|
GRAFTMASTER RX 4.8*19
|
Facility
|
IP
|
$12,041.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,565.43 |
| Max. Negotiated Rate |
$11,560.08 |
| Rate for Payer: Aetna Commercial |
$9,272.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,392.56
|
| Rate for Payer: Cash Price |
$6,020.88
|
| Rate for Payer: Cigna Commercial |
$9,994.65
|
| Rate for Payer: First Health Commercial |
$11,439.66
|
| Rate for Payer: Humana Commercial |
$10,235.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,874.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,886.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,596.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,031.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,565.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.94
|
| Rate for Payer: PHCS Commercial |
$11,560.08
|
| Rate for Payer: United Healthcare All Payer |
$10,596.74
|
|
|
GRAFTMASTER RX 4.8*19
|
Facility
|
OP
|
$12,041.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,565.43 |
| Max. Negotiated Rate |
$11,560.08 |
| Rate for Payer: Aetna Commercial |
$9,272.15
|
| Rate for Payer: Anthem Medicaid |
$4,141.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,392.56
|
| Rate for Payer: Cash Price |
$6,020.88
|
| Rate for Payer: Cigna Commercial |
$9,994.65
|
| Rate for Payer: First Health Commercial |
$11,439.66
|
| Rate for Payer: Humana Commercial |
$10,235.49
|
| Rate for Payer: Humana KY Medicaid |
$4,141.16
|
| Rate for Payer: Kentucky WC Medicaid |
$4,183.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,874.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,886.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,224.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,596.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,031.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,565.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.94
|
| Rate for Payer: PHCS Commercial |
$11,560.08
|
| Rate for Payer: United Healthcare All Payer |
$10,596.74
|
|
|
GRAFT MN BDY BIFR 25*90*16*30
|
Facility
|
IP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GRAFT MN BDY BIFR 25*90*16*30
|
Facility
|
OP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem Medicaid |
$24,481.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Humana KY Medicaid |
$24,481.55
|
| Rate for Payer: Kentucky WC Medicaid |
$24,730.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,972.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GRAFT PATCH 1/3 * 3
|
Facility
|
IP
|
$1,531.96
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.15 |
| Max. Negotiated Rate |
$1,470.68 |
| Rate for Payer: Aetna Commercial |
$1,179.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,194.93
|
| Rate for Payer: Cash Price |
$765.98
|
| Rate for Payer: Cigna Commercial |
$1,271.53
|
| Rate for Payer: First Health Commercial |
$1,455.36
|
| Rate for Payer: Humana Commercial |
$1,302.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,256.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,130.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,348.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,148.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.91
|
| Rate for Payer: PHCS Commercial |
$1,470.68
|
| Rate for Payer: United Healthcare All Payer |
$1,348.12
|
|
|
GRAFT PATCH 1/3 * 3
|
Facility
|
OP
|
$1,531.96
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.15 |
| Max. Negotiated Rate |
$1,470.68 |
| Rate for Payer: Aetna Commercial |
$1,179.61
|
| Rate for Payer: Anthem Medicaid |
$526.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,194.93
|
| Rate for Payer: Cash Price |
$765.98
|
| Rate for Payer: Cigna Commercial |
$1,271.53
|
| Rate for Payer: First Health Commercial |
$1,455.36
|
| Rate for Payer: Humana Commercial |
$1,302.17
|
| Rate for Payer: Humana KY Medicaid |
$526.84
|
| Rate for Payer: Kentucky WC Medicaid |
$532.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,256.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,130.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$537.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,348.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,148.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.91
|
| Rate for Payer: PHCS Commercial |
$1,470.68
|
| Rate for Payer: United Healthcare All Payer |
$1,348.12
|
|
|
GRAFT POSTERIOR TIBIAL ULTRA
|
Facility
|
OP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem Medicaid |
$3,467.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Humana KY Medicaid |
$3,467.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
GRAFT POSTERIOR TIBIAL ULTRA
|
Facility
|
IP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
GRAFT PROCOL VAS BIOPROST 6*30
|
Facility
|
OP
|
$7,727.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.58 |
| Max. Negotiated Rate |
$7,418.40 |
| Rate for Payer: Aetna Commercial |
$5,950.18
|
| Rate for Payer: Anthem Medicaid |
$2,657.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,027.45
|
| Rate for Payer: Cash Price |
$3,863.75
|
| Rate for Payer: Cigna Commercial |
$6,413.82
|
| Rate for Payer: First Health Commercial |
$7,341.12
|
| Rate for Payer: Humana Commercial |
$6,568.38
|
| Rate for Payer: Humana KY Medicaid |
$2,657.49
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,336.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,800.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,395.52
|
| Rate for Payer: PHCS Commercial |
$7,418.40
|
| Rate for Payer: United Healthcare All Payer |
$6,800.20
|
|
|
GRAFT PROCOL VAS BIOPROST 6*30
|
Facility
|
IP
|
$7,727.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.58 |
| Max. Negotiated Rate |
$7,418.40 |
| Rate for Payer: Aetna Commercial |
$5,950.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,027.45
|
| Rate for Payer: Cash Price |
$3,863.75
|
| Rate for Payer: Cigna Commercial |
$6,413.82
|
| Rate for Payer: First Health Commercial |
$7,341.12
|
| Rate for Payer: Humana Commercial |
$6,568.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,336.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,800.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,545.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,395.52
|
| Rate for Payer: PHCS Commercial |
$7,418.40
|
| Rate for Payer: United Healthcare All Payer |
$6,800.20
|
|
|
GRAFT PROPATEN 4-7*45
|
Facility
|
IP
|
$7,282.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.69 |
| Max. Negotiated Rate |
$6,990.91 |
| Rate for Payer: Aetna Commercial |
$5,607.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,680.12
|
| Rate for Payer: Cash Price |
$3,641.10
|
| Rate for Payer: Cigna Commercial |
$6,044.23
|
| Rate for Payer: First Health Commercial |
$6,918.09
|
| Rate for Payer: Humana Commercial |
$6,189.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,971.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,374.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,184.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,408.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,461.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$946.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,257.48
|
| Rate for Payer: PHCS Commercial |
$6,990.91
|
| Rate for Payer: United Healthcare All Payer |
$6,408.34
|
|
|
GRAFT PROPATEN 4-7*45
|
Facility
|
OP
|
$7,282.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.69 |
| Max. Negotiated Rate |
$6,990.91 |
| Rate for Payer: Aetna Commercial |
$5,607.29
|
| Rate for Payer: Anthem Medicaid |
$2,504.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,680.12
|
| Rate for Payer: Cash Price |
$3,641.10
|
| Rate for Payer: Cigna Commercial |
$6,044.23
|
| Rate for Payer: First Health Commercial |
$6,918.09
|
| Rate for Payer: Humana Commercial |
$6,189.87
|
| Rate for Payer: Humana KY Medicaid |
$2,504.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,529.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,971.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,374.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,184.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,554.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,408.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,461.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$946.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,257.48
|
| Rate for Payer: PHCS Commercial |
$6,990.91
|
| Rate for Payer: United Healthcare All Payer |
$6,408.34
|
|
|
GRAFT PROPATEN 6*40
|
Facility
|
OP
|
$7,223.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$939.09 |
| Max. Negotiated Rate |
$6,934.85 |
| Rate for Payer: Aetna Commercial |
$5,562.33
|
| Rate for Payer: Anthem Medicaid |
$2,484.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,634.56
|
| Rate for Payer: Cash Price |
$3,611.90
|
| Rate for Payer: Cigna Commercial |
$5,995.75
|
| Rate for Payer: First Health Commercial |
$6,862.61
|
| Rate for Payer: Humana Commercial |
$6,140.23
|
| Rate for Payer: Humana KY Medicaid |
$2,484.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,509.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,923.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,331.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,167.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,534.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,356.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,417.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$939.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,239.38
|
| Rate for Payer: PHCS Commercial |
$6,934.85
|
| Rate for Payer: United Healthcare All Payer |
$6,356.94
|
|
|
GRAFT PROPATEN 6*40
|
Facility
|
IP
|
$7,223.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$939.09 |
| Max. Negotiated Rate |
$6,934.85 |
| Rate for Payer: Aetna Commercial |
$5,562.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,634.56
|
| Rate for Payer: Cash Price |
$3,611.90
|
| Rate for Payer: Cigna Commercial |
$5,995.75
|
| Rate for Payer: First Health Commercial |
$6,862.61
|
| Rate for Payer: Humana Commercial |
$6,140.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,923.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,331.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,167.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,356.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,417.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$939.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,239.38
|
| Rate for Payer: PHCS Commercial |
$6,934.85
|
| Rate for Payer: United Healthcare All Payer |
$6,356.94
|
|
|
GRAFT PROPATEN 6*40 STD WALL
|
Facility
|
OP
|
$6,577.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$855.11 |
| Max. Negotiated Rate |
$6,314.64 |
| Rate for Payer: Aetna Commercial |
$5,064.87
|
| Rate for Payer: Anthem Medicaid |
$2,262.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,130.64
|
| Rate for Payer: Cash Price |
$3,288.88
|
| Rate for Payer: Cigna Commercial |
$5,459.53
|
| Rate for Payer: First Health Commercial |
$6,248.86
|
| Rate for Payer: Humana Commercial |
$5,591.09
|
| Rate for Payer: Humana KY Medicaid |
$2,262.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,285.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,393.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,854.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,973.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,307.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,788.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,933.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,315.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$855.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,039.10
|
| Rate for Payer: PHCS Commercial |
$6,314.64
|
| Rate for Payer: United Healthcare All Payer |
$5,788.42
|
|
|
GRAFT PROPATEN 6*40 STD WALL
|
Facility
|
IP
|
$6,577.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$855.11 |
| Max. Negotiated Rate |
$6,314.64 |
| Rate for Payer: Aetna Commercial |
$5,064.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,130.64
|
| Rate for Payer: Cash Price |
$3,288.88
|
| Rate for Payer: Cigna Commercial |
$5,459.53
|
| Rate for Payer: First Health Commercial |
$6,248.86
|
| Rate for Payer: Humana Commercial |
$5,591.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,393.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,854.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,973.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,788.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,933.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,315.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$855.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,039.10
|
| Rate for Payer: PHCS Commercial |
$6,314.64
|
| Rate for Payer: United Healthcare All Payer |
$5,788.42
|
|
|
GRAFT PROPATEN 6*50 W/RING
|
Facility
|
IP
|
$9,665.65
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,256.53 |
| Max. Negotiated Rate |
$9,279.02 |
| Rate for Payer: Aetna Commercial |
$7,442.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,539.21
|
| Rate for Payer: Cash Price |
$4,832.82
|
| Rate for Payer: Cigna Commercial |
$8,022.49
|
| Rate for Payer: First Health Commercial |
$9,182.37
|
| Rate for Payer: Humana Commercial |
$8,215.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,925.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,133.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,899.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,505.77
|
| Rate for Payer: Ohio Health Group HMO |
$7,249.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,933.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,256.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,996.35
|
| Rate for Payer: PHCS Commercial |
$9,279.02
|
| Rate for Payer: United Healthcare All Payer |
$8,505.77
|
|
|
GRAFT PROPATEN 6*50 W/RING
|
Facility
|
OP
|
$9,665.65
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,256.53 |
| Max. Negotiated Rate |
$9,279.02 |
| Rate for Payer: Aetna Commercial |
$7,442.55
|
| Rate for Payer: Anthem Medicaid |
$3,324.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,539.21
|
| Rate for Payer: Cash Price |
$4,832.82
|
| Rate for Payer: Cigna Commercial |
$8,022.49
|
| Rate for Payer: First Health Commercial |
$9,182.37
|
| Rate for Payer: Humana Commercial |
$8,215.80
|
| Rate for Payer: Humana KY Medicaid |
$3,324.02
|
| Rate for Payer: Kentucky WC Medicaid |
$3,357.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,925.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,133.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,899.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,390.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,505.77
|
| Rate for Payer: Ohio Health Group HMO |
$7,249.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,933.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,256.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,996.35
|
| Rate for Payer: PHCS Commercial |
$9,279.02
|
| Rate for Payer: United Healthcare All Payer |
$8,505.77
|
|
|
GRAFT PROPATEN 6*70 W/RING
|
Facility
|
IP
|
$12,370.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.13 |
| Max. Negotiated Rate |
$11,875.44 |
| Rate for Payer: Aetna Commercial |
$9,525.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,648.80
|
| Rate for Payer: Cash Price |
$6,185.12
|
| Rate for Payer: Cigna Commercial |
$10,267.31
|
| Rate for Payer: First Health Commercial |
$11,751.74
|
| Rate for Payer: Humana Commercial |
$10,514.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,143.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,129.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,711.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,885.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,277.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.78
|
| Rate for Payer: PHCS Commercial |
$11,875.44
|
| Rate for Payer: United Healthcare All Payer |
$10,885.82
|
|
|
GRAFT PROPATEN 6*70 W/RING
|
Facility
|
OP
|
$12,370.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.13 |
| Max. Negotiated Rate |
$11,875.44 |
| Rate for Payer: Aetna Commercial |
$9,525.09
|
| Rate for Payer: Anthem Medicaid |
$4,254.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,648.80
|
| Rate for Payer: Cash Price |
$6,185.12
|
| Rate for Payer: Cigna Commercial |
$10,267.31
|
| Rate for Payer: First Health Commercial |
$11,751.74
|
| Rate for Payer: Humana Commercial |
$10,514.71
|
| Rate for Payer: Humana KY Medicaid |
$4,254.13
|
| Rate for Payer: Kentucky WC Medicaid |
$4,297.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,143.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,129.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,711.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,339.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,885.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,277.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.78
|
| Rate for Payer: PHCS Commercial |
$11,875.44
|
| Rate for Payer: United Healthcare All Payer |
$10,885.82
|
|
|
GRAFT PROPATEN 6*80 STD WALL
|
Facility
|
IP
|
$10,994.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,429.25 |
| Max. Negotiated Rate |
$10,554.43 |
| Rate for Payer: Aetna Commercial |
$8,465.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,575.48
|
| Rate for Payer: Cash Price |
$5,497.10
|
| Rate for Payer: Cigna Commercial |
$9,125.19
|
| Rate for Payer: First Health Commercial |
$10,444.49
|
| Rate for Payer: Humana Commercial |
$9,345.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,015.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,113.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,298.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,674.90
|
| Rate for Payer: Ohio Health Group HMO |
$8,245.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,198.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,429.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,408.20
|
| Rate for Payer: PHCS Commercial |
$10,554.43
|
| Rate for Payer: United Healthcare All Payer |
$9,674.90
|
|
|
GRAFT PROPATEN 6*80 STD WALL
|
Facility
|
OP
|
$10,994.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,429.25 |
| Max. Negotiated Rate |
$10,554.43 |
| Rate for Payer: Aetna Commercial |
$8,465.53
|
| Rate for Payer: Anthem Medicaid |
$3,780.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,575.48
|
| Rate for Payer: Cash Price |
$5,497.10
|
| Rate for Payer: Cigna Commercial |
$9,125.19
|
| Rate for Payer: First Health Commercial |
$10,444.49
|
| Rate for Payer: Humana Commercial |
$9,345.07
|
| Rate for Payer: Humana KY Medicaid |
$3,780.91
|
| Rate for Payer: Kentucky WC Medicaid |
$3,819.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,015.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,113.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,298.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,856.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,674.90
|
| Rate for Payer: Ohio Health Group HMO |
$8,245.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,198.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,429.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,408.20
|
| Rate for Payer: PHCS Commercial |
$10,554.43
|
| Rate for Payer: United Healthcare All Payer |
$9,674.90
|
|
|
GRAFT PROPATEN INTERING 6*40
|
Facility
|
IP
|
$8,282.30
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.70 |
| Max. Negotiated Rate |
$7,951.01 |
| Rate for Payer: Aetna Commercial |
$6,377.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,460.19
|
| Rate for Payer: Cash Price |
$4,141.15
|
| Rate for Payer: Cigna Commercial |
$6,874.31
|
| Rate for Payer: First Health Commercial |
$7,868.18
|
| Rate for Payer: Humana Commercial |
$7,039.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,791.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,112.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,484.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,288.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,211.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,076.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.51
|
| Rate for Payer: PHCS Commercial |
$7,951.01
|
| Rate for Payer: United Healthcare All Payer |
$7,288.42
|
|
|
GRAFT PROPATEN INTERING 6*40
|
Facility
|
OP
|
$8,282.30
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.70 |
| Max. Negotiated Rate |
$7,951.01 |
| Rate for Payer: Aetna Commercial |
$6,377.37
|
| Rate for Payer: Anthem Medicaid |
$2,848.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,460.19
|
| Rate for Payer: Cash Price |
$4,141.15
|
| Rate for Payer: Cigna Commercial |
$6,874.31
|
| Rate for Payer: First Health Commercial |
$7,868.18
|
| Rate for Payer: Humana Commercial |
$7,039.96
|
| Rate for Payer: Humana KY Medicaid |
$2,848.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,877.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,791.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,112.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,484.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,905.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,288.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,211.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,076.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.51
|
| Rate for Payer: PHCS Commercial |
$7,951.01
|
| Rate for Payer: United Healthcare All Payer |
$7,288.42
|
|
|
GRAFT PROPATEN INTERING 8*40
|
Facility
|
IP
|
$8,282.30
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.70 |
| Max. Negotiated Rate |
$7,951.01 |
| Rate for Payer: Aetna Commercial |
$6,377.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,460.19
|
| Rate for Payer: Cash Price |
$4,141.15
|
| Rate for Payer: Cigna Commercial |
$6,874.31
|
| Rate for Payer: First Health Commercial |
$7,868.18
|
| Rate for Payer: Humana Commercial |
$7,039.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,791.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,112.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,484.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,288.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,211.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,076.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.51
|
| Rate for Payer: PHCS Commercial |
$7,951.01
|
| Rate for Payer: United Healthcare All Payer |
$7,288.42
|
|
