|
GRAFT AORTIC EXT A34-34/C100 V
|
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 APLIGRAF 7.5CM DIAMETER
|
Facility
|
IP
|
$7,453.75
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
27000115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$968.99 |
| Max. Negotiated Rate |
$7,155.60 |
| Rate for Payer: Aetna Commercial |
$5,739.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,813.92
|
| Rate for Payer: Cash Price |
$3,726.88
|
| Rate for Payer: Cigna Commercial |
$6,186.61
|
| Rate for Payer: First Health Commercial |
$7,081.06
|
| Rate for Payer: Humana Commercial |
$6,335.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,112.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,500.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,236.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,559.30
|
| Rate for Payer: Ohio Health Group HMO |
$5,590.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,490.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$968.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,310.66
|
| Rate for Payer: PHCS Commercial |
$7,155.60
|
| Rate for Payer: United Healthcare All Payer |
$6,559.30
|
|
|
GRAFT APLIGRAF 7.5CM DIAMETER
|
Facility
|
OP
|
$7,453.75
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
27000115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$968.99 |
| Max. Negotiated Rate |
$7,155.60 |
| Rate for Payer: Aetna Commercial |
$5,739.39
|
| Rate for Payer: Anthem Medicaid |
$2,563.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,813.92
|
| Rate for Payer: Cash Price |
$3,726.88
|
| Rate for Payer: Cigna Commercial |
$6,186.61
|
| Rate for Payer: First Health Commercial |
$7,081.06
|
| Rate for Payer: Humana Commercial |
$6,335.69
|
| Rate for Payer: Humana KY Medicaid |
$2,563.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,589.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,112.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,500.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,236.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,614.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,559.30
|
| Rate for Payer: Ohio Health Group HMO |
$5,590.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,490.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$968.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,310.66
|
| Rate for Payer: PHCS Commercial |
$7,155.60
|
| Rate for Payer: United Healthcare All Payer |
$6,559.30
|
|
|
GRAFT AX-BYFEM STD W/RING 70*4
|
Facility
|
IP
|
$10,950.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.55 |
| Max. Negotiated Rate |
$10,512.38 |
| Rate for Payer: Aetna Commercial |
$8,431.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.31
|
| Rate for Payer: Cash Price |
$5,475.20
|
| Rate for Payer: Cigna Commercial |
$9,088.83
|
| Rate for Payer: First Health Commercial |
$10,402.88
|
| Rate for Payer: Humana Commercial |
$9,307.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,423.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,394.62
|
| Rate for Payer: PHCS Commercial |
$10,512.38
|
| Rate for Payer: United Healthcare All Payer |
$9,636.35
|
|
|
GRAFT AX-BYFEM STD W/RING 70*4
|
Facility
|
OP
|
$10,950.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.55 |
| Max. Negotiated Rate |
$10,512.38 |
| Rate for Payer: Cigna Commercial |
$9,088.83
|
| Rate for Payer: Aetna Commercial |
$8,431.81
|
| Rate for Payer: Anthem Medicaid |
$3,765.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.31
|
| Rate for Payer: Cash Price |
$5,475.20
|
| Rate for Payer: First Health Commercial |
$10,402.88
|
| Rate for Payer: Humana Commercial |
$9,307.84
|
| Rate for Payer: Humana KY Medicaid |
$3,765.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3,804.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,841.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,423.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,394.62
|
| Rate for Payer: PHCS Commercial |
$10,512.38
|
| Rate for Payer: United Healthcare All Payer |
$9,636.35
|
|
|
GRAFT BONE BIORESORABLE 10CC
|
Facility
|
OP
|
$7,490.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$973.73 |
| Max. Negotiated Rate |
$7,190.64 |
| Rate for Payer: Aetna Commercial |
$5,767.49
|
| Rate for Payer: Anthem Medicaid |
$2,575.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,842.40
|
| Rate for Payer: Cash Price |
$3,745.12
|
| Rate for Payer: Cigna Commercial |
$6,216.91
|
| Rate for Payer: First Health Commercial |
$7,115.74
|
| Rate for Payer: Humana Commercial |
$6,366.71
|
| Rate for Payer: Humana KY Medicaid |
$2,575.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,602.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,142.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,527.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,627.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,591.42
|
| Rate for Payer: Ohio Health Group HMO |
$5,617.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,498.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$973.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,321.98
|
| Rate for Payer: PHCS Commercial |
$7,190.64
|
| Rate for Payer: United Healthcare All Payer |
$6,591.42
|
|
|
GRAFT BONE BIORESORABLE 10CC
|
Facility
|
IP
|
$7,490.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$973.73 |
| Max. Negotiated Rate |
$7,190.64 |
| Rate for Payer: Aetna Commercial |
$5,767.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,842.40
|
| Rate for Payer: Cash Price |
$3,745.12
|
| Rate for Payer: Cigna Commercial |
$6,216.91
|
| Rate for Payer: First Health Commercial |
$7,115.74
|
| Rate for Payer: Humana Commercial |
$6,366.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,142.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,527.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,591.42
|
| Rate for Payer: Ohio Health Group HMO |
$5,617.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,498.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$973.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,321.98
|
| Rate for Payer: PHCS Commercial |
$7,190.64
|
| Rate for Payer: United Healthcare All Payer |
$6,591.42
|
|
|
GRAFT BONE BIORESORABLE 2.5CC
|
Facility
|
IP
|
$3,547.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$461.18 |
| Max. Negotiated Rate |
$3,405.60 |
| Rate for Payer: Aetna Commercial |
$2,731.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,767.05
|
| Rate for Payer: Cash Price |
$1,773.75
|
| Rate for Payer: Cigna Commercial |
$2,944.42
|
| Rate for Payer: First Health Commercial |
$3,370.12
|
| Rate for Payer: Humana Commercial |
$3,015.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,908.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,618.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,064.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,121.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,660.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$709.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,099.72
|
| Rate for Payer: PHCS Commercial |
$3,405.60
|
| Rate for Payer: United Healthcare All Payer |
$3,121.80
|
|
|
GRAFT BONE BIORESORABLE 2.5CC
|
Facility
|
OP
|
$3,547.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$461.18 |
| Max. Negotiated Rate |
$3,405.60 |
| Rate for Payer: Aetna Commercial |
$2,731.58
|
| Rate for Payer: Anthem Medicaid |
$1,219.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,767.05
|
| Rate for Payer: Cash Price |
$1,773.75
|
| Rate for Payer: Cigna Commercial |
$2,944.42
|
| Rate for Payer: First Health Commercial |
$3,370.12
|
| Rate for Payer: Humana Commercial |
$3,015.38
|
| Rate for Payer: Humana KY Medicaid |
$1,219.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,232.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,908.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,618.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,064.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,244.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,121.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,660.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$709.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,099.72
|
| Rate for Payer: PHCS Commercial |
$3,405.60
|
| Rate for Payer: United Healthcare All Payer |
$3,121.80
|
|
|
GRAFT BONE BIORESORABLE 5CC
|
Facility
|
IP
|
$4,545.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.85 |
| Max. Negotiated Rate |
$4,363.20 |
| Rate for Payer: Aetna Commercial |
$3,499.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,545.10
|
| Rate for Payer: Cash Price |
$2,272.50
|
| Rate for Payer: Cigna Commercial |
$3,772.35
|
| Rate for Payer: First Health Commercial |
$4,317.75
|
| Rate for Payer: Humana Commercial |
$3,863.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,726.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,354.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,363.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,999.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,408.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$909.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$590.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.95
|
| Rate for Payer: PHCS Commercial |
$4,363.20
|
| Rate for Payer: United Healthcare All Payer |
$3,999.60
|
|
|
GRAFT BONE BIORESORABLE 5CC
|
Facility
|
OP
|
$4,545.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.85 |
| Max. Negotiated Rate |
$4,363.20 |
| Rate for Payer: Aetna Commercial |
$3,499.65
|
| Rate for Payer: Anthem Medicaid |
$1,563.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,545.10
|
| Rate for Payer: Cash Price |
$2,272.50
|
| Rate for Payer: Cigna Commercial |
$3,772.35
|
| Rate for Payer: First Health Commercial |
$4,317.75
|
| Rate for Payer: Humana Commercial |
$3,863.25
|
| Rate for Payer: Humana KY Medicaid |
$1,563.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,578.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,726.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,354.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,363.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,594.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,999.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,408.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$909.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$590.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.95
|
| Rate for Payer: PHCS Commercial |
$4,363.20
|
| Rate for Payer: United Healthcare All Payer |
$3,999.60
|
|
|
GRAFT CARBOFLO STR 6*40
|
Facility
|
IP
|
$4,160.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.80 |
| Max. Negotiated Rate |
$3,993.60 |
| Rate for Payer: Aetna Commercial |
$3,203.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,244.80
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Cigna Commercial |
$3,452.80
|
| Rate for Payer: First Health Commercial |
$3,952.00
|
| Rate for Payer: Humana Commercial |
$3,536.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,411.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,070.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,248.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,660.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.60
|
| Rate for Payer: PHCS Commercial |
$3,993.60
|
| Rate for Payer: United Healthcare All Payer |
$3,660.80
|
|
|
GRAFT CARBOFLO STR 6*40
|
Facility
|
OP
|
$4,160.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.80 |
| Max. Negotiated Rate |
$3,993.60 |
| Rate for Payer: Aetna Commercial |
$3,203.20
|
| Rate for Payer: Anthem Medicaid |
$1,430.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,244.80
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Cigna Commercial |
$3,452.80
|
| Rate for Payer: First Health Commercial |
$3,952.00
|
| Rate for Payer: Humana Commercial |
$3,536.00
|
| Rate for Payer: Humana KY Medicaid |
$1,430.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,445.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,411.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,070.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,248.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,459.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,660.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.60
|
| Rate for Payer: PHCS Commercial |
$3,993.60
|
| Rate for Payer: United Healthcare All Payer |
$3,660.80
|
|
|
GRAFT DIASTAT 6MM*40CM*25CM
|
Facility
|
IP
|
$5,395.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$701.42 |
| Max. Negotiated Rate |
$5,179.68 |
| Rate for Payer: Aetna Commercial |
$4,154.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,208.49
|
| Rate for Payer: Cash Price |
$2,697.75
|
| Rate for Payer: Cigna Commercial |
$4,478.26
|
| Rate for Payer: First Health Commercial |
$5,125.72
|
| Rate for Payer: Humana Commercial |
$4,586.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,424.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,981.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,618.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,748.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,046.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,672.60
|
| Rate for Payer: PHCS Commercial |
$5,179.68
|
| Rate for Payer: United Healthcare All Payer |
$4,748.04
|
|
|
GRAFT DIASTAT 6MM*40CM*25CM
|
Facility
|
OP
|
$5,395.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$701.42 |
| Max. Negotiated Rate |
$5,179.68 |
| Rate for Payer: Aetna Commercial |
$4,154.54
|
| Rate for Payer: Anthem Medicaid |
$1,855.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,208.49
|
| Rate for Payer: Cash Price |
$2,697.75
|
| Rate for Payer: Cigna Commercial |
$4,478.26
|
| Rate for Payer: First Health Commercial |
$5,125.72
|
| Rate for Payer: Humana Commercial |
$4,586.18
|
| Rate for Payer: Humana KY Medicaid |
$1,855.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,874.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,424.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,981.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,618.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,892.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,748.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,046.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,672.60
|
| Rate for Payer: PHCS Commercial |
$5,179.68
|
| Rate for Payer: United Healthcare All Payer |
$4,748.04
|
|
|
GRAFT DISTAFLO BYPASS FLEX SM
|
Facility
|
IP
|
$9,917.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
|
GRAFT DISTAFLO BYPASS FLEX SM
|
Facility
|
OP
|
$9,917.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem Medicaid |
$3,410.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Humana KY Medicaid |
$3,410.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,479.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
|
GRAFT ENDURANT BIFUR 28*14*103
|
Facility
|
OP
|
$41,208.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,357.14 |
| Max. Negotiated Rate |
$39,560.40 |
| Rate for Payer: Aetna Commercial |
$31,730.74
|
| Rate for Payer: Anthem Medicaid |
$14,171.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,142.82
|
| Rate for Payer: Cash Price |
$20,604.38
|
| Rate for Payer: Cigna Commercial |
$34,203.26
|
| Rate for Payer: First Health Commercial |
$39,148.31
|
| Rate for Payer: Humana Commercial |
$35,027.44
|
| Rate for Payer: Humana KY Medicaid |
$14,171.69
|
| Rate for Payer: Kentucky WC Medicaid |
$14,315.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,791.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,412.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,362.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,456.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,263.70
|
| Rate for Payer: Ohio Health Group HMO |
$30,906.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,241.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,357.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,774.71
|
| Rate for Payer: PHCS Commercial |
$39,560.40
|
| Rate for Payer: United Healthcare All Payer |
$36,263.70
|
|
|
GRAFT ENDURANT BIFUR 28*14*103
|
Facility
|
IP
|
$41,208.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,357.14 |
| Max. Negotiated Rate |
$39,560.40 |
| Rate for Payer: Aetna Commercial |
$31,730.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,142.82
|
| Rate for Payer: Cash Price |
$20,604.38
|
| Rate for Payer: Cigna Commercial |
$34,203.26
|
| Rate for Payer: First Health Commercial |
$39,148.31
|
| Rate for Payer: Humana Commercial |
$35,027.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,791.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,412.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,362.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,263.70
|
| Rate for Payer: Ohio Health Group HMO |
$30,906.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,241.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,357.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,774.71
|
| Rate for Payer: PHCS Commercial |
$39,560.40
|
| Rate for Payer: United Healthcare All Payer |
$36,263.70
|
|
|
GRAFT EPIFIX 18MM DISK
|
Facility
|
IP
|
$4,597.50
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
27000054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$597.68 |
| Max. Negotiated Rate |
$4,413.60 |
| Rate for Payer: Aetna Commercial |
$3,540.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,586.05
|
| Rate for Payer: Cash Price |
$2,298.75
|
| Rate for Payer: Cigna Commercial |
$3,815.92
|
| Rate for Payer: First Health Commercial |
$4,367.62
|
| Rate for Payer: Humana Commercial |
$3,907.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,769.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,392.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,379.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,045.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,448.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$919.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$597.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,425.22
|
| Rate for Payer: PHCS Commercial |
$4,413.60
|
| Rate for Payer: United Healthcare All Payer |
$4,045.80
|
|
|
GRAFT EPIFIX 18MM DISK
|
Facility
|
OP
|
$4,597.50
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
27000054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$597.68 |
| Max. Negotiated Rate |
$4,413.60 |
| Rate for Payer: Aetna Commercial |
$3,540.08
|
| Rate for Payer: Anthem Medicaid |
$1,581.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,586.05
|
| Rate for Payer: Cash Price |
$2,298.75
|
| Rate for Payer: Cigna Commercial |
$3,815.92
|
| Rate for Payer: First Health Commercial |
$4,367.62
|
| Rate for Payer: Humana Commercial |
$3,907.88
|
| Rate for Payer: Humana KY Medicaid |
$1,581.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,597.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,769.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,392.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,379.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,612.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,045.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,448.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$919.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$597.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,425.22
|
| Rate for Payer: PHCS Commercial |
$4,413.60
|
| Rate for Payer: United Healthcare All Payer |
$4,045.80
|
|
|
GRAFT EPIFIX 2*3CM
|
Facility
|
OP
|
$6,975.60
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
27000054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$906.83 |
| Max. Negotiated Rate |
$6,696.58 |
| Rate for Payer: Aetna Commercial |
$5,371.21
|
| Rate for Payer: Anthem Medicaid |
$2,398.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,440.97
|
| Rate for Payer: Cash Price |
$3,487.80
|
| Rate for Payer: Cigna Commercial |
$5,789.75
|
| Rate for Payer: First Health Commercial |
$6,626.82
|
| Rate for Payer: Humana Commercial |
$5,929.26
|
| Rate for Payer: Humana KY Medicaid |
$2,398.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,423.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,719.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,147.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,092.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,447.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,138.53
|
| Rate for Payer: Ohio Health Group HMO |
$5,231.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,395.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,162.44
|
| Rate for Payer: PHCS Commercial |
$6,696.58
|
| Rate for Payer: United Healthcare All Payer |
$6,138.53
|
|
|
GRAFT EPIFIX 2*3CM
|
Facility
|
IP
|
$6,975.60
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
27000054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$906.83 |
| Max. Negotiated Rate |
$6,696.58 |
| Rate for Payer: Aetna Commercial |
$5,371.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,440.97
|
| Rate for Payer: Cash Price |
$3,487.80
|
| Rate for Payer: Cigna Commercial |
$5,789.75
|
| Rate for Payer: First Health Commercial |
$6,626.82
|
| Rate for Payer: Humana Commercial |
$5,929.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,719.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,147.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,092.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,138.53
|
| Rate for Payer: Ohio Health Group HMO |
$5,231.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,395.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,162.44
|
| Rate for Payer: PHCS Commercial |
$6,696.58
|
| Rate for Payer: United Healthcare All Payer |
$6,138.53
|
|
|
GRAFT EXCLDR CNTRA16*14.5*10 1
|
Facility
|
IP
|
$23,707.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,081.91 |
| Max. Negotiated Rate |
$22,758.72 |
| Rate for Payer: Aetna Commercial |
$18,254.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,491.46
|
| Rate for Payer: Cash Price |
$11,853.50
|
| Rate for Payer: Cigna Commercial |
$19,676.81
|
| Rate for Payer: First Health Commercial |
$22,521.65
|
| Rate for Payer: Humana Commercial |
$20,150.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,439.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,495.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,112.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$17,780.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,741.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,081.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,349.17
|
| Rate for Payer: PHCS Commercial |
$22,758.72
|
| Rate for Payer: United Healthcare All Payer |
$20,862.16
|
|
|
GRAFT EXCLDR CNTRA16*14.5*10 1
|
Facility
|
OP
|
$23,707.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,081.91 |
| Max. Negotiated Rate |
$22,758.72 |
| Rate for Payer: Aetna Commercial |
$18,254.39
|
| Rate for Payer: Anthem Medicaid |
$8,152.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,491.46
|
| Rate for Payer: Cash Price |
$11,853.50
|
| Rate for Payer: Cigna Commercial |
$19,676.81
|
| Rate for Payer: First Health Commercial |
$22,521.65
|
| Rate for Payer: Humana Commercial |
$20,150.95
|
| Rate for Payer: Humana KY Medicaid |
$8,152.84
|
| Rate for Payer: Kentucky WC Medicaid |
$8,235.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,439.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,495.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,112.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,316.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$17,780.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,741.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,081.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,349.17
|
| Rate for Payer: PHCS Commercial |
$22,758.72
|
| Rate for Payer: United Healthcare All Payer |
$20,862.16
|
|
