|
GRAFT AORTIC BDY OVTN 20*80
|
Facility
|
IP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
GRAFT AORTIC BDY OVTN 20*80
|
Facility
|
OP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem Medicaid |
$11,064.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Humana KY Medicaid |
$11,064.98
|
| Rate for Payer: Kentucky WC Medicaid |
$11,177.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,286.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
GRAFT AORTIC BDY OVTN 23*80
|
Facility
|
IP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
GRAFT AORTIC BDY OVTN 23*80
|
Facility
|
OP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem Medicaid |
$11,064.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Humana KY Medicaid |
$11,064.98
|
| Rate for Payer: Kentucky WC Medicaid |
$11,177.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,286.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
GRAFT AORTIC BDY OVTN 26*80
|
Facility
|
IP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
GRAFT AORTIC BDY OVTN 26*80
|
Facility
|
OP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem Medicaid |
$11,064.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Humana KY Medicaid |
$11,064.98
|
| Rate for Payer: Kentucky WC Medicaid |
$11,177.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,286.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
GRAFT AORTIC BDY OVTN 29*80
|
Facility
|
OP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem Medicaid |
$11,064.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Humana KY Medicaid |
$11,064.98
|
| Rate for Payer: Kentucky WC Medicaid |
$11,177.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,286.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
GRAFT AORTIC BDY OVTN 29*80
|
Facility
|
IP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
GRAFT AORTIC BDY OVTN 34*80
|
Facility
|
IP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
GRAFT AORTIC BDY OVTN 34*80
|
Facility
|
OP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem Medicaid |
$11,064.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Humana KY Medicaid |
$11,064.98
|
| Rate for Payer: Kentucky WC Medicaid |
$11,177.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,286.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
GRAFT AORTIC BDY OVTN IX 20*80
|
Facility
|
OP
|
$72,696.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,450.53 |
| Max. Negotiated Rate |
$69,788.54 |
| Rate for Payer: Aetna Commercial |
$55,976.23
|
| Rate for Payer: Anthem Medicaid |
$25,000.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,703.19
|
| Rate for Payer: Cash Price |
$36,348.20
|
| Rate for Payer: Cigna Commercial |
$60,338.01
|
| Rate for Payer: First Health Commercial |
$69,061.58
|
| Rate for Payer: Humana Commercial |
$61,791.94
|
| Rate for Payer: Humana KY Medicaid |
$25,000.29
|
| Rate for Payer: Kentucky WC Medicaid |
$25,254.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,611.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,649.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,808.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,501.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,972.83
|
| Rate for Payer: Ohio Health Group HMO |
$54,522.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,539.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,450.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,535.88
|
| Rate for Payer: PHCS Commercial |
$69,788.54
|
| Rate for Payer: United Healthcare All Payer |
$63,972.83
|
|
|
GRAFT AORTIC BDY OVTN IX 20*80
|
Facility
|
IP
|
$72,696.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,450.53 |
| Max. Negotiated Rate |
$69,788.54 |
| Rate for Payer: Aetna Commercial |
$55,976.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,703.19
|
| Rate for Payer: Cash Price |
$36,348.20
|
| Rate for Payer: Cigna Commercial |
$60,338.01
|
| Rate for Payer: First Health Commercial |
$69,061.58
|
| Rate for Payer: Humana Commercial |
$61,791.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,611.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,649.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,808.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,972.83
|
| Rate for Payer: Ohio Health Group HMO |
$54,522.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,539.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,450.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,535.88
|
| Rate for Payer: PHCS Commercial |
$69,788.54
|
| Rate for Payer: United Healthcare All Payer |
$63,972.83
|
|
|
GRAFT AORTIC BDY OVTN IX 23*80
|
Facility
|
IP
|
$79,896.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,386.53 |
| Max. Negotiated Rate |
$76,700.54 |
| Rate for Payer: Aetna Commercial |
$61,520.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,319.19
|
| Rate for Payer: Cash Price |
$39,948.20
|
| Rate for Payer: Cigna Commercial |
$66,314.01
|
| Rate for Payer: First Health Commercial |
$75,901.58
|
| Rate for Payer: Humana Commercial |
$67,911.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,515.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,963.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,968.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,308.83
|
| Rate for Payer: Ohio Health Group HMO |
$59,922.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,979.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,386.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,767.88
|
| Rate for Payer: PHCS Commercial |
$76,700.54
|
| Rate for Payer: United Healthcare All Payer |
$70,308.83
|
|
|
GRAFT AORTIC BDY OVTN IX 23*80
|
Facility
|
OP
|
$79,896.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,386.53 |
| Max. Negotiated Rate |
$76,700.54 |
| Rate for Payer: Aetna Commercial |
$61,520.23
|
| Rate for Payer: Anthem Medicaid |
$27,476.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,319.19
|
| Rate for Payer: Cash Price |
$39,948.20
|
| Rate for Payer: Cigna Commercial |
$66,314.01
|
| Rate for Payer: First Health Commercial |
$75,901.58
|
| Rate for Payer: Humana Commercial |
$67,911.94
|
| Rate for Payer: Humana KY Medicaid |
$27,476.37
|
| Rate for Payer: Kentucky WC Medicaid |
$27,756.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,515.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,963.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,968.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,027.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,308.83
|
| Rate for Payer: Ohio Health Group HMO |
$59,922.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,979.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,386.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,767.88
|
| Rate for Payer: PHCS Commercial |
$76,700.54
|
| Rate for Payer: United Healthcare All Payer |
$70,308.83
|
|
|
GRAFT AORTIC BDY OVTN IX 26*80
|
Facility
|
IP
|
$74,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,684.53 |
| Max. Negotiated Rate |
$71,516.54 |
| Rate for Payer: Aetna Commercial |
$57,362.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,107.19
|
| Rate for Payer: Cash Price |
$37,248.20
|
| Rate for Payer: Cigna Commercial |
$61,832.01
|
| Rate for Payer: First Health Commercial |
$70,771.58
|
| Rate for Payer: Humana Commercial |
$63,321.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,087.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,978.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,348.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,556.83
|
| Rate for Payer: Ohio Health Group HMO |
$55,872.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,899.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,684.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,093.88
|
| Rate for Payer: PHCS Commercial |
$71,516.54
|
| Rate for Payer: United Healthcare All Payer |
$65,556.83
|
|
|
GRAFT AORTIC BDY OVTN IX 26*80
|
Facility
|
OP
|
$74,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,684.53 |
| Max. Negotiated Rate |
$71,516.54 |
| Rate for Payer: Aetna Commercial |
$57,362.23
|
| Rate for Payer: Anthem Medicaid |
$25,619.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,107.19
|
| Rate for Payer: Cash Price |
$37,248.20
|
| Rate for Payer: Cigna Commercial |
$61,832.01
|
| Rate for Payer: First Health Commercial |
$70,771.58
|
| Rate for Payer: Humana Commercial |
$63,321.94
|
| Rate for Payer: Humana KY Medicaid |
$25,619.31
|
| Rate for Payer: Kentucky WC Medicaid |
$25,880.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,087.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,978.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,348.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,133.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,556.83
|
| Rate for Payer: Ohio Health Group HMO |
$55,872.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,899.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,684.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,093.88
|
| Rate for Payer: PHCS Commercial |
$71,516.54
|
| Rate for Payer: United Healthcare All Payer |
$65,556.83
|
|
|
GRAFT AORTIC BDY OVTN IX 34*80
|
Facility
|
IP
|
$72,696.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,450.53 |
| Max. Negotiated Rate |
$69,788.54 |
| Rate for Payer: Aetna Commercial |
$55,976.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,703.19
|
| Rate for Payer: Cash Price |
$36,348.20
|
| Rate for Payer: Cigna Commercial |
$60,338.01
|
| Rate for Payer: First Health Commercial |
$69,061.58
|
| Rate for Payer: Humana Commercial |
$61,791.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,611.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,649.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,808.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,972.83
|
| Rate for Payer: Ohio Health Group HMO |
$54,522.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,539.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,450.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,535.88
|
| Rate for Payer: PHCS Commercial |
$69,788.54
|
| Rate for Payer: United Healthcare All Payer |
$63,972.83
|
|
|
GRAFT AORTIC BDY OVTN IX 34*80
|
Facility
|
OP
|
$72,696.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,450.53 |
| Max. Negotiated Rate |
$69,788.54 |
| Rate for Payer: Aetna Commercial |
$55,976.23
|
| Rate for Payer: Anthem Medicaid |
$25,000.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,703.19
|
| Rate for Payer: Cash Price |
$36,348.20
|
| Rate for Payer: Cigna Commercial |
$60,338.01
|
| Rate for Payer: First Health Commercial |
$69,061.58
|
| Rate for Payer: Humana Commercial |
$61,791.94
|
| Rate for Payer: Humana KY Medicaid |
$25,000.29
|
| Rate for Payer: Kentucky WC Medicaid |
$25,254.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,611.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,649.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,808.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,501.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,972.83
|
| Rate for Payer: Ohio Health Group HMO |
$54,522.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,539.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,450.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,535.88
|
| Rate for Payer: PHCS Commercial |
$69,788.54
|
| Rate for Payer: United Healthcare All Payer |
$63,972.83
|
|
|
GRAFT AORTIC EXT A25-25/C55
|
Facility
|
IP
|
$25,601.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,328.18 |
| Max. Negotiated Rate |
$24,577.30 |
| Rate for Payer: Aetna Commercial |
$19,713.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,969.05
|
| Rate for Payer: Cash Price |
$12,800.67
|
| Rate for Payer: Cigna Commercial |
$21,249.12
|
| Rate for Payer: First Health Commercial |
$24,321.28
|
| Rate for Payer: Humana Commercial |
$21,761.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,993.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,893.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,680.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,529.19
|
| Rate for Payer: Ohio Health Group HMO |
$19,201.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,120.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,328.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,936.42
|
| Rate for Payer: PHCS Commercial |
$24,577.30
|
| Rate for Payer: United Healthcare All Payer |
$22,529.19
|
|
|
GRAFT AORTIC EXT A25-25/C55
|
Facility
|
OP
|
$25,601.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,328.18 |
| Max. Negotiated Rate |
$24,577.30 |
| Rate for Payer: Aetna Commercial |
$19,713.04
|
| Rate for Payer: Anthem Medicaid |
$8,804.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,969.05
|
| Rate for Payer: Cash Price |
$12,800.67
|
| Rate for Payer: Cigna Commercial |
$21,249.12
|
| Rate for Payer: First Health Commercial |
$24,321.28
|
| Rate for Payer: Humana Commercial |
$21,761.15
|
| Rate for Payer: Humana KY Medicaid |
$8,804.30
|
| Rate for Payer: Kentucky WC Medicaid |
$8,893.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,993.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,893.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,680.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,980.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,529.19
|
| Rate for Payer: Ohio Health Group HMO |
$19,201.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,120.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,328.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,936.42
|
| Rate for Payer: PHCS Commercial |
$24,577.30
|
| Rate for Payer: United Healthcare All Payer |
$22,529.19
|
|
|
GRAFT AORTIC EXT A28-28/C55
|
Facility
|
OP
|
$23,177.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,013.11 |
| Max. Negotiated Rate |
$22,250.64 |
| Rate for Payer: Aetna Commercial |
$17,846.87
|
| Rate for Payer: Anthem Medicaid |
$7,970.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,078.64
|
| Rate for Payer: Cash Price |
$11,588.88
|
| Rate for Payer: Cigna Commercial |
$19,237.53
|
| Rate for Payer: First Health Commercial |
$22,018.86
|
| Rate for Payer: Humana Commercial |
$19,701.09
|
| Rate for Payer: Humana KY Medicaid |
$7,970.83
|
| Rate for Payer: Kentucky WC Medicaid |
$8,051.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,005.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,105.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,953.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,130.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,396.42
|
| Rate for Payer: Ohio Health Group HMO |
$17,383.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,635.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,013.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,185.10
|
| Rate for Payer: PHCS Commercial |
$22,250.64
|
| Rate for Payer: United Healthcare All Payer |
$20,396.42
|
|
|
GRAFT AORTIC EXT A28-28/C55
|
Facility
|
IP
|
$23,177.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,013.11 |
| Max. Negotiated Rate |
$22,250.64 |
| Rate for Payer: Aetna Commercial |
$17,846.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,078.64
|
| Rate for Payer: Cash Price |
$11,588.88
|
| Rate for Payer: Cigna Commercial |
$19,237.53
|
| Rate for Payer: First Health Commercial |
$22,018.86
|
| Rate for Payer: Humana Commercial |
$19,701.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,005.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,105.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,953.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,396.42
|
| Rate for Payer: Ohio Health Group HMO |
$17,383.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,635.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,013.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,185.10
|
| Rate for Payer: PHCS Commercial |
$22,250.64
|
| Rate for Payer: United Healthcare All Payer |
$20,396.42
|
|
|
GRAFT AORTIC EXT A28-28/C75-O2
|
Facility
|
OP
|
$25,601.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,328.18 |
| Max. Negotiated Rate |
$24,577.30 |
| Rate for Payer: Aetna Commercial |
$19,713.04
|
| Rate for Payer: Anthem Medicaid |
$8,804.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,969.05
|
| Rate for Payer: Cash Price |
$12,800.67
|
| Rate for Payer: Cigna Commercial |
$21,249.12
|
| Rate for Payer: First Health Commercial |
$24,321.28
|
| Rate for Payer: Humana Commercial |
$21,761.15
|
| Rate for Payer: Humana KY Medicaid |
$8,804.30
|
| Rate for Payer: Kentucky WC Medicaid |
$8,893.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,993.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,893.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,680.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,980.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,529.19
|
| Rate for Payer: Ohio Health Group HMO |
$19,201.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,120.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,328.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,936.42
|
| Rate for Payer: PHCS Commercial |
$24,577.30
|
| Rate for Payer: United Healthcare All Payer |
$22,529.19
|
|
|
GRAFT AORTIC EXT A28-28/C75-O2
|
Facility
|
IP
|
$25,601.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,328.18 |
| Max. Negotiated Rate |
$24,577.30 |
| Rate for Payer: Aetna Commercial |
$19,713.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,969.05
|
| Rate for Payer: Cash Price |
$12,800.67
|
| Rate for Payer: Cigna Commercial |
$21,249.12
|
| Rate for Payer: First Health Commercial |
$24,321.28
|
| Rate for Payer: Humana Commercial |
$21,761.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,993.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,893.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,680.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,529.19
|
| Rate for Payer: Ohio Health Group HMO |
$19,201.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,120.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,328.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,936.42
|
| Rate for Payer: PHCS Commercial |
$24,577.30
|
| Rate for Payer: United Healthcare All Payer |
$22,529.19
|
|
|
GRAFT AORTIC EXT A34-34/C100 V
|
Facility
|
OP
|
$25,601.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,328.18 |
| Max. Negotiated Rate |
$24,577.30 |
| Rate for Payer: Aetna Commercial |
$19,713.04
|
| Rate for Payer: Anthem Medicaid |
$8,804.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,969.05
|
| Rate for Payer: Cash Price |
$12,800.67
|
| Rate for Payer: Cigna Commercial |
$21,249.12
|
| Rate for Payer: First Health Commercial |
$24,321.28
|
| Rate for Payer: Humana Commercial |
$21,761.15
|
| Rate for Payer: Humana KY Medicaid |
$8,804.30
|
| Rate for Payer: Kentucky WC Medicaid |
$8,893.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,993.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,893.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,680.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,980.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,529.19
|
| Rate for Payer: Ohio Health Group HMO |
$19,201.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,120.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,328.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,936.42
|
| Rate for Payer: PHCS Commercial |
$24,577.30
|
| Rate for Payer: United Healthcare All Payer |
$22,529.19
|
|
