|
C2 KIT 3.5*12
|
Facility
|
OP
|
$21,955.00
|
|
|
Service Code
|
HCPCS C1761
|
| Hospital Charge Code |
27000275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.15 |
| Max. Negotiated Rate |
$21,076.80 |
| Rate for Payer: Aetna Commercial |
$16,905.35
|
| Rate for Payer: Anthem Medicaid |
$7,550.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,124.90
|
| Rate for Payer: Cash Price |
$10,977.50
|
| Rate for Payer: Cigna Commercial |
$18,222.65
|
| Rate for Payer: First Health Commercial |
$20,857.25
|
| Rate for Payer: Humana Commercial |
$18,661.75
|
| Rate for Payer: Humana KY Medicaid |
$7,550.32
|
| Rate for Payer: Kentucky WC Medicaid |
$7,627.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,003.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,202.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,586.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,701.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,320.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,466.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,391.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,854.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,806.05
|
| Rate for Payer: PHCS Commercial |
$21,076.80
|
| Rate for Payer: United Healthcare All Payer |
$19,320.40
|
|
|
CABG ART SINGLE
|
Professional
|
Both
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33533
|
| Hospital Charge Code |
76101308
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,651.21 |
| Max. Negotiated Rate |
$5,500.00 |
| Rate for Payer: Aetna Commercial |
$3,272.51
|
| Rate for Payer: Anthem Medicaid |
$1,651.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,500.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$3,154.84
|
| Rate for Payer: Healthspan PPO |
$3,217.52
|
| Rate for Payer: Humana Medicaid |
$1,651.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,671.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,684.23
|
| Rate for Payer: Molina Healthcare Passport |
$1,651.21
|
| Rate for Payer: Multiplan PHCS |
$3,300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,850.00
|
| Rate for Payer: UHCCP Medicaid |
$1,925.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,667.72
|
|
|
CABG ART SINGLE
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33533
|
| Hospital Charge Code |
76101308
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.00 |
| Max. Negotiated Rate |
$5,280.00 |
| Rate for Payer: Aetna Commercial |
$4,235.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,290.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,565.00
|
| Rate for Payer: First Health Commercial |
$5,225.00
|
| Rate for Payer: Humana Commercial |
$4,675.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,510.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,059.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,840.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,705.00
|
| Rate for Payer: PHCS Commercial |
$5,280.00
|
| Rate for Payer: United Healthcare All Payer |
$4,840.00
|
|
|
CABG ART SINGLE
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33533
|
| Hospital Charge Code |
76101308
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.00 |
| Max. Negotiated Rate |
$5,280.00 |
| Rate for Payer: Aetna Commercial |
$4,235.00
|
| Rate for Payer: Anthem Medicaid |
$1,891.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,290.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,565.00
|
| Rate for Payer: First Health Commercial |
$5,225.00
|
| Rate for Payer: Humana Commercial |
$4,675.00
|
| Rate for Payer: Humana KY Medicaid |
$1,891.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,510.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,059.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,929.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,840.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,705.00
|
| Rate for Payer: PHCS Commercial |
$5,280.00
|
| Rate for Payer: United Healthcare All Payer |
$4,840.00
|
|
|
CABG ART SINGLE(P
|
Professional
|
Both
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33533
|
| Hospital Charge Code |
761P1308
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,651.21 |
| Max. Negotiated Rate |
$5,500.00 |
| Rate for Payer: Aetna Commercial |
$3,272.51
|
| Rate for Payer: Anthem Medicaid |
$1,651.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,500.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$3,154.84
|
| Rate for Payer: Healthspan PPO |
$3,217.52
|
| Rate for Payer: Humana Medicaid |
$1,651.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,671.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,684.23
|
| Rate for Payer: Molina Healthcare Passport |
$1,651.21
|
| Rate for Payer: Multiplan PHCS |
$3,300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,850.00
|
| Rate for Payer: UHCCP Medicaid |
$1,925.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,667.72
|
|
|
CABG ART VEIN 2
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 33518
|
| Hospital Charge Code |
76101302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
CABG ART VEIN 2
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 33518
|
| Hospital Charge Code |
76101302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
CABG ART VEIN 2
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 33518
|
| Hospital Charge Code |
76101302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$313.06 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$685.88
|
| Rate for Payer: Anthem Medicaid |
$313.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$609.83
|
| Rate for Payer: Healthspan PPO |
$674.36
|
| Rate for Payer: Humana Medicaid |
$313.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$584.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$319.32
|
| Rate for Payer: Molina Healthcare Passport |
$313.06
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$316.19
|
|
|
CABG ART VEIN 2(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 33518
|
| Hospital Charge Code |
761P1302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$313.06 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$685.88
|
| Rate for Payer: Anthem Medicaid |
$313.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$609.83
|
| Rate for Payer: Healthspan PPO |
$674.36
|
| Rate for Payer: Humana Medicaid |
$313.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$584.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$319.32
|
| Rate for Payer: Molina Healthcare Passport |
$313.06
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$316.19
|
|
|
CABG ART VEIN 3
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 33519
|
| Hospital Charge Code |
76101303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
CABG ART VEIN 3
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 33519
|
| Hospital Charge Code |
76101303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$469.07 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$917.33
|
| Rate for Payer: Anthem Medicaid |
$469.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$821.46
|
| Rate for Payer: Healthspan PPO |
$901.90
|
| Rate for Payer: Humana Medicaid |
$469.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$774.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$478.45
|
| Rate for Payer: Molina Healthcare Passport |
$469.07
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$473.76
|
|
|
CABG ART VEIN 3
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 33519
|
| Hospital Charge Code |
76101303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
CABG ART VEIN 3(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 33519
|
| Hospital Charge Code |
761P1303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$469.07 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$917.33
|
| Rate for Payer: Anthem Medicaid |
$469.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$821.46
|
| Rate for Payer: Healthspan PPO |
$901.90
|
| Rate for Payer: Humana Medicaid |
$469.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$774.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$478.45
|
| Rate for Payer: Molina Healthcare Passport |
$469.07
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$473.76
|
|
|
CABG ART-VEIN SIX OR MORE
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 33523
|
| Hospital Charge Code |
76101306
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem Medicaid |
$790.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Humana KY Medicaid |
$790.97
|
| Rate for Payer: Kentucky WC Medicaid |
$799.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$690.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$299.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$713.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
CABG ART-VEIN SIX OR MORE
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 33523
|
| Hospital Charge Code |
76101306
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$805.00 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$1,458.93
|
| Rate for Payer: Anthem Medicaid |
$939.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,300.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,337.28
|
| Rate for Payer: Healthspan PPO |
$1,434.41
|
| Rate for Payer: Humana Medicaid |
$939.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,192.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$957.99
|
| Rate for Payer: Molina Healthcare Passport |
$939.21
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,610.00
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$948.60
|
|
|
CABG ART-VEIN SIX OR MORE
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 33523
|
| Hospital Charge Code |
76101306
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$690.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$299.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$713.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
CABG ART-VEIN SIX OR MORE(P
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 33523
|
| Hospital Charge Code |
761P1306
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$805.00 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$1,458.93
|
| Rate for Payer: Anthem Medicaid |
$939.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,300.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,337.28
|
| Rate for Payer: Healthspan PPO |
$1,434.41
|
| Rate for Payer: Humana Medicaid |
$939.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,192.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$957.99
|
| Rate for Payer: Molina Healthcare Passport |
$939.21
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,610.00
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$948.60
|
|
|
CABG VEIN 3
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS 33512
|
| Hospital Charge Code |
76101299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$5,760.00 |
| Rate for Payer: Aetna Commercial |
$4,620.00
|
| Rate for Payer: Anthem Medicaid |
$2,063.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,680.00
|
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Cigna Commercial |
$4,980.00
|
| Rate for Payer: First Health Commercial |
$5,700.00
|
| Rate for Payer: Humana Commercial |
$5,100.00
|
| Rate for Payer: Humana KY Medicaid |
$2,063.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,084.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,920.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,428.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,800.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,104.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,280.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$780.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,860.00
|
| Rate for Payer: PHCS Commercial |
$5,760.00
|
| Rate for Payer: United Healthcare All Payer |
$5,280.00
|
|
|
CABG VEIN 3
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
HCPCS 33512
|
| Hospital Charge Code |
76101299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$5,760.00 |
| Rate for Payer: Aetna Commercial |
$4,620.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,680.00
|
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Cigna Commercial |
$4,980.00
|
| Rate for Payer: First Health Commercial |
$5,700.00
|
| Rate for Payer: Humana Commercial |
$5,100.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,920.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,428.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,280.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$780.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,860.00
|
| Rate for Payer: PHCS Commercial |
$5,760.00
|
| Rate for Payer: United Healthcare All Payer |
$5,280.00
|
|
|
CABG VEIN 3
|
Professional
|
Both
|
$6,000.00
|
|
|
Service Code
|
HCPCS 33512
|
| Hospital Charge Code |
76101299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,915.68 |
| Max. Negotiated Rate |
$6,000.00 |
| Rate for Payer: Aetna Commercial |
$4,094.09
|
| Rate for Payer: Anthem Medicaid |
$1,915.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,000.00
|
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Cigna Commercial |
$3,854.51
|
| Rate for Payer: Healthspan PPO |
$4,025.29
|
| Rate for Payer: Humana Medicaid |
$1,915.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,434.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,953.99
|
| Rate for Payer: Molina Healthcare Passport |
$1,915.68
|
| Rate for Payer: Multiplan PHCS |
$3,600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,200.00
|
| Rate for Payer: UHCCP Medicaid |
$2,100.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,934.84
|
|
|
CABG VEIN 3(P
|
Professional
|
Both
|
$6,000.00
|
|
|
Service Code
|
HCPCS 33512
|
| Hospital Charge Code |
761P1299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,915.68 |
| Max. Negotiated Rate |
$6,000.00 |
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Aetna Commercial |
$4,094.09
|
| Rate for Payer: Anthem Medicaid |
$1,915.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,000.00
|
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Cigna Commercial |
$3,854.51
|
| Rate for Payer: Healthspan PPO |
$4,025.29
|
| Rate for Payer: Humana Medicaid |
$1,915.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,434.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,953.99
|
| Rate for Payer: Molina Healthcare Passport |
$1,915.68
|
| Rate for Payer: Multiplan PHCS |
$3,600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,200.00
|
| Rate for Payer: UHCCP Medicaid |
$2,100.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,934.84
|
|
|
CABG - VEIN - TWO
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33511
|
| Hospital Charge Code |
76101298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.00 |
| Max. Negotiated Rate |
$5,280.00 |
| Rate for Payer: Aetna Commercial |
$4,235.00
|
| Rate for Payer: Anthem Medicaid |
$1,891.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,290.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,565.00
|
| Rate for Payer: First Health Commercial |
$5,225.00
|
| Rate for Payer: Humana Commercial |
$4,675.00
|
| Rate for Payer: Humana KY Medicaid |
$1,891.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,510.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,059.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,929.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,840.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,705.00
|
| Rate for Payer: PHCS Commercial |
$5,280.00
|
| Rate for Payer: United Healthcare All Payer |
$4,840.00
|
|
|
CABG - VEIN - TWO
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33511
|
| Hospital Charge Code |
76101298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.00 |
| Max. Negotiated Rate |
$5,280.00 |
| Rate for Payer: Aetna Commercial |
$4,235.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,290.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,565.00
|
| Rate for Payer: First Health Commercial |
$5,225.00
|
| Rate for Payer: Humana Commercial |
$4,675.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,510.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,059.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,840.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,705.00
|
| Rate for Payer: PHCS Commercial |
$5,280.00
|
| Rate for Payer: United Healthcare All Payer |
$4,840.00
|
|
|
CABG - VEIN - TWO
|
Professional
|
Both
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33511
|
| Hospital Charge Code |
76101298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,759.16 |
| Max. Negotiated Rate |
$5,500.00 |
| Rate for Payer: Aetna Commercial |
$3,648.86
|
| Rate for Payer: Anthem Medicaid |
$1,759.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,500.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$3,477.80
|
| Rate for Payer: Healthspan PPO |
$3,587.54
|
| Rate for Payer: Humana Medicaid |
$1,759.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,026.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,794.34
|
| Rate for Payer: Molina Healthcare Passport |
$1,759.16
|
| Rate for Payer: Multiplan PHCS |
$3,300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,850.00
|
| Rate for Payer: UHCCP Medicaid |
$1,925.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,776.75
|
|
|
CABG - VEIN - TWO(P
|
Professional
|
Both
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33511
|
| Hospital Charge Code |
761P1298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,759.16 |
| Max. Negotiated Rate |
$5,500.00 |
| Rate for Payer: Aetna Commercial |
$3,648.86
|
| Rate for Payer: Anthem Medicaid |
$1,759.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,500.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$3,477.80
|
| Rate for Payer: Healthspan PPO |
$3,587.54
|
| Rate for Payer: Humana Medicaid |
$1,759.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,026.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,794.34
|
| Rate for Payer: Molina Healthcare Passport |
$1,759.16
|
| Rate for Payer: Multiplan PHCS |
$3,300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,850.00
|
| Rate for Payer: UHCCP Medicaid |
$1,925.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,776.75
|
|
