|
CORIAL FEM STEM WO COLLAR SZ13
|
Facility
|
OP
|
$22,501.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.23 |
| Max. Negotiated Rate |
$21,601.70 |
| Rate for Payer: Aetna Commercial |
$17,326.36
|
| Rate for Payer: Anthem Medicaid |
$7,738.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.38
|
| Rate for Payer: Cash Price |
$11,250.89
|
| Rate for Payer: Cigna Commercial |
$18,676.47
|
| Rate for Payer: First Health Commercial |
$21,376.68
|
| Rate for Payer: Humana Commercial |
$19,126.50
|
| Rate for Payer: Humana KY Medicaid |
$7,738.36
|
| Rate for Payer: Kentucky WC Medicaid |
$7,817.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,451.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,893.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,801.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.55
|
| Rate for Payer: PHCS Commercial |
$21,601.70
|
| Rate for Payer: United Healthcare All Payer |
$19,801.56
|
|
|
CORIAL FEM STEM WO COLLAR SZ13
|
Facility
|
IP
|
$22,501.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.23 |
| Max. Negotiated Rate |
$21,601.70 |
| Rate for Payer: Aetna Commercial |
$17,326.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.38
|
| Rate for Payer: Cash Price |
$11,250.89
|
| Rate for Payer: Cigna Commercial |
$18,676.47
|
| Rate for Payer: First Health Commercial |
$21,376.68
|
| Rate for Payer: Humana Commercial |
$19,126.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,451.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,801.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.55
|
| Rate for Payer: PHCS Commercial |
$21,601.70
|
| Rate for Payer: United Healthcare All Payer |
$19,801.56
|
|
|
CORKSCREW FT II 5.5 SUT ANCHOR
|
Facility
|
IP
|
$3,197.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.68 |
| Max. Negotiated Rate |
$3,069.60 |
| Rate for Payer: Aetna Commercial |
$2,462.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,494.05
|
| Rate for Payer: Cash Price |
$1,598.75
|
| Rate for Payer: Cigna Commercial |
$2,653.92
|
| Rate for Payer: First Health Commercial |
$3,037.62
|
| Rate for Payer: Humana Commercial |
$2,717.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,621.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,359.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$959.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,813.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,398.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$639.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$991.22
|
| Rate for Payer: PHCS Commercial |
$3,069.60
|
| Rate for Payer: United Healthcare All Payer |
$2,813.80
|
|
|
CORKSCREW FT II 5.5 SUT ANCHOR
|
Facility
|
OP
|
$3,197.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.68 |
| Max. Negotiated Rate |
$3,069.60 |
| Rate for Payer: Aetna Commercial |
$2,462.08
|
| Rate for Payer: Anthem Medicaid |
$1,099.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,494.05
|
| Rate for Payer: Cash Price |
$1,598.75
|
| Rate for Payer: Cigna Commercial |
$2,653.92
|
| Rate for Payer: First Health Commercial |
$3,037.62
|
| Rate for Payer: Humana Commercial |
$2,717.88
|
| Rate for Payer: Humana KY Medicaid |
$1,099.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,110.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,621.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,359.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$959.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,121.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,813.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,398.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$639.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$991.22
|
| Rate for Payer: PHCS Commercial |
$3,069.60
|
| Rate for Payer: United Healthcare All Payer |
$2,813.80
|
|
|
CORKSCREW FT SUTURE ANCHOR 5.5
|
Facility
|
IP
|
$3,337.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.88 |
| Max. Negotiated Rate |
$3,204.00 |
| Rate for Payer: Aetna Commercial |
$2,569.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,603.25
|
| Rate for Payer: Cash Price |
$1,668.75
|
| Rate for Payer: Cigna Commercial |
$2,770.12
|
| Rate for Payer: First Health Commercial |
$3,170.62
|
| Rate for Payer: Humana Commercial |
$2,836.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,736.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,463.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,937.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,503.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,034.62
|
| Rate for Payer: PHCS Commercial |
$3,204.00
|
| Rate for Payer: United Healthcare All Payer |
$2,937.00
|
|
|
CORKSCREW FT SUTURE ANCHOR 5.5
|
Facility
|
OP
|
$3,337.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.88 |
| Max. Negotiated Rate |
$3,204.00 |
| Rate for Payer: Aetna Commercial |
$2,569.88
|
| Rate for Payer: Anthem Medicaid |
$1,147.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,603.25
|
| Rate for Payer: Cash Price |
$1,668.75
|
| Rate for Payer: Cigna Commercial |
$2,770.12
|
| Rate for Payer: First Health Commercial |
$3,170.62
|
| Rate for Payer: Humana Commercial |
$2,836.88
|
| Rate for Payer: Humana KY Medicaid |
$1,147.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,159.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,736.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,463.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,170.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,937.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,503.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,034.62
|
| Rate for Payer: PHCS Commercial |
$3,204.00
|
| Rate for Payer: United Healthcare All Payer |
$2,937.00
|
|
|
CORMATRIX 4*7 TISSUE REPAIR
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
CORMATRIX 4*7 TISSUE REPAIR
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
CORMATRIX 7*10 TISSUE REPAIR
|
Facility
|
OP
|
$5,612.50
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$729.62 |
| Max. Negotiated Rate |
$5,388.00 |
| Rate for Payer: Aetna Commercial |
$4,321.62
|
| Rate for Payer: Anthem Medicaid |
$1,930.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,377.75
|
| Rate for Payer: Cash Price |
$2,806.25
|
| Rate for Payer: Cigna Commercial |
$4,658.38
|
| Rate for Payer: First Health Commercial |
$5,331.88
|
| Rate for Payer: Humana Commercial |
$4,770.62
|
| Rate for Payer: Humana KY Medicaid |
$1,930.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,949.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,602.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,142.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,683.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,968.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,939.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,209.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,122.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$729.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,739.88
|
| Rate for Payer: PHCS Commercial |
$5,388.00
|
| Rate for Payer: United Healthcare All Payer |
$4,939.00
|
|
|
CORMATRIX 7*10 TISSUE REPAIR
|
Facility
|
IP
|
$5,612.50
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$729.62 |
| Max. Negotiated Rate |
$5,388.00 |
| Rate for Payer: Aetna Commercial |
$4,321.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,377.75
|
| Rate for Payer: Cash Price |
$2,806.25
|
| Rate for Payer: Cigna Commercial |
$4,658.38
|
| Rate for Payer: First Health Commercial |
$5,331.88
|
| Rate for Payer: Humana Commercial |
$4,770.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,602.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,142.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,683.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,939.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,209.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,122.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$729.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,739.88
|
| Rate for Payer: PHCS Commercial |
$5,388.00
|
| Rate for Payer: United Healthcare All Payer |
$4,939.00
|
|
|
CORN IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000799
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
CORN IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000799
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
CORONARY ART BYPASS 3 GRAFTS
|
Facility
|
IP
|
$6,200.00
|
|
|
Service Code
|
HCPCS 33535
|
| Hospital Charge Code |
76101310
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$806.00 |
| Max. Negotiated Rate |
$5,952.00 |
| Rate for Payer: Aetna Commercial |
$4,774.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,836.00
|
| Rate for Payer: Cash Price |
$3,100.00
|
| Rate for Payer: Cigna Commercial |
$5,146.00
|
| Rate for Payer: First Health Commercial |
$5,890.00
|
| Rate for Payer: Humana Commercial |
$5,270.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,084.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,575.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,860.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,456.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$806.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,922.00
|
| Rate for Payer: PHCS Commercial |
$5,952.00
|
| Rate for Payer: United Healthcare All Payer |
$5,456.00
|
|
|
CORONARY ART BYPASS 3 GRAFTS
|
Facility
|
OP
|
$6,200.00
|
|
|
Service Code
|
HCPCS 33535
|
| Hospital Charge Code |
76101310
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$806.00 |
| Max. Negotiated Rate |
$5,952.00 |
| Rate for Payer: Aetna Commercial |
$4,774.00
|
| Rate for Payer: Anthem Medicaid |
$2,132.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,836.00
|
| Rate for Payer: Cash Price |
$3,100.00
|
| Rate for Payer: Cigna Commercial |
$5,146.00
|
| Rate for Payer: First Health Commercial |
$5,890.00
|
| Rate for Payer: Humana Commercial |
$5,270.00
|
| Rate for Payer: Humana KY Medicaid |
$2,132.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,153.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,084.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,575.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,860.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,174.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,456.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$806.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,922.00
|
| Rate for Payer: PHCS Commercial |
$5,952.00
|
| Rate for Payer: United Healthcare All Payer |
$5,456.00
|
|
|
CORONARY ART BYPASS 3 GRAFTS
|
Professional
|
Both
|
$6,200.00
|
|
|
Service Code
|
HCPCS 33535
|
| Hospital Charge Code |
76101310
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,062.56 |
| Max. Negotiated Rate |
$6,200.00 |
| Rate for Payer: Aetna Commercial |
$4,195.78
|
| Rate for Payer: Anthem Medicaid |
$2,062.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,200.00
|
| Rate for Payer: Cash Price |
$3,100.00
|
| Rate for Payer: Cash Price |
$3,100.00
|
| Rate for Payer: Cigna Commercial |
$3,950.31
|
| Rate for Payer: Healthspan PPO |
$4,125.27
|
| Rate for Payer: Humana Medicaid |
$2,062.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,494.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,103.81
|
| Rate for Payer: Molina Healthcare Passport |
$2,062.56
|
| Rate for Payer: Multiplan PHCS |
$3,720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,340.00
|
| Rate for Payer: UHCCP Medicaid |
$2,170.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,083.19
|
|
|
CORONARY ART BYPASS 3 GRAFTS(P
|
Professional
|
Both
|
$6,200.00
|
|
|
Service Code
|
HCPCS 33535
|
| Hospital Charge Code |
761P1310
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,062.56 |
| Max. Negotiated Rate |
$6,200.00 |
| Rate for Payer: Aetna Commercial |
$4,195.78
|
| Rate for Payer: Anthem Medicaid |
$2,062.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,200.00
|
| Rate for Payer: Cash Price |
$3,100.00
|
| Rate for Payer: Cash Price |
$3,100.00
|
| Rate for Payer: Cigna Commercial |
$3,950.31
|
| Rate for Payer: Healthspan PPO |
$4,125.27
|
| Rate for Payer: Humana Medicaid |
$2,062.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,494.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,103.81
|
| Rate for Payer: Molina Healthcare Passport |
$2,062.56
|
| Rate for Payer: Multiplan PHCS |
$3,720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,340.00
|
| Rate for Payer: UHCCP Medicaid |
$2,170.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,083.19
|
|
|
CORONARY ART BYPASS 4 OR MORE
|
Professional
|
Both
|
$6,000.00
|
|
|
Service Code
|
HCPCS 33536
|
| Hospital Charge Code |
76101311
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,100.00 |
| Max. Negotiated Rate |
$6,000.00 |
| Rate for Payer: Aetna Commercial |
$4,498.97
|
| Rate for Payer: Anthem Medicaid |
$2,267.94
|
| 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 |
$4,209.58
|
| Rate for Payer: Healthspan PPO |
$4,423.37
|
| Rate for Payer: Humana Medicaid |
$2,267.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,760.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,313.30
|
| Rate for Payer: Molina Healthcare Passport |
$2,267.94
|
| 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 |
$2,290.62
|
|
|
CORONARY ART BYPASS VEIN ONLY
|
Professional
|
Both
|
$4,600.00
|
|
|
Service Code
|
HCPCS 33510
|
| Hospital Charge Code |
76101297
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,602.35 |
| Max. Negotiated Rate |
$4,600.00 |
| Rate for Payer: Aetna Commercial |
$3,351.00
|
| Rate for Payer: Anthem Medicaid |
$1,602.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,600.00
|
| Rate for Payer: Cash Price |
$2,300.00
|
| Rate for Payer: Cash Price |
$2,300.00
|
| Rate for Payer: Cigna Commercial |
$3,216.19
|
| Rate for Payer: Healthspan PPO |
$3,294.68
|
| Rate for Payer: Humana Medicaid |
$1,602.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,761.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,634.40
|
| Rate for Payer: Molina Healthcare Passport |
$1,602.35
|
| Rate for Payer: Multiplan PHCS |
$2,760.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,220.00
|
| Rate for Payer: UHCCP Medicaid |
$1,610.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,618.37
|
|
|
CORONARY ARTER BYPASS
|
Professional
|
Both
|
$6,000.00
|
|
|
Service Code
|
HCPCS 33513
|
| Hospital Charge Code |
76101300
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,072.22 |
| Max. Negotiated Rate |
$6,000.00 |
| Rate for Payer: Aetna Commercial |
$4,187.65
|
| Rate for Payer: Anthem Medicaid |
$2,072.22
|
| 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 |
$3,964.44
|
| Rate for Payer: Healthspan PPO |
$4,117.28
|
| Rate for Payer: Humana Medicaid |
$2,072.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,521.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,113.66
|
| Rate for Payer: Molina Healthcare Passport |
$2,072.22
|
| 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 |
$2,092.94
|
|
|
CORONARY ARTER BYPASS
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS 33513
|
| Hospital Charge Code |
76101300
|
|
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
|
|
|
CORONARY ARTER BYPASS
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
HCPCS 33513
|
| Hospital Charge Code |
76101300
|
|
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
|
|
|
CORONARY ARTER BYPASS(P
|
Professional
|
Both
|
$6,000.00
|
|
|
Service Code
|
HCPCS 33513
|
| Hospital Charge Code |
761P1300
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,072.22 |
| Max. Negotiated Rate |
$6,000.00 |
| Rate for Payer: Aetna Commercial |
$4,187.65
|
| Rate for Payer: Anthem Medicaid |
$2,072.22
|
| 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 |
$3,964.44
|
| Rate for Payer: Healthspan PPO |
$4,117.28
|
| Rate for Payer: Humana Medicaid |
$2,072.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,521.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,113.66
|
| Rate for Payer: Molina Healthcare Passport |
$2,072.22
|
| 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 |
$2,092.94
|
|
|
CORONARY ARTERY BYPASS
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 33521
|
| Hospital Charge Code |
76101304
|
|
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
|
|
|
CORONARY ARTERY BYPASS
|
Professional
|
Both
|
$6,000.00
|
|
|
Service Code
|
HCPCS 33534
|
| Hospital Charge Code |
76101309
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,856.89 |
| Max. Negotiated Rate |
$6,000.00 |
| Rate for Payer: Aetna Commercial |
$3,784.06
|
| Rate for Payer: Anthem Medicaid |
$1,856.89
|
| 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 |
$3,605.76
|
| Rate for Payer: Healthspan PPO |
$3,720.47
|
| Rate for Payer: Humana Medicaid |
$1,856.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,135.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,894.03
|
| Rate for Payer: Molina Healthcare Passport |
$1,856.89
|
| 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 |
$1,875.46
|
|
|
CORONARY ARTERY BYPASS
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS 33534
|
| Hospital Charge Code |
76101309
|
|
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
|
|
