|
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 |
$4,215.60 |
| 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 |
$11,241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,225.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,695.88
|
| 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 |
$4,215.60 |
| 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 |
$11,241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,225.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,695.88
|
| 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
|
$14,544.00
|
|
|
Service Code
|
HCPCS C9608
|
| Hospital Charge Code |
48100091
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,363.20 |
| Max. Negotiated Rate |
$13,962.24 |
| Rate for Payer: Aetna Commercial |
$11,198.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,344.32
|
| Rate for Payer: Cash Price |
$7,272.00
|
| Rate for Payer: Cigna Commercial |
$12,071.52
|
| Rate for Payer: First Health Commercial |
$13,816.80
|
| Rate for Payer: Humana Commercial |
$12,362.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,926.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,733.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,363.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,798.72
|
| Rate for Payer: Ohio Health Group HMO |
$10,908.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,635.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,653.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,035.36
|
| Rate for Payer: PHCS Commercial |
$13,962.24
|
| Rate for Payer: United Healthcare All Payer |
$12,798.72
|
|
|
PERC DE COR REVASC CHRO SINGLE
|
Facility
|
OP
|
$30,893.00
|
|
|
Service Code
|
HCPCS C9607
|
| Hospital Charge Code |
48100090
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,624.10 |
| Max. Negotiated Rate |
$29,657.28 |
| Rate for Payer: Aetna Commercial |
$23,787.61
|
| Rate for Payer: Anthem Medicaid |
$10,624.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,591.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,096.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,228.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,398.73
|
| Rate for Payer: Cash Price |
$15,446.50
|
| Rate for Payer: Cash Price |
$15,446.50
|
| Rate for Payer: Cigna Commercial |
$25,641.19
|
| Rate for Payer: First Health Commercial |
$29,348.35
|
| Rate for Payer: Humana Commercial |
$26,259.05
|
| Rate for Payer: Humana KY Medicaid |
$10,624.10
|
| Rate for Payer: Humana Medicare Advantage |
$16,591.65
|
| Rate for Payer: Kentucky WC Medicaid |
$10,732.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,332.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,799.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,909.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,837.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,185.84
|
| Rate for Payer: Ohio Health Group HMO |
$23,169.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,714.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,876.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,316.17
|
| Rate for Payer: PHCS Commercial |
$29,657.28
|
| Rate for Payer: United Healthcare All Payer |
$27,185.84
|
|
|
PERC DE COR REVASC CHRO SINGLE
|
Facility
|
IP
|
$30,893.00
|
|
|
Service Code
|
HCPCS C9607
|
| Hospital Charge Code |
48100090
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,267.90 |
| Max. Negotiated Rate |
$29,657.28 |
| Rate for Payer: Aetna Commercial |
$23,787.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,096.54
|
| Rate for Payer: Cash Price |
$15,446.50
|
| Rate for Payer: Cigna Commercial |
$25,641.19
|
| Rate for Payer: First Health Commercial |
$29,348.35
|
| Rate for Payer: Humana Commercial |
$26,259.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,332.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,799.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,267.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,185.84
|
| Rate for Payer: Ohio Health Group HMO |
$23,169.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,714.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,876.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,316.17
|
| Rate for Payer: PHCS Commercial |
$29,657.28
|
| Rate for Payer: United Healthcare All Payer |
$27,185.84
|
|
|
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 |
$9,455.53 |
| 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 |
$16,591.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,446.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,228.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,398.73
|
| 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 |
$16,591.65
|
| 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 |
$19,909.98
|
| 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 |
$21,996.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,920.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,971.55
|
| 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
|
$27,495.00
|
|
|
Service Code
|
HCPCS C9607
|
| Hospital Charge Code |
76102531
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8,248.50 |
| 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 |
$21,996.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,920.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,971.55
|
| 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 |
$4,215.60 |
| 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 |
$11,241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,225.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,695.88
|
| 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
|
$14,966.00
|
|
|
Service Code
|
HCPCS C9605
|
| Hospital Charge Code |
48100088
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,489.80 |
| Max. Negotiated Rate |
$14,367.36 |
| Rate for Payer: Aetna Commercial |
$11,523.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,673.48
|
| Rate for Payer: Cash Price |
$7,483.00
|
| Rate for Payer: Cigna Commercial |
$12,421.78
|
| Rate for Payer: First Health Commercial |
$14,217.70
|
| Rate for Payer: Humana Commercial |
$12,721.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,272.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,044.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,489.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,170.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,224.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,972.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,020.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,326.54
|
| Rate for Payer: PHCS Commercial |
$14,367.36
|
| Rate for Payer: United Healthcare All Payer |
$13,170.08
|
|
|
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 |
$4,215.60 |
| 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 |
$11,241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,225.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,695.88
|
| 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
|
$14,966.00
|
|
|
Service Code
|
HCPCS C9605
|
| Hospital Charge Code |
48100088
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,489.80 |
| Max. Negotiated Rate |
$14,367.36 |
| Rate for Payer: Aetna Commercial |
$11,523.82
|
| Rate for Payer: Anthem Medicaid |
$5,146.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,673.48
|
| Rate for Payer: Cash Price |
$7,483.00
|
| Rate for Payer: Cigna Commercial |
$12,421.78
|
| Rate for Payer: First Health Commercial |
$14,217.70
|
| Rate for Payer: Humana Commercial |
$12,721.10
|
| Rate for Payer: Humana KY Medicaid |
$5,146.81
|
| Rate for Payer: Kentucky WC Medicaid |
$5,199.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,272.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,044.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,489.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,250.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,170.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,224.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,972.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,020.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,326.54
|
| Rate for Payer: PHCS Commercial |
$14,367.36
|
| Rate for Payer: United Healthcare All Payer |
$13,170.08
|
|
|
PERC DE COR REVASC T CABG SING
|
Facility
|
OP
|
$21,141.00
|
|
|
Service Code
|
HCPCS C9604
|
| Hospital Charge Code |
48100087
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,270.39 |
| Max. Negotiated Rate |
$20,295.36 |
| Rate for Payer: Aetna Commercial |
$16,278.57
|
| Rate for Payer: Anthem Medicaid |
$7,270.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,489.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| Rate for Payer: Cash Price |
$10,570.50
|
| Rate for Payer: Cash Price |
$10,570.50
|
| Rate for Payer: Cigna Commercial |
$17,547.03
|
| Rate for Payer: First Health Commercial |
$20,083.95
|
| Rate for Payer: Humana Commercial |
$17,969.85
|
| Rate for Payer: Humana KY Medicaid |
$7,270.39
|
| Rate for Payer: Humana Medicare Advantage |
$10,478.46
|
| Rate for Payer: Kentucky WC Medicaid |
$7,344.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,335.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,602.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,574.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,416.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,604.08
|
| Rate for Payer: Ohio Health Group HMO |
$15,855.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,912.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,392.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,587.29
|
| Rate for Payer: PHCS Commercial |
$20,295.36
|
| Rate for Payer: United Healthcare All Payer |
$18,604.08
|
|
|
PERC DE COR REVASC T CABG SING
|
Facility
|
IP
|
$21,141.00
|
|
|
Service Code
|
HCPCS C9604
|
| Hospital Charge Code |
48100087
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,342.30 |
| Max. Negotiated Rate |
$20,295.36 |
| Rate for Payer: Aetna Commercial |
$16,278.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,489.98
|
| Rate for Payer: Cash Price |
$10,570.50
|
| Rate for Payer: Cigna Commercial |
$17,547.03
|
| Rate for Payer: First Health Commercial |
$20,083.95
|
| Rate for Payer: Humana Commercial |
$17,969.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,335.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,602.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,342.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,604.08
|
| Rate for Payer: Ohio Health Group HMO |
$15,855.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,912.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,392.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,587.29
|
| Rate for Payer: PHCS Commercial |
$20,295.36
|
| Rate for Payer: United Healthcare All Payer |
$18,604.08
|
|
|
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 |
$5,411.70 |
| 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 |
$14,431.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,693.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,446.91
|
| 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 |
$6,203.61 |
| 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 |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,070.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| 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 |
$10,478.46
|
| 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 |
$12,574.15
|
| 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 |
$14,431.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,693.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,446.91
|
| Rate for Payer: PHCS Commercial |
$17,317.44
|
| Rate for Payer: United Healthcare All Payer |
$15,874.32
|
|
|
Perc d-e cor revasc w ami s
|
Facility
|
OP
|
$32,221.00
|
|
|
Service Code
|
HCPCS C9606
|
| Hospital Charge Code |
48100089
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,666.30 |
| Max. Negotiated Rate |
$30,932.16 |
| Rate for Payer: Aetna Commercial |
$24,810.17
|
| Rate for Payer: Anthem Medicaid |
$11,080.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,132.38
|
| Rate for Payer: Cash Price |
$16,110.50
|
| Rate for Payer: Cigna Commercial |
$26,743.43
|
| Rate for Payer: First Health Commercial |
$30,609.95
|
| Rate for Payer: Humana Commercial |
$27,387.85
|
| Rate for Payer: Humana KY Medicaid |
$11,080.80
|
| Rate for Payer: Kentucky WC Medicaid |
$11,193.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,421.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,779.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,666.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,303.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,354.48
|
| Rate for Payer: Ohio Health Group HMO |
$24,165.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,776.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,032.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,232.49
|
| Rate for Payer: PHCS Commercial |
$30,932.16
|
| Rate for Payer: United Healthcare All Payer |
$28,354.48
|
|
|
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 |
$8,248.50 |
| 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 |
$21,996.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,920.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,971.55
|
| 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 |
$8,248.50 |
| 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 |
$21,996.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,920.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,971.55
|
| 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
|
$32,221.00
|
|
|
Service Code
|
HCPCS C9606
|
| Hospital Charge Code |
48100089
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,666.30 |
| Max. Negotiated Rate |
$30,932.16 |
| Rate for Payer: Aetna Commercial |
$24,810.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,132.38
|
| Rate for Payer: Cash Price |
$16,110.50
|
| Rate for Payer: Cigna Commercial |
$26,743.43
|
| Rate for Payer: First Health Commercial |
$30,609.95
|
| Rate for Payer: Humana Commercial |
$27,387.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,421.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,779.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,666.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,354.48
|
| Rate for Payer: Ohio Health Group HMO |
$24,165.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,776.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,032.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,232.49
|
| Rate for Payer: PHCS Commercial |
$30,932.16
|
| Rate for Payer: United Healthcare All Payer |
$28,354.48
|
|
|
Perc d-e cor stent ather br
|
Facility
|
OP
|
$14,052.00
|
|
|
Service Code
|
HCPCS C9603
|
| Hospital Charge Code |
76102527
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,215.60 |
| 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 |
$11,241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,225.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,695.88
|
| Rate for Payer: PHCS Commercial |
$13,489.92
|
| Rate for Payer: United Healthcare All Payer |
$12,365.76
|
|
|
Perc d-e cor stent ather br
|
Facility
|
OP
|
$14,052.00
|
|
|
Service Code
|
HCPCS C9603
|
| Hospital Charge Code |
48100086
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,215.60 |
| 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 |
$11,241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,225.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,695.88
|
| Rate for Payer: PHCS Commercial |
$13,489.92
|
| Rate for Payer: United Healthcare All Payer |
$12,365.76
|
|
|
Perc d-e cor stent ather br
|
Facility
|
IP
|
$14,052.00
|
|
|
Service Code
|
HCPCS C9603
|
| Hospital Charge Code |
48100086
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,215.60 |
| 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 |
$11,241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,225.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,695.88
|
| Rate for Payer: PHCS Commercial |
$13,489.92
|
| Rate for Payer: United Healthcare All Payer |
$12,365.76
|
|
|
Perc d-e cor stent ather br
|
Facility
|
IP
|
$14,052.00
|
|
|
Service Code
|
HCPCS C9603
|
| Hospital Charge Code |
76102527
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,215.60 |
| 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 |
$11,241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,225.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,695.88
|
| Rate for Payer: PHCS Commercial |
$13,489.92
|
| Rate for Payer: United Healthcare All Payer |
$12,365.76
|
|
|
Perc d-e cor stent ather s
|
Facility
|
IP
|
$30,893.00
|
|
|
Service Code
|
HCPCS C9602
|
| Hospital Charge Code |
48100085
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,267.90 |
| Max. Negotiated Rate |
$29,657.28 |
| Rate for Payer: Aetna Commercial |
$23,787.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,096.54
|
| Rate for Payer: Cash Price |
$15,446.50
|
| Rate for Payer: Cigna Commercial |
$25,641.19
|
| Rate for Payer: First Health Commercial |
$29,348.35
|
| Rate for Payer: Humana Commercial |
$26,259.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,332.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,799.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,267.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,185.84
|
| Rate for Payer: Ohio Health Group HMO |
$23,169.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,714.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,876.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,316.17
|
| Rate for Payer: PHCS Commercial |
$29,657.28
|
| Rate for Payer: United Healthcare All Payer |
$27,185.84
|
|
|
Perc d-e cor stent ather s
|
Facility
|
OP
|
$27,495.00
|
|
|
Service Code
|
HCPCS C9602
|
| Hospital Charge Code |
76102526
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9,455.53 |
| 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 |
$16,591.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,446.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,228.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,398.73
|
| 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 |
$16,591.65
|
| 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 |
$19,909.98
|
| 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 |
$21,996.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,920.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,971.55
|
| Rate for Payer: PHCS Commercial |
$26,395.20
|
| Rate for Payer: United Healthcare All Payer |
$24,195.60
|
|
