|
GRAFT INTUITRAK BI 22-16-100BL
|
Facility
|
IP
|
$68,362.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,887.06 |
| Max. Negotiated Rate |
$65,627.52 |
| Rate for Payer: Aetna Commercial |
$52,638.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,322.36
|
| Rate for Payer: Cash Price |
$34,181.00
|
| Rate for Payer: Cigna Commercial |
$56,740.46
|
| Rate for Payer: First Health Commercial |
$64,943.90
|
| Rate for Payer: Humana Commercial |
$58,107.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,056.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,451.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,508.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,158.56
|
| Rate for Payer: Ohio Health Group HMO |
$51,271.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,672.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,887.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,192.22
|
| Rate for Payer: PHCS Commercial |
$65,627.52
|
| Rate for Payer: United Healthcare All Payer |
$60,158.56
|
|
|
GRAFT INTUITRAK BI 22-16-100BL
|
Facility
|
OP
|
$68,362.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,887.06 |
| Max. Negotiated Rate |
$65,627.52 |
| Rate for Payer: Aetna Commercial |
$52,638.74
|
| Rate for Payer: Anthem Medicaid |
$23,509.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,322.36
|
| Rate for Payer: Cash Price |
$34,181.00
|
| Rate for Payer: Cigna Commercial |
$56,740.46
|
| Rate for Payer: First Health Commercial |
$64,943.90
|
| Rate for Payer: Humana Commercial |
$58,107.70
|
| Rate for Payer: Humana KY Medicaid |
$23,509.69
|
| Rate for Payer: Kentucky WC Medicaid |
$23,748.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,056.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,451.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,508.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,981.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,158.56
|
| Rate for Payer: Ohio Health Group HMO |
$51,271.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,672.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,887.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,192.22
|
| Rate for Payer: PHCS Commercial |
$65,627.52
|
| Rate for Payer: United Healthcare All Payer |
$60,158.56
|
|
|
GRAFT INTUITRAK BI 22-16-120BL
|
Facility
|
IP
|
$66,562.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,653.06 |
| Max. Negotiated Rate |
$63,899.52 |
| Rate for Payer: Aetna Commercial |
$51,252.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51,918.36
|
| Rate for Payer: Cash Price |
$33,281.00
|
| Rate for Payer: Cigna Commercial |
$55,246.46
|
| Rate for Payer: First Health Commercial |
$63,233.90
|
| Rate for Payer: Humana Commercial |
$56,577.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54,580.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49,122.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,968.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$58,574.56
|
| Rate for Payer: Ohio Health Group HMO |
$49,921.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,312.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,653.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,634.22
|
| Rate for Payer: PHCS Commercial |
$63,899.52
|
| Rate for Payer: United Healthcare All Payer |
$58,574.56
|
|
|
GRAFT INTUITRAK BI 22-16-120BL
|
Facility
|
OP
|
$66,562.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,653.06 |
| Max. Negotiated Rate |
$63,899.52 |
| Rate for Payer: Aetna Commercial |
$51,252.74
|
| Rate for Payer: Anthem Medicaid |
$22,890.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51,918.36
|
| Rate for Payer: Cash Price |
$33,281.00
|
| Rate for Payer: Cigna Commercial |
$55,246.46
|
| Rate for Payer: First Health Commercial |
$63,233.90
|
| Rate for Payer: Humana Commercial |
$56,577.70
|
| Rate for Payer: Humana KY Medicaid |
$22,890.67
|
| Rate for Payer: Kentucky WC Medicaid |
$23,123.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54,580.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49,122.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,968.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,349.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$58,574.56
|
| Rate for Payer: Ohio Health Group HMO |
$49,921.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,312.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,653.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,634.22
|
| Rate for Payer: PHCS Commercial |
$63,899.52
|
| Rate for Payer: United Healthcare All Payer |
$58,574.56
|
|
|
GRAFT INTUITRAK BI 25-13-100BL
|
Facility
|
OP
|
$70,162.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,121.06 |
| Max. Negotiated Rate |
$67,355.52 |
| Rate for Payer: Aetna Commercial |
$54,024.74
|
| Rate for Payer: Anthem Medicaid |
$24,128.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,726.36
|
| Rate for Payer: Cash Price |
$35,081.00
|
| Rate for Payer: Cigna Commercial |
$58,234.46
|
| Rate for Payer: First Health Commercial |
$66,653.90
|
| Rate for Payer: Humana Commercial |
$59,637.70
|
| Rate for Payer: Humana KY Medicaid |
$24,128.71
|
| Rate for Payer: Kentucky WC Medicaid |
$24,374.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,532.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,779.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,048.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,612.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,742.56
|
| Rate for Payer: Ohio Health Group HMO |
$52,621.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,032.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,121.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,750.22
|
| Rate for Payer: PHCS Commercial |
$67,355.52
|
| Rate for Payer: United Healthcare All Payer |
$61,742.56
|
|
|
GRAFT INTUITRAK BI 25-13-100BL
|
Facility
|
IP
|
$70,162.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,121.06 |
| Max. Negotiated Rate |
$67,355.52 |
| Rate for Payer: Aetna Commercial |
$54,024.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,726.36
|
| Rate for Payer: Cash Price |
$35,081.00
|
| Rate for Payer: Cigna Commercial |
$58,234.46
|
| Rate for Payer: First Health Commercial |
$66,653.90
|
| Rate for Payer: Humana Commercial |
$59,637.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,532.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,779.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,048.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,742.56
|
| Rate for Payer: Ohio Health Group HMO |
$52,621.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,032.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,121.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,750.22
|
| Rate for Payer: PHCS Commercial |
$67,355.52
|
| Rate for Payer: United Healthcare All Payer |
$61,742.56
|
|
|
GRAFT INTUITRAK BI 25-13-120BL
|
Facility
|
OP
|
$68,362.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,887.06 |
| Max. Negotiated Rate |
$65,627.52 |
| Rate for Payer: Aetna Commercial |
$52,638.74
|
| Rate for Payer: Anthem Medicaid |
$23,509.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,322.36
|
| Rate for Payer: Cash Price |
$34,181.00
|
| Rate for Payer: Cigna Commercial |
$56,740.46
|
| Rate for Payer: First Health Commercial |
$64,943.90
|
| Rate for Payer: Humana Commercial |
$58,107.70
|
| Rate for Payer: Humana KY Medicaid |
$23,509.69
|
| Rate for Payer: Kentucky WC Medicaid |
$23,748.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,056.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,451.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,508.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,981.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,158.56
|
| Rate for Payer: Ohio Health Group HMO |
$51,271.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,672.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,887.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,192.22
|
| Rate for Payer: PHCS Commercial |
$65,627.52
|
| Rate for Payer: United Healthcare All Payer |
$60,158.56
|
|
|
GRAFT INTUITRAK BI 25-13-120BL
|
Facility
|
IP
|
$68,362.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,887.06 |
| Max. Negotiated Rate |
$65,627.52 |
| Rate for Payer: Aetna Commercial |
$52,638.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,322.36
|
| Rate for Payer: Cash Price |
$34,181.00
|
| Rate for Payer: Cigna Commercial |
$56,740.46
|
| Rate for Payer: First Health Commercial |
$64,943.90
|
| Rate for Payer: Humana Commercial |
$58,107.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,056.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,451.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,508.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,158.56
|
| Rate for Payer: Ohio Health Group HMO |
$51,271.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,672.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,887.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,192.22
|
| Rate for Payer: PHCS Commercial |
$65,627.52
|
| Rate for Payer: United Healthcare All Payer |
$60,158.56
|
|
|
GRAFT INTUITRAK BI 25-16-100BL
|
Facility
|
OP
|
$68,362.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,887.06 |
| Max. Negotiated Rate |
$65,627.52 |
| Rate for Payer: Aetna Commercial |
$52,638.74
|
| Rate for Payer: Anthem Medicaid |
$23,509.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,322.36
|
| Rate for Payer: Cash Price |
$34,181.00
|
| Rate for Payer: Cigna Commercial |
$56,740.46
|
| Rate for Payer: First Health Commercial |
$64,943.90
|
| Rate for Payer: Humana Commercial |
$58,107.70
|
| Rate for Payer: Humana KY Medicaid |
$23,509.69
|
| Rate for Payer: Kentucky WC Medicaid |
$23,748.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,056.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,451.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,508.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,981.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,158.56
|
| Rate for Payer: Ohio Health Group HMO |
$51,271.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,672.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,887.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,192.22
|
| Rate for Payer: PHCS Commercial |
$65,627.52
|
| Rate for Payer: United Healthcare All Payer |
$60,158.56
|
|
|
GRAFT INTUITRAK BI 25-16-100BL
|
Facility
|
IP
|
$68,362.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,887.06 |
| Max. Negotiated Rate |
$65,627.52 |
| Rate for Payer: Aetna Commercial |
$52,638.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,322.36
|
| Rate for Payer: Cash Price |
$34,181.00
|
| Rate for Payer: Cigna Commercial |
$56,740.46
|
| Rate for Payer: First Health Commercial |
$64,943.90
|
| Rate for Payer: Humana Commercial |
$58,107.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,056.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,451.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,508.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,158.56
|
| Rate for Payer: Ohio Health Group HMO |
$51,271.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,672.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,887.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,192.22
|
| Rate for Payer: PHCS Commercial |
$65,627.52
|
| Rate for Payer: United Healthcare All Payer |
$60,158.56
|
|
|
GRAFT INTUITRAK BI 25-16-135BL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
GRAFT INTUITRAK BI 25-16-135BL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
GRAFT INTUITRAK BI 25-16-155BL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
GRAFT INTUITRAK BI 25-16-155BL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
GRAFT INTUITRAK BI 28-13-100BL
|
Facility
|
IP
|
$70,162.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,121.06 |
| Max. Negotiated Rate |
$67,355.52 |
| Rate for Payer: Aetna Commercial |
$54,024.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,726.36
|
| Rate for Payer: Cash Price |
$35,081.00
|
| Rate for Payer: Cigna Commercial |
$58,234.46
|
| Rate for Payer: First Health Commercial |
$66,653.90
|
| Rate for Payer: Humana Commercial |
$59,637.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,532.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,779.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,048.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,742.56
|
| Rate for Payer: Ohio Health Group HMO |
$52,621.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,032.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,121.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,750.22
|
| Rate for Payer: PHCS Commercial |
$67,355.52
|
| Rate for Payer: United Healthcare All Payer |
$61,742.56
|
|
|
GRAFT INTUITRAK BI 28-13-100BL
|
Facility
|
OP
|
$70,162.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,121.06 |
| Max. Negotiated Rate |
$67,355.52 |
| Rate for Payer: Aetna Commercial |
$54,024.74
|
| Rate for Payer: Anthem Medicaid |
$24,128.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,726.36
|
| Rate for Payer: Cash Price |
$35,081.00
|
| Rate for Payer: Cigna Commercial |
$58,234.46
|
| Rate for Payer: First Health Commercial |
$66,653.90
|
| Rate for Payer: Humana Commercial |
$59,637.70
|
| Rate for Payer: Humana KY Medicaid |
$24,128.71
|
| Rate for Payer: Kentucky WC Medicaid |
$24,374.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,532.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,779.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,048.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,612.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,742.56
|
| Rate for Payer: Ohio Health Group HMO |
$52,621.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,032.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,121.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,750.22
|
| Rate for Payer: PHCS Commercial |
$67,355.52
|
| Rate for Payer: United Healthcare All Payer |
$61,742.56
|
|
|
GRAFT INTUITRAK BI 28-13-120BL
|
Facility
|
OP
|
$70,162.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,121.06 |
| Max. Negotiated Rate |
$67,355.52 |
| Rate for Payer: Aetna Commercial |
$54,024.74
|
| Rate for Payer: Anthem Medicaid |
$24,128.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,726.36
|
| Rate for Payer: Cash Price |
$35,081.00
|
| Rate for Payer: Cigna Commercial |
$58,234.46
|
| Rate for Payer: First Health Commercial |
$66,653.90
|
| Rate for Payer: Humana Commercial |
$59,637.70
|
| Rate for Payer: Humana KY Medicaid |
$24,128.71
|
| Rate for Payer: Kentucky WC Medicaid |
$24,374.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,532.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,779.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,048.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,612.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,742.56
|
| Rate for Payer: Ohio Health Group HMO |
$52,621.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,032.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,121.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,750.22
|
| Rate for Payer: PHCS Commercial |
$67,355.52
|
| Rate for Payer: United Healthcare All Payer |
$61,742.56
|
|
|
GRAFT INTUITRAK BI 28-13-120BL
|
Facility
|
IP
|
$70,162.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,121.06 |
| Max. Negotiated Rate |
$67,355.52 |
| Rate for Payer: Aetna Commercial |
$54,024.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,726.36
|
| Rate for Payer: Cash Price |
$35,081.00
|
| Rate for Payer: Cigna Commercial |
$58,234.46
|
| Rate for Payer: First Health Commercial |
$66,653.90
|
| Rate for Payer: Humana Commercial |
$59,637.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,532.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,779.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,048.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,742.56
|
| Rate for Payer: Ohio Health Group HMO |
$52,621.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,032.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,121.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,750.22
|
| Rate for Payer: PHCS Commercial |
$67,355.52
|
| Rate for Payer: United Healthcare All Payer |
$61,742.56
|
|
|
GRAFT INTUITRAK BI 28-16-100BL
|
Facility
|
IP
|
$68,362.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,887.06 |
| Max. Negotiated Rate |
$65,627.52 |
| Rate for Payer: Aetna Commercial |
$52,638.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,322.36
|
| Rate for Payer: Cash Price |
$34,181.00
|
| Rate for Payer: Cigna Commercial |
$56,740.46
|
| Rate for Payer: First Health Commercial |
$64,943.90
|
| Rate for Payer: Humana Commercial |
$58,107.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,056.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,451.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,508.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,158.56
|
| Rate for Payer: Ohio Health Group HMO |
$51,271.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,672.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,887.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,192.22
|
| Rate for Payer: PHCS Commercial |
$65,627.52
|
| Rate for Payer: United Healthcare All Payer |
$60,158.56
|
|
|
GRAFT INTUITRAK BI 28-16-100BL
|
Facility
|
OP
|
$68,362.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,887.06 |
| Max. Negotiated Rate |
$65,627.52 |
| Rate for Payer: Aetna Commercial |
$52,638.74
|
| Rate for Payer: Anthem Medicaid |
$23,509.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,322.36
|
| Rate for Payer: Cash Price |
$34,181.00
|
| Rate for Payer: Cigna Commercial |
$56,740.46
|
| Rate for Payer: First Health Commercial |
$64,943.90
|
| Rate for Payer: Humana Commercial |
$58,107.70
|
| Rate for Payer: Humana KY Medicaid |
$23,509.69
|
| Rate for Payer: Kentucky WC Medicaid |
$23,748.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,056.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,451.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,508.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,981.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,158.56
|
| Rate for Payer: Ohio Health Group HMO |
$51,271.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,672.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,887.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,192.22
|
| Rate for Payer: PHCS Commercial |
$65,627.52
|
| Rate for Payer: United Healthcare All Payer |
$60,158.56
|
|
|
GRAFT INTUITRAK BI 28-16-120BL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
GRAFT INTUITRAK BI 28-16-120BL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
GRAFT INTUITRAK BI 28-16-135BL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
GRAFT INTUITRAK BI 28-16-135BL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
GRAFTJACKET 5CM*5CM 8600-5X05
|
Facility
|
OP
|
$12,906.80
|
|
|
Service Code
|
HCPCS Q4107
|
| Hospital Charge Code |
27000117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,677.88 |
| Max. Negotiated Rate |
$12,390.53 |
| Rate for Payer: Aetna Commercial |
$9,938.24
|
| Rate for Payer: Anthem Medicaid |
$4,438.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,067.30
|
| Rate for Payer: Cash Price |
$6,453.40
|
| Rate for Payer: Cigna Commercial |
$10,712.64
|
| Rate for Payer: First Health Commercial |
$12,261.46
|
| Rate for Payer: Humana Commercial |
$10,970.78
|
| Rate for Payer: Humana KY Medicaid |
$4,438.65
|
| Rate for Payer: Kentucky WC Medicaid |
$4,483.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,583.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,525.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,872.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,527.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,357.98
|
| Rate for Payer: Ohio Health Group HMO |
$9,680.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,581.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,677.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,001.11
|
| Rate for Payer: PHCS Commercial |
$12,390.53
|
| Rate for Payer: United Healthcare All Payer |
$11,357.98
|
|
