.56
|
| Rate for Payer: Cash Price |
$7,026.00
|
| Rate for Payer: Cigna Commercial |
$11,663.16
|
| Rate for Payer: First Health Commercial |
$13,349.40
|
| Rate for Payer: Humana Commercial |
$11,944.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,522.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,370.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,215.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,365.76
|
| Rate for Payer: Ohio Health Group HMO |
$10,539.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,810.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,826.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,356.12
|
| Rate for Payer: PHCS Commercial |
$13,489.92
|
| Rate for Payer: United Healthcare All Payer |
$12,365.76
|
|
|
PERC DE COR REVASC CHRO ADTL
|
Facility
|
OP
|
$14,052.00
|
|
|
Service Code
|
HCPCS C9608
|
| Hospital Charge Code |
76102532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,826.76 |
| Max. Negotiated Rate |
$13,489.92 |
| Rate for Payer: Aetna Commercial |
$10,820.04
|
| Rate for Payer: Anthem Medicaid |
$4,832.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,960.56
|
| Rate for Payer: Cash Price |
$7,026.00
|
| Rate for Payer: Cigna Commercial |
$11,663.16
|
| Rate for Payer: First Health Commercial |
$13,349.40
|
| Rate for Payer: Humana Commercial |
$11,944.20
|
| Rate for Payer: Humana KY Medicaid |
$4,832.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,881.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,522.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,370.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,215.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,929.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,365.76
|
| Rate for Payer: Ohio Health Group HMO |
$10,539.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,810.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,826.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,356.12
|
| Rate for Payer: PHCS Commercial |
$13,489.92
|
| Rate for Payer: United Healthcare All Payer |
$12,365.76
|
|
|
PERC DE COR REVASC CHRO ADTL
|
Facility
|
OP
|
$14,052.00
|
|
|
Service Code
|
HCPCS C9608
|
| Hospital Charge Code |
48100091
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,826.76 |
| Max. Negotiated Rate |
$13,489.92 |
| Rate for Payer: Aetna Commercial |
$10,820.04
|
| Rate for Payer: Anthem Medicaid |
$4,832.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,960.56
|
| Rate for Payer: Cash Price |
$7,026.00
|
| Rate for Payer: Cigna Commercial |
$11,663.16
|
| Rate for Payer: First Health Commercial |
$13,349.40
|
| Rate for Payer: Humana Commercial |
$11,944.20
|
| Rate for Payer: Humana KY Medicaid |
$4,832.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,881.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,522.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,370.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,215.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,929.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,365.76
|
| Rate for Payer: Ohio Health Group HMO |
$10,539.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,810.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,826.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,356.12
|
| Rate for Payer: PHCS Commercial |
$13,489.92
|
| Rate for Payer: United Healthcare All Payer |
$12,365.76
|
|
|
PERC DE COR REVASC CHRO SINGLE
|
Facility
|
OP
|
$29,007.00
|
|
|
Service Code
|
HCPCS C9607
|
| Hospital Charge Code |
48100090
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,770.91 |
| Max. Negotiated Rate |
$27,846.72 |
| Rate for Payer: Aetna Commercial |
$22,335.39
|
| Rate for Payer: Anthem Medicaid |
$9,975.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,163.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,625.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,228.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,470.79
|
| Rate for Payer: Cash Price |
$14,503.50
|
| Rate for Payer: Cash Price |
$14,503.50
|
| Rate for Payer: Cigna Commercial |
$24,075.81
|
| Rate for Payer: First Health Commercial |
$27,556.65
|
| Rate for Payer: Humana Commercial |
$24,655.95
|
| Rate for Payer: Humana KY Medicaid |
$9,975.51
|
| Rate for Payer: Humana Medicare Advantage |
$15,163.55
|
| Rate for Payer: Kentucky WC Medicaid |
$10,077.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,785.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,407.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,196.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,175.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,526.16
|
| Rate for Payer: Ohio Health Group HMO |
$21,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,801.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,770.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,992.17
|
| Rate for Payer: PHCS Commercial |
$27,846.72
|
| Rate for Payer: United Healthcare All Payer |
$25,526.16
|
|
|
PERC DE COR REVASC CHRO SINGLE
|
Facility
|
OP
|
$27,495.00
|
|
|
Service Code
|
HCPCS C9607
|
| Hospital Charge Code |
76102531
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,574.35 |
| Max. Negotiated Rate |
$26,395.20 |
| Rate for Payer: Aetna Commercial |
$21,171.15
|
| Rate for Payer: Anthem Medicaid |
$9,455.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,163.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,446.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,228.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,470.79
|
| Rate for Payer: Cash Price |
$13,747.50
|
| Rate for Payer: Cash Price |
$13,747.50
|
| Rate for Payer: Cigna Commercial |
$22,820.85
|
| Rate for Payer: First Health Commercial |
$26,120.25
|
| Rate for Payer: Humana Commercial |
$23,370.75
|
| Rate for Payer: Humana KY Medicaid |
$9,455.53
|
| Rate for Payer: Humana Medicare Advantage |
$15,163.55
|
| Rate for Payer: Kentucky WC Medicaid |
$9,551.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,545.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,291.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,196.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,645.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,195.60
|
| Rate for Payer: Ohio Health Group HMO |
$20,621.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,499.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,574.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,523.45
|
| Rate for Payer: PHCS Commercial |
$26,395.20
|
| Rate for Payer: United Healthcare All Payer |
$24,195.60
|
|
|
PERC DE COR REVASC CHRO SINGLE
|
Facility
|
IP
|
$29,007.00
|
|
|
Service Code
|
HCPCS C9607
|
| Hospital Charge Code |
48100090
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,770.91 |
| Max. Negotiated Rate |
$27,846.72 |
| Rate for Payer: Aetna Commercial |
$22,335.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,625.46
|
| Rate for Payer: Cash Price |
$14,503.50
|
| Rate for Payer: Cigna Commercial |
$24,075.81
|
| Rate for Payer: First Health Commercial |
$27,556.65
|
| Rate for Payer: Humana Commercial |
$24,655.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,785.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,407.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,702.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,526.16
|
| Rate for Payer: Ohio Health Group HMO |
$21,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,801.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,770.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,992.17
|
| Rate for Payer: PHCS Commercial |
$27,846.72
|
| Rate for Payer: United Healthcare All Payer |
$25,526.16
|
|
|
PERC DE COR REVASC CHRO SINGLE
|
Facility
|
IP
|
$27,495.00
|
|
|
Service Code
|
HCPCS C9607
|
| Hospital Charge Code |
76102531
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,574.35 |
| Max. Negotiated Rate |
$26,395.20 |
| Rate for Payer: Aetna Commercial |
$21,171.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,446.10
|
| Rate for Payer: Cash Price |
$13,747.50
|
| Rate for Payer: Cigna Commercial |
$22,820.85
|
| Rate for Payer: First Health Commercial |
$26,120.25
|
| Rate for Payer: Humana Commercial |
$23,370.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,545.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,291.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,248.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,195.60
|
| Rate for Payer: Ohio Health Group HMO |
$20,621.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,499.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,574.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,523.45
|
| Rate for Payer: PHCS Commercial |
$26,395.20
|
| Rate for Payer: United Healthcare All Payer |
$24,195.60
|
|
|
Perc d-e cor revasc t cabg b
|
Facility
|
OP
|
$14,052.00
|
|
|
Service Code
|
HCPCS C9605
|
| Hospital Charge Code |
76102529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,826.76 |
| Max. Negotiated Rate |
$13,489.92 |
| Rate for Payer: Aetna Commercial |
$10,820.04
|
| Rate for Payer: Anthem Medicaid |
$4,832.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,960.56
|
| Rate for Payer: Cash Price |
$7,026.00
|
| Rate for Payer: Cigna Commercial |
$11,663.16
|
| Rate for Payer: First Health Commercial |
$13,349.40
|
| Rate for Payer: Humana Commercial |
$11,944.20
|
| Rate for Payer: Humana KY Medicaid |
$4,832.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,881.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,522.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,370.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,215.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,929.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,365.76
|
| Rate for Payer: Ohio Health Group HMO |
$10,539.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,810.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,826.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,356.12
|
| Rate for Payer: PHCS Commercial |
$13,489.92
|
| Rate for Payer: United Healthcare All Payer |
$12,365.76
|
|
|
Perc d-e cor revasc t cabg b
|
Facility
|
OP
|
$14,052.00
|
|
|
Service Code
|
HCPCS C9605
|
| Hospital Charge Code |
48100088
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,826.76 |
| Max. Negotiated Rate |
$13,489.92 |
| Rate for Payer: Aetna Commercial |
$10,820.04
|
| Rate for Payer: Anthem Medicaid |
$4,832.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,960.56
|
| Rate for Payer: Cash Price |
$7,026.00
|
| Rate for Payer: Cigna Commercial |
$11,663.16
|
| Rate for Payer: First Health Commercial |
$13,349.40
|
| Rate for Payer: Humana Commercial |
$11,944.20
|
| Rate for Payer: Humana KY Medicaid |
$4,832.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,881.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,522.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,370.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,215.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,929.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,365.76
|
| Rate for Payer: Ohio Health Group HMO |
$10,539.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,810.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,826.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,356.12
|
| Rate for Payer: PHCS Commercial |
$13,489.92
|
| Rate for Payer: United Healthcare All Payer |
$12,365.76
|
|
|
Perc d-e cor revasc t cabg b
|
Facility
|
IP
|
$14,052.00
|
|
|
Service Code
|
HCPCS C9605
|
| Hospital Charge Code |
76102529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,826.76 |
| Max. Negotiated Rate |
$13,489.92 |
| Rate for Payer: Aetna Commercial |
$10,820.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,960.56
|
| Rate for Payer: Cash Price |
$7,026.00
|
| Rate for Payer: Cigna Commercial |
$11,663.16
|
| Rate for Payer: First Health Commercial |
$13,349.40
|
| Rate for Payer: Humana Commercial |
$11,944.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,522.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,370.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,215.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,365.76
|
| Rate for Payer: Ohio Health Group HMO |
$10,539.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,810.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,826.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,356.12
|
| Rate for Payer: PHCS Commercial |
$13,489.92
|
| Rate for Payer: United Healthcare All Payer |
$12,365.76
|
|
|
Perc d-e cor revasc t cabg b
|
Facility
|
IP
|
$14,052.00
|
|
|
Service Code
|
HCPCS C9605
|
| Hospital Charge Code |
48100088
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,826.76 |
| Max. Negotiated Rate |
$13,489.92 |
| Rate for Payer: Aetna Commercial |
$10,820.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,960.56
|
| Rate for Payer: Cash Price |
$7,026.00
|
| Rate for Payer: Cigna Commercial |
$11,663.16
|
| Rate for Payer: First Health Commercial |
$13,349.40
|
| Rate for Payer: Humana Commercial |
$11,944.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,522.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,370.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,215.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,365.76
|
| Rate for Payer: Ohio Health Group HMO |
$10,539.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,810.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,826.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,356.12
|
| Rate for Payer: PHCS Commercial |
$13,489.92
|
| Rate for Payer: United Healthcare All Payer |
$12,365.76
|
|
|
PERC DE COR REVASC T CABG SING
|
Facility
|
OP
|
$19,850.00
|
|
|
Service Code
|
HCPCS C9604
|
| Hospital Charge Code |
48100087
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,580.50 |
| Max. Negotiated Rate |
$19,056.00 |
| Rate for Payer: Aetna Commercial |
$15,284.50
|
| Rate for Payer: Anthem Medicaid |
$6,826.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,483.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,318.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,842.94
|
| Rate for Payer: Cash Price |
$9,925.00
|
| Rate for Payer: Cash Price |
$9,925.00
|
| Rate for Payer: Cigna Commercial |
$16,475.50
|
| Rate for Payer: First Health Commercial |
$18,857.50
|
| Rate for Payer: Humana Commercial |
$16,872.50
|
| Rate for Payer: Humana KY Medicaid |
$6,826.42
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,895.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,277.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,649.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,963.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,468.00
|
| Rate for Payer: Ohio Health Group HMO |
$14,887.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,970.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,580.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,153.50
|
| Rate for Payer: PHCS Commercial |
$19,056.00
|
| Rate for Payer: United Healthcare All Payer |
$17,468.00
|
|
|
PERC DE COR REVASC T CABG SING
|
Facility
|
IP
|
$18,039.00
|
|
|
Service Code
|
HCPCS C9604
|
| Hospital Charge Code |
76102528
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,345.07 |
| Max. Negotiated Rate |
$17,317.44 |
| Rate for Payer: Aetna Commercial |
$13,890.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,070.42
|
| Rate for Payer: Cash Price |
$9,019.50
|
| Rate for Payer: Cigna Commercial |
$14,972.37
|
| Rate for Payer: First Health Commercial |
$17,137.05
|
| Rate for Payer: Humana Commercial |
$15,333.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,791.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,312.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,411.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,874.32
|
| Rate for Payer: Ohio Health Group HMO |
$13,529.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,607.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,345.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,592.09
|
| Rate for Payer: PHCS Commercial |
$17,317.44
|
| Rate for Payer: United Healthcare All Payer |
$15,874.32
|
|
|
PERC DE COR REVASC T CABG SING
|
Facility
|
OP
|
$18,039.00
|
|
|
Service Code
|
HCPCS C9604
|
| Hospital Charge Code |
76102528
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,345.07 |
| Max. Negotiated Rate |
$17,317.44 |
| Rate for Payer: Aetna Commercial |
$13,890.03
|
| Rate for Payer: Anthem Medicaid |
$6,203.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,070.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,318.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,842.94
|
| Rate for Payer: Cash Price |
$9,019.50
|
| Rate for Payer: Cash Price |
$9,019.50
|
| Rate for Payer: Cigna Commercial |
$14,972.37
|
| Rate for Payer: First Health Commercial |
$17,137.05
|
| Rate for Payer: Humana Commercial |
$15,333.15
|
| Rate for Payer: Humana KY Medicaid |
$6,203.61
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,266.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,791.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,312.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,328.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,874.32
|
| Rate for Payer: Ohio Health Group HMO |
$13,529.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,607.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,345.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,592.09
|
| Rate for Payer: PHCS Commercial |
$17,317.44
|
| Rate for Payer: United Healthcare All Payer |
$15,874.32
|
|
|
PERC DE COR REVASC T CABG SING
|
Facility
|
IP
|
$19,850.00
|
|
|
Service Code
|
HCPCS C9604
|
| Hospital Charge Code |
48100087
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,580.50 |
| Max. Negotiated Rate |
$19,056.00 |
| Rate for Payer: Aetna Commercial |
$15,284.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,483.00
|
| Rate for Payer: Cash Price |
$9,925.00
|
| Rate for Payer: Cigna Commercial |
$16,475.50
|
| Rate for Payer: First Health Commercial |
$18,857.50
|
| Rate for Payer: Humana Commercial |
$16,872.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,277.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,649.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,955.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,468.00
|
| Rate for Payer: Ohio Health Group HMO |
$14,887.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,970.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,580.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,153.50
|
| Rate for Payer: PHCS Commercial |
$19,056.00
|
| Rate for Payer: United Healthcare All Payer |
$17,468.00
|
|
|
Perc d-e cor revasc w ami s
|
Facility
|
OP
|
$30,254.00
|
|
|
Service Code
|
HCPCS C9606
|
| Hospital Charge Code |
48100089
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,933.02 |
| Max. Negotiated Rate |
$29,043.84 |
| Rate for Payer: Aetna Commercial |
$23,295.58
|
| Rate for Payer: Anthem Medicaid |
$10,404.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,598.12
|
| Rate for Payer: Cash Price |
$15,127.00
|
| Rate for Payer: Cigna Commercial |
$25,110.82
|
| Rate for Payer: First Health Commercial |
$28,741.30
|
| Rate for Payer: Humana Commercial |
$25,715.90
|
| Rate for Payer: Humana KY Medicaid |
$10,404.35
|
| Rate for Payer: Kentucky WC Medicaid |
$10,510.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,808.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,327.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,076.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,613.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,623.52
|
| Rate for Payer: Ohio Health Group HMO |
$22,690.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,933.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,378.74
|
| Rate for Payer: PHCS Commercial |
$29,043.84
|
| Rate for Payer: United Healthcare All Payer |
$26,623.52
|
|
|
Perc d-e cor revasc w ami s
|
Facility
|
IP
|
$30,254.00
|
|
|
Service Code
|
HCPCS C9606
|
| Hospital Charge Code |
48100089
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,933.02 |
| Max. Negotiated Rate |
$29,043.84 |
| Rate for Payer: Aetna Commercial |
$23,295.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,598.12
|
| Rate for Payer: Cash Price |
$15,127.00
|
| Rate for Payer: Cigna Commercial |
$25,110.82
|
| Rate for Payer: First Health Commercial |
$28,741.30
|
| Rate for Payer: Humana Commercial |
$25,715.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,808.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,327.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,076.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,623.52
|
| Rate for Payer: Ohio Health Group HMO |
$22,690.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,933.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,378.74
|
| Rate for Payer: PHCS Commercial |
$29,043.84
|
| Rate for Payer: United Healthcare All Payer |
$26,623.52
|
|
|
Perc d-e cor revasc w ami s
|
Facility
|
OP
|
$27,495.00
|
|
|
Service Code
|
HCPCS C9606
|
| Hospital Charge Code |
76102530
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,574.35 |
| Max. Negotiated Rate |
$26,395.20 |
| Rate for Payer: Aetna Commercial |
$21,171.15
|
| Rate for Payer: Anthem Medicaid |
$9,455.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,446.10
|
| Rate for Payer: Cash Price |
$13,747.50
|
| Rate for Payer: Cigna Commercial |
$22,820.85
|
| Rate for Payer: First Health Commercial |
$26,120.25
|
| Rate for Payer: Humana Commercial |
$23,370.75
|
| Rate for Payer: Humana KY Medicaid |
$9,455.53
|
| Rate for Payer: Kentucky WC Medicaid |
$9,551.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,545.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,291.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,248.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,645.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,195.60
|
| Rate for Payer: Ohio Health Group HMO |
$20,621.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,499.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,574.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,523.45
|
| Rate for Payer: PHCS Commercial |
$26,395.20
|
| Rate for Payer: United Healthcare All Payer |
$24,195.60
|
|
|
Perc d-e cor revasc w ami s
|
Facility
|
IP
|
$27,495.00
|
|
|
Service Code
|
HCPCS C9606
|
| Hospital Charge Code |
76102530
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,574.35 |
| Max. Negotiated Rate |
$26,395.20 |
| Rate for Payer: Aetna Commercial |
$21,171.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,446.10
|
| Rate for Payer: Cash Price |
$13,747.50
|
| Rate for Payer: Cigna Commercial |
$22,820.85
|
| Rate for Payer: First Health Commercial |
$26,120.25
|
| Rate for Payer: Humana Commercial |
$23,370.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,545.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,291.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,248.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,195.60
|
| Rate for Payer: Ohio Health Group HMO |
$20,621.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,499.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,574.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,523.45
|
| Rate for Payer: PHCS Commercial |
$26,395.20
|
| Rate for Payer: United Healthcare All Payer |
$24,195.60
|
|
