|
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 |
$4,187.65 |
| Rate for Payer: Aetna Commercial |
$4,187.65
|
| Rate for Payer: Ambetter Exchange |
$2,320.79
|
| Rate for Payer: Anthem Medicaid |
$2,072.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,320.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,320.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,784.95
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$2,320.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,320.79
|
| 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 |
$3,017.03
|
| Rate for Payer: UHCCP Medicaid |
$2,100.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,092.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,320.79
|
|
|
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 |
$4,187.65 |
| Rate for Payer: Aetna Commercial |
$4,187.65
|
| Rate for Payer: Ambetter Exchange |
$2,320.79
|
| Rate for Payer: Anthem Medicaid |
$2,072.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,320.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,320.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,784.95
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$2,320.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,320.79
|
| 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 |
$3,017.03
|
| Rate for Payer: UHCCP Medicaid |
$2,100.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,092.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,320.79
|
|
|
CORONARY ARTERY BYPASS
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 33521
|
| Hospital Charge Code |
76101304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.00 |
| 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 |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
CORONARY ARTERY BYPASS
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
HCPCS 33534
|
| Hospital Charge Code |
76101309
|
|
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
|
|
|
CORONARY ARTERY BYPASS
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 33521
|
| Hospital Charge Code |
76101304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.00 |
| 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 |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
CORONARY ARTERY BYPASS
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS 33534
|
| Hospital Charge Code |
76101309
|
|
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
|
|
|
CORONARY ARTERY BYPASS
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 33521
|
| Hospital Charge Code |
76101304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$610.88 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,114.10
|
| Rate for Payer: Ambetter Exchange |
$610.88
|
| Rate for Payer: Anthem Medicaid |
$625.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$610.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$610.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.06
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,006.84
|
| Rate for Payer: Healthspan PPO |
$1,095.38
|
| Rate for Payer: Humana Medicaid |
$625.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$933.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$610.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$638.40
|
| Rate for Payer: Molina Healthcare Passport |
$625.88
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$794.14
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$632.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$610.88
|
|
|
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 |
$3,784.06 |
| Rate for Payer: Aetna Commercial |
$3,784.06
|
| Rate for Payer: Ambetter Exchange |
$2,066.69
|
| Rate for Payer: Anthem Medicaid |
$1,856.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,066.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,066.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,480.03
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$2,066.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,066.69
|
| 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 |
$2,686.70
|
| Rate for Payer: UHCCP Medicaid |
$2,100.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,875.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,066.69
|
|
|
CORONARY ARTERY BYPASS(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 33521
|
| Hospital Charge Code |
761P1304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$610.88 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,114.10
|
| Rate for Payer: Ambetter Exchange |
$610.88
|
| Rate for Payer: Anthem Medicaid |
$625.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$610.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$610.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.06
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,006.84
|
| Rate for Payer: Healthspan PPO |
$1,095.38
|
| Rate for Payer: Humana Medicaid |
$625.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$933.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$610.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$638.40
|
| Rate for Payer: Molina Healthcare Passport |
$625.88
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$794.14
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$632.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$610.88
|
|
|
CORONARY ARTERY BYPASS(P
|
Professional
|
Both
|
$6,000.00
|
|
|
Service Code
|
HCPCS 33534
|
| Hospital Charge Code |
761P1309
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,856.89 |
| Max. Negotiated Rate |
$3,784.06 |
| Rate for Payer: Aetna Commercial |
$3,784.06
|
| Rate for Payer: Ambetter Exchange |
$2,066.69
|
| Rate for Payer: Anthem Medicaid |
$1,856.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,066.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,066.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,480.03
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$2,066.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,066.69
|
| 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 |
$2,686.70
|
| Rate for Payer: UHCCP Medicaid |
$2,100.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,875.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,066.69
|
|
|
CORONARY ARTERY BYPASS/REOP
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
HCPCS 33530
|
| Hospital Charge Code |
76101307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$1,128.00 |
| Rate for Payer: Aetna Commercial |
$904.75
|
| Rate for Payer: Anthem Medicaid |
$404.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$916.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$975.25
|
| Rate for Payer: First Health Commercial |
$1,116.25
|
| Rate for Payer: Humana Commercial |
$998.75
|
| Rate for Payer: Humana KY Medicaid |
$404.08
|
| Rate for Payer: Kentucky WC Medicaid |
$408.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$963.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$412.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,034.00
|
| Rate for Payer: Ohio Health Group HMO |
$881.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,022.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.75
|
| Rate for Payer: PHCS Commercial |
$1,128.00
|
| Rate for Payer: United Healthcare All Payer |
$1,034.00
|
|
|
CORONARY ARTERY BYPASS/REOP
|
Professional
|
Both
|
$1,175.00
|
|
|
Service Code
|
HCPCS 33530
|
| Hospital Charge Code |
76101307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.50 |
| Max. Negotiated Rate |
$870.44 |
| Rate for Payer: Aetna Commercial |
$870.44
|
| Rate for Payer: Ambetter Exchange |
$491.22
|
| Rate for Payer: Anthem Medicaid |
$309.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$491.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$491.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$589.46
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$771.29
|
| Rate for Payer: Healthspan PPO |
$855.81
|
| Rate for Payer: Humana Medicaid |
$309.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$744.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$491.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$491.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$315.69
|
| Rate for Payer: Molina Healthcare Passport |
$309.50
|
| Rate for Payer: Multiplan PHCS |
$705.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$638.59
|
| Rate for Payer: UHCCP Medicaid |
$411.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$312.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$491.22
|
|
|
CORONARY ARTERY BYPASS/REOP
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
HCPCS 33530
|
| Hospital Charge Code |
76101307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$1,128.00 |
| Rate for Payer: Aetna Commercial |
$904.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$916.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$975.25
|
| Rate for Payer: First Health Commercial |
$1,116.25
|
| Rate for Payer: Humana Commercial |
$998.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$963.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,034.00
|
| Rate for Payer: Ohio Health Group HMO |
$881.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,022.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.75
|
| Rate for Payer: PHCS Commercial |
$1,128.00
|
| Rate for Payer: United Healthcare All Payer |
$1,034.00
|
|
|
CORONARY ARTERY BYPASS/REOP(P
|
Professional
|
Both
|
$1,175.00
|
|
|
Service Code
|
HCPCS 33530
|
| Hospital Charge Code |
761P1307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.50 |
| Max. Negotiated Rate |
$870.44 |
| Rate for Payer: Aetna Commercial |
$870.44
|
| Rate for Payer: Ambetter Exchange |
$491.22
|
| Rate for Payer: Anthem Medicaid |
$309.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$491.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$491.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$589.46
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$771.29
|
| Rate for Payer: Healthspan PPO |
$855.81
|
| Rate for Payer: Humana Medicaid |
$309.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$744.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$491.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$491.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$315.69
|
| Rate for Payer: Molina Healthcare Passport |
$309.50
|
| Rate for Payer: Multiplan PHCS |
$705.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$638.59
|
| Rate for Payer: UHCCP Medicaid |
$411.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$312.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$491.22
|
|
|
CORONARY ART/GRFT ANGIO S&I
|
Facility
|
OP
|
$13,870.00
|
|
|
Service Code
|
HCPCS 93455
|
| Hospital Charge Code |
48100066
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$13,315.20 |
| Rate for Payer: Aetna Commercial |
$10,679.90
|
| Rate for Payer: Anthem Medicaid |
$4,769.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,818.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$6,935.00
|
| Rate for Payer: Cash Price |
$6,935.00
|
| Rate for Payer: Cigna Commercial |
$11,512.10
|
| Rate for Payer: First Health Commercial |
$13,176.50
|
| Rate for Payer: Humana Commercial |
$11,789.50
|
| Rate for Payer: Humana KY Medicaid |
$4,769.89
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$4,818.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,373.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,236.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,865.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,205.60
|
| Rate for Payer: Ohio Health Group HMO |
$10,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,096.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,066.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,570.30
|
| Rate for Payer: PHCS Commercial |
$13,315.20
|
| Rate for Payer: United Healthcare All Payer |
$12,205.60
|
|
|
CORONARY ART/GRFT ANGIO S&I
|
Professional
|
Both
|
$13,533.00
|
|
|
Service Code
|
HCPCS 93455
|
| Hospital Charge Code |
76102479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.32 |
| Max. Negotiated Rate |
$8,119.80 |
| Rate for Payer: Aetna Commercial |
$1,599.15
|
| Rate for Payer: Ambetter Exchange |
$869.48
|
| Rate for Payer: Anthem Medicaid |
$890.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$869.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$869.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,043.38
|
| Rate for Payer: Cash Price |
$6,766.50
|
| Rate for Payer: Cash Price |
$6,766.50
|
| Rate for Payer: Cigna Commercial |
$1,751.87
|
| Rate for Payer: Healthspan PPO |
$1,188.57
|
| Rate for Payer: Humana Medicaid |
$890.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$412.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$869.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$869.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$908.50
|
| Rate for Payer: Molina Healthcare Passport |
$890.69
|
| Rate for Payer: Multiplan PHCS |
$8,119.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,130.32
|
| Rate for Payer: UHCCP Medicaid |
$4,736.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$899.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$869.48
|
|
|
CORONARY ART/GRFT ANGIO S&I
|
Facility
|
IP
|
$13,870.00
|
|
|
Service Code
|
HCPCS 93455
|
| Hospital Charge Code |
48100066
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,161.00 |
| Max. Negotiated Rate |
$13,315.20 |
| Rate for Payer: Aetna Commercial |
$10,679.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,818.60
|
| Rate for Payer: Cash Price |
$6,935.00
|
| Rate for Payer: Cigna Commercial |
$11,512.10
|
| Rate for Payer: First Health Commercial |
$13,176.50
|
| Rate for Payer: Humana Commercial |
$11,789.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,373.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,236.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,161.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,205.60
|
| Rate for Payer: Ohio Health Group HMO |
$10,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,096.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,066.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,570.30
|
| Rate for Payer: PHCS Commercial |
$13,315.20
|
| Rate for Payer: United Healthcare All Payer |
$12,205.60
|
|
|
CORONARY ART/GRFT ANGIO S&I
|
Facility
|
IP
|
$13,533.00
|
|
|
Service Code
|
HCPCS 93455
|
| Hospital Charge Code |
76102479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,059.90 |
| Max. Negotiated Rate |
$12,991.68 |
| Rate for Payer: Aetna Commercial |
$10,420.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,555.74
|
| Rate for Payer: Cash Price |
$6,766.50
|
| Rate for Payer: Cigna Commercial |
$11,232.39
|
| Rate for Payer: First Health Commercial |
$12,856.35
|
| Rate for Payer: Humana Commercial |
$11,503.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,097.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,987.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,059.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,909.04
|
| Rate for Payer: Ohio Health Group HMO |
$10,149.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,826.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,773.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,337.77
|
| Rate for Payer: PHCS Commercial |
$12,991.68
|
| Rate for Payer: United Healthcare All Payer |
$11,909.04
|
|
|
CORONARY ART/GRFT ANGIO S&I
|
Facility
|
OP
|
$13,533.00
|
|
|
Service Code
|
HCPCS 93455
|
| Hospital Charge Code |
76102479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$12,991.68 |
| Rate for Payer: Aetna Commercial |
$10,420.41
|
| Rate for Payer: Anthem Medicaid |
$4,654.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,555.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$6,766.50
|
| Rate for Payer: Cash Price |
$6,766.50
|
| Rate for Payer: Cigna Commercial |
$11,232.39
|
| Rate for Payer: First Health Commercial |
$12,856.35
|
| Rate for Payer: Humana Commercial |
$11,503.05
|
| Rate for Payer: Humana KY Medicaid |
$4,654.00
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$4,701.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,097.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,987.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,747.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,909.04
|
| Rate for Payer: Ohio Health Group HMO |
$10,149.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,826.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,773.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,337.77
|
| Rate for Payer: PHCS Commercial |
$12,991.68
|
| Rate for Payer: United Healthcare All Payer |
$11,909.04
|
|
|
CORONARY ART/GRFT ANGIO S&I(P
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 93455
|
| Hospital Charge Code |
761P2479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.50 |
| Max. Negotiated Rate |
$1,751.87 |
| Rate for Payer: Aetna Commercial |
$1,599.15
|
| Rate for Payer: Ambetter Exchange |
$869.48
|
| Rate for Payer: Anthem Medicaid |
$890.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$869.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$869.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,043.38
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cigna Commercial |
$1,751.87
|
| Rate for Payer: Healthspan PPO |
$1,188.57
|
| Rate for Payer: Humana Medicaid |
$890.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$412.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$869.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$869.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$908.50
|
| Rate for Payer: Molina Healthcare Passport |
$890.69
|
| Rate for Payer: Multiplan PHCS |
$306.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,130.32
|
| Rate for Payer: UHCCP Medicaid |
$178.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$899.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$869.48
|
|
|
CORONARY ART/GRFT ANGIO S&I(T
|
Facility
|
IP
|
$13,023.00
|
|
|
Service Code
|
HCPCS 93455
|
| Hospital Charge Code |
761T2479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,906.90 |
| Max. Negotiated Rate |
$12,502.08 |
| Rate for Payer: Aetna Commercial |
$10,027.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,157.94
|
| Rate for Payer: Cash Price |
$6,511.50
|
| Rate for Payer: Cigna Commercial |
$10,809.09
|
| Rate for Payer: First Health Commercial |
$12,371.85
|
| Rate for Payer: Humana Commercial |
$11,069.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,678.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,610.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,906.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,460.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,767.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,418.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,330.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,985.87
|
| Rate for Payer: PHCS Commercial |
$12,502.08
|
| Rate for Payer: United Healthcare All Payer |
$11,460.24
|
|
|
CORONARY ART/GRFT ANGIO S&I(T
|
Facility
|
OP
|
$13,023.00
|
|
|
Service Code
|
HCPCS 93455
|
| Hospital Charge Code |
761T2479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$12,502.08 |
| Rate for Payer: Aetna Commercial |
$10,027.71
|
| Rate for Payer: Anthem Medicaid |
$4,478.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,157.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$6,511.50
|
| Rate for Payer: Cash Price |
$6,511.50
|
| Rate for Payer: Cigna Commercial |
$10,809.09
|
| Rate for Payer: First Health Commercial |
$12,371.85
|
| Rate for Payer: Humana Commercial |
$11,069.55
|
| Rate for Payer: Humana KY Medicaid |
$4,478.61
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$4,524.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,678.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,610.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,568.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,460.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,767.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,418.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,330.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,985.87
|
| Rate for Payer: PHCS Commercial |
$12,502.08
|
| Rate for Payer: United Healthcare All Payer |
$11,460.24
|
|
|
CORONARY BYPASS SINGL VEIN GRA
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33517
|
| Hospital Charge Code |
761P1301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.27 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$318.68
|
| Rate for Payer: Ambetter Exchange |
$175.23
|
| Rate for Payer: Anthem Medicaid |
$156.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$175.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$210.28
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$287.14
|
| Rate for Payer: Healthspan PPO |
$313.33
|
| Rate for Payer: Humana Medicaid |
$156.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$266.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$175.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$159.40
|
| Rate for Payer: Molina Healthcare Passport |
$156.27
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$227.80
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$157.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.23
|
|
|
CORONARY BYPASS SINGL VEIN GRA
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33517
|
| Hospital Charge Code |
76101301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
CORONARY BYPASS SINGL VEIN GRA
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33517
|
| Hospital Charge Code |
76101301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
