|
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 |
$690.00 |
| 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 |
$1,840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,001.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.00
|
| 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 |
$772.42 |
| Max. Negotiated Rate |
$1,458.93 |
| Rate for Payer: Aetna Commercial |
$1,458.93
|
| Rate for Payer: Ambetter Exchange |
$772.42
|
| Rate for Payer: Anthem Medicaid |
$939.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$772.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$772.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$926.90
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$772.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$772.42
|
| 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 |
$1,004.15
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$948.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$772.42
|
|
|
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 |
$772.42 |
| Max. Negotiated Rate |
$1,458.93 |
| Rate for Payer: Aetna Commercial |
$1,458.93
|
| Rate for Payer: Ambetter Exchange |
$772.42
|
| Rate for Payer: Anthem Medicaid |
$939.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$772.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$772.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$926.90
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$772.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$772.42
|
| 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 |
$1,004.15
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$948.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$772.42
|
|
|
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 |
$4,094.09 |
| Rate for Payer: Aetna Commercial |
$4,094.09
|
| Rate for Payer: Ambetter Exchange |
$2,270.25
|
| Rate for Payer: Anthem Medicaid |
$1,915.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,270.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,270.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,724.30
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$2,270.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,270.25
|
| 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 |
$2,951.32
|
| Rate for Payer: UHCCP Medicaid |
$2,100.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,934.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,270.25
|
|
|
CABG VEIN 3
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS 33512
|
| Hospital Charge Code |
76101299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,800.00 |
| 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 |
$4,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,220.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.00
|
| 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 |
$1,800.00 |
| 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 |
$4,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,220.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.00
|
| Rate for Payer: PHCS Commercial |
$5,760.00
|
| Rate for Payer: United Healthcare All Payer |
$5,280.00
|
|
|
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 |
$4,094.09 |
| Rate for Payer: Aetna Commercial |
$4,094.09
|
| Rate for Payer: Ambetter Exchange |
$2,270.25
|
| Rate for Payer: Anthem Medicaid |
$1,915.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,270.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,270.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,724.30
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$2,270.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,270.25
|
| 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 |
$2,951.32
|
| Rate for Payer: UHCCP Medicaid |
$2,100.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,934.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,270.25
|
|
|
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 |
$3,648.86 |
| Rate for Payer: Aetna Commercial |
$3,648.86
|
| Rate for Payer: Ambetter Exchange |
$1,994.56
|
| Rate for Payer: Anthem Medicaid |
$1,759.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,994.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,994.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,393.47
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,994.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,994.56
|
| 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 |
$2,592.93
|
| Rate for Payer: UHCCP Medicaid |
$1,925.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,776.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,994.56
|
|
|
CABG - VEIN - TWO
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33511
|
| Hospital Charge Code |
76101298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,650.00 |
| 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 |
$4,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,785.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.00
|
| 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 |
$1,650.00 |
| 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 |
$4,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,785.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.00
|
| Rate for Payer: PHCS Commercial |
$5,280.00
|
| Rate for Payer: United Healthcare All Payer |
$4,840.00
|
|
|
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 |
$3,648.86 |
| Rate for Payer: Aetna Commercial |
$3,648.86
|
| Rate for Payer: Ambetter Exchange |
$1,994.56
|
| Rate for Payer: Anthem Medicaid |
$1,759.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,994.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,994.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,393.47
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,994.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,994.56
|
| 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 |
$2,592.93
|
| Rate for Payer: UHCCP Medicaid |
$1,925.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,776.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,994.56
|
|
|
CABLE 1.6MM*750MM COIL
|
Facility
|
OP
|
$3,252.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$975.75 |
| Max. Negotiated Rate |
$3,122.40 |
| Rate for Payer: Aetna Commercial |
$2,504.43
|
| Rate for Payer: Anthem Medicaid |
$1,118.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,536.95
|
| Rate for Payer: Cash Price |
$1,626.25
|
| Rate for Payer: Cigna Commercial |
$2,699.57
|
| Rate for Payer: First Health Commercial |
$3,089.88
|
| Rate for Payer: Humana Commercial |
$2,764.62
|
| Rate for Payer: Humana KY Medicaid |
$1,118.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,667.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,400.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,862.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,439.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,602.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,829.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,244.22
|
| Rate for Payer: PHCS Commercial |
$3,122.40
|
| Rate for Payer: United Healthcare All Payer |
$2,862.20
|
|
|
CABLE 1.6MM*750MM COIL
|
Facility
|
IP
|
$3,252.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$975.75 |
| Max. Negotiated Rate |
$3,122.40 |
| Rate for Payer: Aetna Commercial |
$2,504.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,536.95
|
| Rate for Payer: Cash Price |
$1,626.25
|
| Rate for Payer: Cigna Commercial |
$2,699.57
|
| Rate for Payer: First Health Commercial |
$3,089.88
|
| Rate for Payer: Humana Commercial |
$2,764.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,667.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,400.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,862.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,439.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,602.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,829.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,244.22
|
| Rate for Payer: PHCS Commercial |
$3,122.40
|
| Rate for Payer: United Healthcare All Payer |
$2,862.20
|
|
|
CABLE ASSY CRCLGE COCR 1.8X36
|
Facility
|
IP
|
$5,637.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.25 |
| Max. Negotiated Rate |
$5,412.00 |
| Rate for Payer: Aetna Commercial |
$4,340.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,397.25
|
| Rate for Payer: Cash Price |
$2,818.75
|
| Rate for Payer: Cigna Commercial |
$4,679.12
|
| Rate for Payer: First Health Commercial |
$5,355.62
|
| Rate for Payer: Humana Commercial |
$4,791.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,961.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,228.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,904.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,889.88
|
| Rate for Payer: PHCS Commercial |
$5,412.00
|
| Rate for Payer: United Healthcare All Payer |
$4,961.00
|
|
|
CABLE ASSY CRCLGE COCR 1.8X36
|
Facility
|
OP
|
$5,637.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.25 |
| Max. Negotiated Rate |
$5,412.00 |
| Rate for Payer: Aetna Commercial |
$4,340.88
|
| Rate for Payer: Anthem Medicaid |
$1,938.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,397.25
|
| Rate for Payer: Cash Price |
$2,818.75
|
| Rate for Payer: Cigna Commercial |
$4,679.12
|
| Rate for Payer: First Health Commercial |
$5,355.62
|
| Rate for Payer: Humana Commercial |
$4,791.88
|
| Rate for Payer: Humana KY Medicaid |
$1,938.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,958.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,977.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,961.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,228.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,904.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,889.88
|
| Rate for Payer: PHCS Commercial |
$5,412.00
|
| Rate for Payer: United Healthcare All Payer |
$4,961.00
|
|
|
CABLE MULTI LEAD TRIAL 3013
|
Facility
|
IP
|
$1,946.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.80 |
| Max. Negotiated Rate |
$1,868.16 |
| Rate for Payer: Aetna Commercial |
$1,498.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.88
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cigna Commercial |
$1,615.18
|
| Rate for Payer: First Health Commercial |
$1,848.70
|
| Rate for Payer: Humana Commercial |
$1,654.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,595.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,436.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,712.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,459.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,693.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,342.74
|
| Rate for Payer: PHCS Commercial |
$1,868.16
|
| Rate for Payer: United Healthcare All Payer |
$1,712.48
|
|
|
CABLE MULTI LEAD TRIAL 3013
|
Facility
|
OP
|
$1,946.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.80 |
| Max. Negotiated Rate |
$1,868.16 |
| Rate for Payer: Aetna Commercial |
$1,498.42
|
| Rate for Payer: Anthem Medicaid |
$669.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.88
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cigna Commercial |
$1,615.18
|
| Rate for Payer: First Health Commercial |
$1,848.70
|
| Rate for Payer: Humana Commercial |
$1,654.10
|
| Rate for Payer: Humana KY Medicaid |
$669.23
|
| Rate for Payer: Kentucky WC Medicaid |
$676.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,595.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,436.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$682.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,712.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,459.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,693.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,342.74
|
| Rate for Payer: PHCS Commercial |
$1,868.16
|
| Rate for Payer: United Healthcare All Payer |
$1,712.48
|
|
|
CABLE PERI-LOC SADDLE SHORT SS
|
Facility
|
OP
|
$1,892.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.61 |
| Max. Negotiated Rate |
$1,816.36 |
| Rate for Payer: Aetna Commercial |
$1,456.87
|
| Rate for Payer: Anthem Medicaid |
$650.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,475.79
|
| Rate for Payer: Cash Price |
$946.02
|
| Rate for Payer: Cigna Commercial |
$1,570.39
|
| Rate for Payer: First Health Commercial |
$1,797.44
|
| Rate for Payer: Humana Commercial |
$1,608.23
|
| Rate for Payer: Humana KY Medicaid |
$650.67
|
| Rate for Payer: Kentucky WC Medicaid |
$657.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,513.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.51
|
| Rate for Payer: PHCS Commercial |
$1,816.36
|
| Rate for Payer: United Healthcare All Payer |
$1,665.00
|
|
|
CABLE PERI-LOC SADDLE SHORT SS
|
Facility
|
IP
|
$1,892.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.61 |
| Max. Negotiated Rate |
$1,816.36 |
| Rate for Payer: Aetna Commercial |
$1,456.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,475.79
|
| Rate for Payer: Cash Price |
$946.02
|
| Rate for Payer: Cigna Commercial |
$1,570.39
|
| Rate for Payer: First Health Commercial |
$1,797.44
|
| Rate for Payer: Humana Commercial |
$1,608.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,513.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.51
|
| Rate for Payer: PHCS Commercial |
$1,816.36
|
| Rate for Payer: United Healthcare All Payer |
$1,665.00
|
|
|
CABLE PERI-LOC SADDLE TALL SS
|
Facility
|
IP
|
$1,892.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.61 |
| Max. Negotiated Rate |
$1,816.36 |
| Rate for Payer: Aetna Commercial |
$1,456.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,475.79
|
| Rate for Payer: Cash Price |
$946.02
|
| Rate for Payer: Cigna Commercial |
$1,570.39
|
| Rate for Payer: First Health Commercial |
$1,797.44
|
| Rate for Payer: Humana Commercial |
$1,608.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,513.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.51
|
| Rate for Payer: PHCS Commercial |
$1,816.36
|
| Rate for Payer: United Healthcare All Payer |
$1,665.00
|
|
|
CABLE PERI-LOC SADDLE TALL SS
|
Facility
|
OP
|
$1,892.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.61 |
| Max. Negotiated Rate |
$1,816.36 |
| Rate for Payer: Aetna Commercial |
$1,456.87
|
| Rate for Payer: Anthem Medicaid |
$650.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,475.79
|
| Rate for Payer: Cash Price |
$946.02
|
| Rate for Payer: Cigna Commercial |
$1,570.39
|
| Rate for Payer: First Health Commercial |
$1,797.44
|
| Rate for Payer: Humana Commercial |
$1,608.23
|
| Rate for Payer: Humana KY Medicaid |
$650.67
|
| Rate for Payer: Kentucky WC Medicaid |
$657.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,513.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.51
|
| Rate for Payer: PHCS Commercial |
$1,816.36
|
| Rate for Payer: United Healthcare All Payer |
$1,665.00
|
|
|
CABLE REM S-101-97-12
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.00 |
| Max. Negotiated Rate |
$787.20 |
| Rate for Payer: Aetna Commercial |
$631.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$639.60
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cigna Commercial |
$680.60
|
| Rate for Payer: First Health Commercial |
$779.00
|
| Rate for Payer: Humana Commercial |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$672.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$605.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$246.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$721.60
|
| Rate for Payer: Ohio Health Group HMO |
$615.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$713.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.80
|
| Rate for Payer: PHCS Commercial |
$787.20
|
| Rate for Payer: United Healthcare All Payer |
$721.60
|
|
|
CABLE REM S-101-97-12
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.00 |
| Max. Negotiated Rate |
$787.20 |
| Rate for Payer: Aetna Commercial |
$631.40
|
| Rate for Payer: Anthem Medicaid |
$282.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$639.60
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cigna Commercial |
$680.60
|
| Rate for Payer: First Health Commercial |
$779.00
|
| Rate for Payer: Humana Commercial |
$697.00
|
| Rate for Payer: Humana KY Medicaid |
$282.00
|
| Rate for Payer: Kentucky WC Medicaid |
$284.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$672.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$605.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$246.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$287.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$721.60
|
| Rate for Payer: Ohio Health Group HMO |
$615.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$713.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.80
|
| Rate for Payer: PHCS Commercial |
$787.20
|
| Rate for Payer: United Healthcare All Payer |
$721.60
|
|
|
CABLE SS 2.0*750MM
|
Facility
|
IP
|
$2,143.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.08 |
| Max. Negotiated Rate |
$2,057.86 |
| Rate for Payer: Aetna Commercial |
$1,650.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,672.01
|
| Rate for Payer: Cash Price |
$1,071.80
|
| Rate for Payer: Cigna Commercial |
$1,779.19
|
| Rate for Payer: First Health Commercial |
$2,036.42
|
| Rate for Payer: Humana Commercial |
$1,822.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,757.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,581.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$643.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,886.37
|
| Rate for Payer: Ohio Health Group HMO |
$1,607.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,714.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,864.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,479.08
|
| Rate for Payer: PHCS Commercial |
$2,057.86
|
| Rate for Payer: United Healthcare All Payer |
$1,886.37
|
|
|
CABLE SS 2.0*750MM
|
Facility
|
OP
|
$2,143.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.08 |
| Max. Negotiated Rate |
$2,057.86 |
| Rate for Payer: Aetna Commercial |
$1,650.57
|
| Rate for Payer: Anthem Medicaid |
$737.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,672.01
|
| Rate for Payer: Cash Price |
$1,071.80
|
| Rate for Payer: Cigna Commercial |
$1,779.19
|
| Rate for Payer: First Health Commercial |
$2,036.42
|
| Rate for Payer: Humana Commercial |
$1,822.06
|
| Rate for Payer: Humana KY Medicaid |
$737.18
|
| Rate for Payer: Kentucky WC Medicaid |
$744.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,757.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,581.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$643.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$751.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,886.37
|
| Rate for Payer: Ohio Health Group HMO |
$1,607.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,714.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,864.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,479.08
|
| Rate for Payer: PHCS Commercial |
$2,057.86
|
| Rate for Payer: United Healthcare All Payer |
$1,886.37
|
|
