|
GRAFT FLIXENE 8MM*40CM
|
Facility
|
IP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
GRAFT FLIXENE 8MM*50CM
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
GRAFT FLIXENE 8MM*50CM
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem Medicaid |
$2,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Humana KY Medicaid |
$2,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
GRAFT FUSION BIOLINE CTD 6M*60
|
Facility
|
IP
|
$8,056.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.28 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.36
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
|
GRAFT FUSION BIOLINE CTD 6M*60
|
Facility
|
OP
|
$8,056.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.28 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem Medicaid |
$2,770.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Humana KY Medicaid |
$2,770.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,798.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,826.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.36
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
|
GRAFT GORE HYBRID 7-5CM*6*40
|
Facility
|
IP
|
$12,242.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.52 |
| Max. Negotiated Rate |
$11,752.80 |
| Rate for Payer: Aetna Commercial |
$9,426.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,549.15
|
| Rate for Payer: Cash Price |
$6,121.25
|
| Rate for Payer: Cigna Commercial |
$10,161.28
|
| Rate for Payer: First Health Commercial |
$11,630.38
|
| Rate for Payer: Humana Commercial |
$10,406.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,038.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,034.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,672.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,773.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,448.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.18
|
| Rate for Payer: PHCS Commercial |
$11,752.80
|
| Rate for Payer: United Healthcare All Payer |
$10,773.40
|
|
|
GRAFT GORE HYBRID 7-5CM*6*40
|
Facility
|
OP
|
$12,242.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.52 |
| Max. Negotiated Rate |
$11,752.80 |
| Rate for Payer: Aetna Commercial |
$9,426.72
|
| Rate for Payer: Anthem Medicaid |
$4,210.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,549.15
|
| Rate for Payer: Cash Price |
$6,121.25
|
| Rate for Payer: Cigna Commercial |
$10,161.28
|
| Rate for Payer: First Health Commercial |
$11,630.38
|
| Rate for Payer: Humana Commercial |
$10,406.12
|
| Rate for Payer: Humana KY Medicaid |
$4,210.20
|
| Rate for Payer: Kentucky WC Medicaid |
$4,253.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,038.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,034.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,672.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,773.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,448.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.18
|
| Rate for Payer: PHCS Commercial |
$11,752.80
|
| Rate for Payer: United Healthcare All Payer |
$10,773.40
|
|
|
GRAFT HEMA 1 BRANCH PLAT 22*50
|
Facility
|
IP
|
$5,397.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$701.66 |
| Max. Negotiated Rate |
$5,181.49 |
| Rate for Payer: Aetna Commercial |
$4,155.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,209.96
|
| Rate for Payer: Cash Price |
$2,698.70
|
| Rate for Payer: Cigna Commercial |
$4,479.83
|
| Rate for Payer: First Health Commercial |
$5,127.52
|
| Rate for Payer: Humana Commercial |
$4,587.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,425.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,983.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,749.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,048.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,673.19
|
| Rate for Payer: PHCS Commercial |
$5,181.49
|
| Rate for Payer: United Healthcare All Payer |
$4,749.70
|
|
|
GRAFT HEMA 1 BRANCH PLAT 22*50
|
Facility
|
OP
|
$5,397.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$701.66 |
| Max. Negotiated Rate |
$5,181.49 |
| Rate for Payer: Aetna Commercial |
$4,155.99
|
| Rate for Payer: Anthem Medicaid |
$1,856.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,209.96
|
| Rate for Payer: Cash Price |
$2,698.70
|
| Rate for Payer: Cigna Commercial |
$4,479.83
|
| Rate for Payer: First Health Commercial |
$5,127.52
|
| Rate for Payer: Humana Commercial |
$4,587.78
|
| Rate for Payer: Humana KY Medicaid |
$1,856.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,875.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,425.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,983.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,893.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,749.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,048.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,673.19
|
| Rate for Payer: PHCS Commercial |
$5,181.49
|
| Rate for Payer: United Healthcare All Payer |
$4,749.70
|
|
|
GRAFT HEMA 1 BRANCH PLAT 24*50
|
Facility
|
OP
|
$5,397.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$701.66 |
| Max. Negotiated Rate |
$5,181.49 |
| Rate for Payer: Aetna Commercial |
$4,155.99
|
| Rate for Payer: Anthem Medicaid |
$1,856.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,209.96
|
| Rate for Payer: Cash Price |
$2,698.70
|
| Rate for Payer: Cigna Commercial |
$4,479.83
|
| Rate for Payer: First Health Commercial |
$5,127.52
|
| Rate for Payer: Humana Commercial |
$4,587.78
|
| Rate for Payer: Humana KY Medicaid |
$1,856.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,875.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,425.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,983.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,893.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,749.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,048.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,673.19
|
| Rate for Payer: PHCS Commercial |
$5,181.49
|
| Rate for Payer: United Healthcare All Payer |
$4,749.70
|
|
|
GRAFT HEMA 1 BRANCH PLAT 24*50
|
Facility
|
IP
|
$5,397.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$701.66 |
| Max. Negotiated Rate |
$5,181.49 |
| Rate for Payer: Aetna Commercial |
$4,155.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,209.96
|
| Rate for Payer: Cash Price |
$2,698.70
|
| Rate for Payer: Cigna Commercial |
$4,479.83
|
| Rate for Payer: First Health Commercial |
$5,127.52
|
| Rate for Payer: Humana Commercial |
$4,587.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,425.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,983.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,749.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,048.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,673.19
|
| Rate for Payer: PHCS Commercial |
$5,181.49
|
| Rate for Payer: United Healthcare All Payer |
$4,749.70
|
|
|
GRAFT HEMA 1 BRANCH PLAT 26*50
|
Facility
|
OP
|
$5,397.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$701.66 |
| Max. Negotiated Rate |
$5,181.49 |
| Rate for Payer: Aetna Commercial |
$4,155.99
|
| Rate for Payer: Anthem Medicaid |
$1,856.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,209.96
|
| Rate for Payer: Cash Price |
$2,698.70
|
| Rate for Payer: Cigna Commercial |
$4,479.83
|
| Rate for Payer: First Health Commercial |
$5,127.52
|
| Rate for Payer: Humana Commercial |
$4,587.78
|
| Rate for Payer: Humana KY Medicaid |
$1,856.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,875.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,425.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,983.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,893.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,749.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,048.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,673.19
|
| Rate for Payer: PHCS Commercial |
$5,181.49
|
| Rate for Payer: United Healthcare All Payer |
$4,749.70
|
|
|
GRAFT HEMA 1 BRANCH PLAT 26*50
|
Facility
|
IP
|
$5,397.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$701.66 |
| Max. Negotiated Rate |
$5,181.49 |
| Rate for Payer: Aetna Commercial |
$4,155.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,209.96
|
| Rate for Payer: Cash Price |
$2,698.70
|
| Rate for Payer: Cigna Commercial |
$4,479.83
|
| Rate for Payer: First Health Commercial |
$5,127.52
|
| Rate for Payer: Humana Commercial |
$4,587.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,425.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,983.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,749.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,048.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,673.19
|
| Rate for Payer: PHCS Commercial |
$5,181.49
|
| Rate for Payer: United Healthcare All Payer |
$4,749.70
|
|
|
GRAFT HEMA 1 BRANCH PLAT 28*50
|
Facility
|
IP
|
$5,397.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$701.66 |
| Max. Negotiated Rate |
$5,181.49 |
| Rate for Payer: Aetna Commercial |
$4,155.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,209.96
|
| Rate for Payer: Cash Price |
$2,698.70
|
| Rate for Payer: Cigna Commercial |
$4,479.83
|
| Rate for Payer: First Health Commercial |
$5,127.52
|
| Rate for Payer: Humana Commercial |
$4,587.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,425.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,983.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,749.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,048.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,673.19
|
| Rate for Payer: PHCS Commercial |
$5,181.49
|
| Rate for Payer: United Healthcare All Payer |
$4,749.70
|
|
|
GRAFT HEMA 1 BRANCH PLAT 28*50
|
Facility
|
OP
|
$5,397.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$701.66 |
| Max. Negotiated Rate |
$5,181.49 |
| Rate for Payer: Aetna Commercial |
$4,155.99
|
| Rate for Payer: Anthem Medicaid |
$1,856.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,209.96
|
| Rate for Payer: Cash Price |
$2,698.70
|
| Rate for Payer: Cigna Commercial |
$4,479.83
|
| Rate for Payer: First Health Commercial |
$5,127.52
|
| Rate for Payer: Humana Commercial |
$4,587.78
|
| Rate for Payer: Humana KY Medicaid |
$1,856.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,875.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,425.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,983.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,893.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,749.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,048.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,673.19
|
| Rate for Payer: PHCS Commercial |
$5,181.49
|
| Rate for Payer: United Healthcare All Payer |
$4,749.70
|
|
|
GRAFT HEMA 1 BRANCH PLAT 30*50
|
Facility
|
IP
|
$5,397.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$701.66 |
| Max. Negotiated Rate |
$5,181.49 |
| Rate for Payer: Aetna Commercial |
$4,155.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,209.96
|
| Rate for Payer: Cash Price |
$2,698.70
|
| Rate for Payer: Cigna Commercial |
$4,479.83
|
| Rate for Payer: First Health Commercial |
$5,127.52
|
| Rate for Payer: Humana Commercial |
$4,587.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,425.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,983.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,749.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,048.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,673.19
|
| Rate for Payer: PHCS Commercial |
$5,181.49
|
| Rate for Payer: United Healthcare All Payer |
$4,749.70
|
|
|
GRAFT HEMA 1 BRANCH PLAT 30*50
|
Facility
|
OP
|
$5,397.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$701.66 |
| Max. Negotiated Rate |
$5,181.49 |
| Rate for Payer: Aetna Commercial |
$4,155.99
|
| Rate for Payer: Anthem Medicaid |
$1,856.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,209.96
|
| Rate for Payer: Cash Price |
$2,698.70
|
| Rate for Payer: Cigna Commercial |
$4,479.83
|
| Rate for Payer: First Health Commercial |
$5,127.52
|
| Rate for Payer: Humana Commercial |
$4,587.78
|
| Rate for Payer: Humana KY Medicaid |
$1,856.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,875.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,425.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,983.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,893.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,749.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,048.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,673.19
|
| Rate for Payer: PHCS Commercial |
$5,181.49
|
| Rate for Payer: United Healthcare All Payer |
$4,749.70
|
|
|
GRAFT HEMA 4 BRANCH 22M PLAT
|
Facility
|
OP
|
$6,698.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.84 |
| Max. Negotiated Rate |
$6,430.83 |
| Rate for Payer: Aetna Commercial |
$5,158.06
|
| Rate for Payer: Anthem Medicaid |
$2,303.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,225.05
|
| Rate for Payer: Cash Price |
$3,349.39
|
| Rate for Payer: Cigna Commercial |
$5,559.99
|
| Rate for Payer: First Health Commercial |
$6,363.84
|
| Rate for Payer: Humana Commercial |
$5,693.96
|
| Rate for Payer: Humana KY Medicaid |
$2,303.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,327.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,493.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,943.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,009.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,349.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,894.93
|
| Rate for Payer: Ohio Health Group HMO |
$5,024.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,339.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,076.62
|
| Rate for Payer: PHCS Commercial |
$6,430.83
|
| Rate for Payer: United Healthcare All Payer |
$5,894.93
|
|
|
GRAFT HEMA 4 BRANCH 22M PLAT
|
Facility
|
IP
|
$6,698.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.84 |
| Max. Negotiated Rate |
$6,430.83 |
| Rate for Payer: Aetna Commercial |
$5,158.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,225.05
|
| Rate for Payer: Cash Price |
$3,349.39
|
| Rate for Payer: Cigna Commercial |
$5,559.99
|
| Rate for Payer: First Health Commercial |
$6,363.84
|
| Rate for Payer: Humana Commercial |
$5,693.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,493.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,943.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,009.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,894.93
|
| Rate for Payer: Ohio Health Group HMO |
$5,024.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,339.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,076.62
|
| Rate for Payer: PHCS Commercial |
$6,430.83
|
| Rate for Payer: United Healthcare All Payer |
$5,894.93
|
|
|
GRAFT HEMA 4 BRANCH 24M PLAT
|
Facility
|
OP
|
$6,698.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.84 |
| Max. Negotiated Rate |
$6,430.83 |
| Rate for Payer: Aetna Commercial |
$5,158.06
|
| Rate for Payer: Anthem Medicaid |
$2,303.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,225.05
|
| Rate for Payer: Cash Price |
$3,349.39
|
| Rate for Payer: Cigna Commercial |
$5,559.99
|
| Rate for Payer: First Health Commercial |
$6,363.84
|
| Rate for Payer: Humana Commercial |
$5,693.96
|
| Rate for Payer: Humana KY Medicaid |
$2,303.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,327.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,493.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,943.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,009.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,349.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,894.93
|
| Rate for Payer: Ohio Health Group HMO |
$5,024.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,339.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,076.62
|
| Rate for Payer: PHCS Commercial |
$6,430.83
|
| Rate for Payer: United Healthcare All Payer |
$5,894.93
|
|
|
GRAFT HEMA 4 BRANCH 24M PLAT
|
Facility
|
IP
|
$6,698.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.84 |
| Max. Negotiated Rate |
$6,430.83 |
| Rate for Payer: Aetna Commercial |
$5,158.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,225.05
|
| Rate for Payer: Cash Price |
$3,349.39
|
| Rate for Payer: Cigna Commercial |
$5,559.99
|
| Rate for Payer: First Health Commercial |
$6,363.84
|
| Rate for Payer: Humana Commercial |
$5,693.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,493.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,943.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,009.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,894.93
|
| Rate for Payer: Ohio Health Group HMO |
$5,024.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,339.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,076.62
|
| Rate for Payer: PHCS Commercial |
$6,430.83
|
| Rate for Payer: United Healthcare All Payer |
$5,894.93
|
|
|
GRAFT HEMA 4 BRANCH 26M PLAT
|
Facility
|
IP
|
$6,698.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.85 |
| Max. Negotiated Rate |
$6,430.91 |
| Rate for Payer: Aetna Commercial |
$5,158.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,225.11
|
| Rate for Payer: Cash Price |
$3,349.43
|
| Rate for Payer: Cigna Commercial |
$5,560.05
|
| Rate for Payer: First Health Commercial |
$6,363.92
|
| Rate for Payer: Humana Commercial |
$5,694.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,493.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,943.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,009.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,024.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,339.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,076.65
|
| Rate for Payer: PHCS Commercial |
$6,430.91
|
| Rate for Payer: United Healthcare All Payer |
$5,895.00
|
|
|
GRAFT HEMA 4 BRANCH 26M PLAT
|
Facility
|
OP
|
$6,698.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.85 |
| Max. Negotiated Rate |
$6,430.91 |
| Rate for Payer: Aetna Commercial |
$5,158.12
|
| Rate for Payer: Anthem Medicaid |
$2,303.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,225.11
|
| Rate for Payer: Cash Price |
$3,349.43
|
| Rate for Payer: Cigna Commercial |
$5,560.05
|
| Rate for Payer: First Health Commercial |
$6,363.92
|
| Rate for Payer: Humana Commercial |
$5,694.03
|
| Rate for Payer: Humana KY Medicaid |
$2,303.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,327.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,493.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,943.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,009.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,349.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,024.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,339.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,076.65
|
| Rate for Payer: PHCS Commercial |
$6,430.91
|
| Rate for Payer: United Healthcare All Payer |
$5,895.00
|
|
|
GRAFT HEMA 4 BRANCH 28M PLAT
|
Facility
|
IP
|
$6,698.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.84 |
| Max. Negotiated Rate |
$6,430.83 |
| Rate for Payer: Aetna Commercial |
$5,158.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,225.05
|
| Rate for Payer: Cash Price |
$3,349.39
|
| Rate for Payer: Cigna Commercial |
$5,559.99
|
| Rate for Payer: First Health Commercial |
$6,363.84
|
| Rate for Payer: Humana Commercial |
$5,693.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,493.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,943.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,009.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,894.93
|
| Rate for Payer: Ohio Health Group HMO |
$5,024.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,339.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,076.62
|
| Rate for Payer: PHCS Commercial |
$6,430.83
|
| Rate for Payer: United Healthcare All Payer |
$5,894.93
|
|
|
GRAFT HEMA 4 BRANCH 28M PLAT
|
Facility
|
OP
|
$6,698.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.84 |
| Max. Negotiated Rate |
$6,430.83 |
| Rate for Payer: Aetna Commercial |
$5,158.06
|
| Rate for Payer: Anthem Medicaid |
$2,303.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,225.05
|
| Rate for Payer: Cash Price |
$3,349.39
|
| Rate for Payer: Cigna Commercial |
$5,559.99
|
| Rate for Payer: First Health Commercial |
$6,363.84
|
| Rate for Payer: Humana Commercial |
$5,693.96
|
| Rate for Payer: Humana KY Medicaid |
$2,303.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,327.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,493.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,943.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,009.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,349.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,894.93
|
| Rate for Payer: Ohio Health Group HMO |
$5,024.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,339.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,076.62
|
| Rate for Payer: PHCS Commercial |
$6,430.83
|
| Rate for Payer: United Healthcare All Payer |
$5,894.93
|
|
