|
GRAFT TW STRETCH 10*40CM
|
Facility
|
IP
|
$4,156.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.34 |
| Max. Negotiated Rate |
$3,990.24 |
| Rate for Payer: Aetna Commercial |
$3,200.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,242.07
|
| Rate for Payer: Cash Price |
$2,078.25
|
| Rate for Payer: Cigna Commercial |
$3,449.90
|
| Rate for Payer: First Health Commercial |
$3,948.68
|
| Rate for Payer: Humana Commercial |
$3,533.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,408.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,067.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,246.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,657.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,117.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$831.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,288.52
|
| Rate for Payer: PHCS Commercial |
$3,990.24
|
| Rate for Payer: United Healthcare All Payer |
$3,657.72
|
|
|
GRAFT TW STRETCH 4*70CM
|
Facility
|
OP
|
$5,535.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$719.62 |
| Max. Negotiated Rate |
$5,314.08 |
| Rate for Payer: Aetna Commercial |
$4,262.34
|
| Rate for Payer: Anthem Medicaid |
$1,903.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,317.69
|
| Rate for Payer: Cash Price |
$2,767.75
|
| Rate for Payer: Cigna Commercial |
$4,594.46
|
| Rate for Payer: First Health Commercial |
$5,258.72
|
| Rate for Payer: Humana Commercial |
$4,705.18
|
| Rate for Payer: Humana KY Medicaid |
$1,903.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,923.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,539.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,085.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,660.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,941.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,871.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,151.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,107.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$719.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,716.00
|
| Rate for Payer: PHCS Commercial |
$5,314.08
|
| Rate for Payer: United Healthcare All Payer |
$4,871.24
|
|
|
GRAFT TW STRETCH 4*70CM
|
Facility
|
IP
|
$5,535.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$719.62 |
| Max. Negotiated Rate |
$5,314.08 |
| Rate for Payer: Aetna Commercial |
$4,262.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,317.69
|
| Rate for Payer: Cash Price |
$2,767.75
|
| Rate for Payer: Cigna Commercial |
$4,594.46
|
| Rate for Payer: First Health Commercial |
$5,258.72
|
| Rate for Payer: Humana Commercial |
$4,705.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,539.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,085.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,660.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,871.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,151.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,107.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$719.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,716.00
|
| Rate for Payer: PHCS Commercial |
$5,314.08
|
| Rate for Payer: United Healthcare All Payer |
$4,871.24
|
|
|
GRAFT TW STRETCH 5*70CM
|
Facility
|
OP
|
$4,734.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.42 |
| Max. Negotiated Rate |
$4,544.64 |
| Rate for Payer: Aetna Commercial |
$3,645.18
|
| Rate for Payer: Anthem Medicaid |
$1,628.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,692.52
|
| Rate for Payer: Cash Price |
$2,367.00
|
| Rate for Payer: Cigna Commercial |
$3,929.22
|
| Rate for Payer: First Health Commercial |
$4,497.30
|
| Rate for Payer: Humana Commercial |
$4,023.90
|
| Rate for Payer: Humana KY Medicaid |
$1,628.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,644.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,881.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,493.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,420.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,660.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,165.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,550.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.54
|
| Rate for Payer: PHCS Commercial |
$4,544.64
|
| Rate for Payer: United Healthcare All Payer |
$4,165.92
|
|
|
GRAFT TW STRETCH 5*70CM
|
Facility
|
IP
|
$4,734.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.42 |
| Max. Negotiated Rate |
$4,544.64 |
| Rate for Payer: Aetna Commercial |
$3,645.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,692.52
|
| Rate for Payer: Cash Price |
$2,367.00
|
| Rate for Payer: Cigna Commercial |
$3,929.22
|
| Rate for Payer: First Health Commercial |
$4,497.30
|
| Rate for Payer: Humana Commercial |
$4,023.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,881.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,493.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,420.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,165.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,550.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.54
|
| Rate for Payer: PHCS Commercial |
$4,544.64
|
| Rate for Payer: United Healthcare All Payer |
$4,165.92
|
|
|
GRAFT TW STRETCH 6*70CM
|
Facility
|
OP
|
$4,807.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.98 |
| Max. Negotiated Rate |
$4,615.20 |
| Rate for Payer: Aetna Commercial |
$3,701.78
|
| Rate for Payer: Anthem Medicaid |
$1,653.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.85
|
| Rate for Payer: Cash Price |
$2,403.75
|
| Rate for Payer: Cigna Commercial |
$3,990.22
|
| Rate for Payer: First Health Commercial |
$4,567.12
|
| Rate for Payer: Humana Commercial |
$4,086.38
|
| Rate for Payer: Humana KY Medicaid |
$1,653.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,670.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,942.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,442.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,686.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,230.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$961.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,490.32
|
| Rate for Payer: PHCS Commercial |
$4,615.20
|
| Rate for Payer: United Healthcare All Payer |
$4,230.60
|
|
|
GRAFT TW STRETCH 6*70CM
|
Facility
|
IP
|
$4,807.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.98 |
| Max. Negotiated Rate |
$4,615.20 |
| Rate for Payer: Aetna Commercial |
$3,701.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.85
|
| Rate for Payer: Cash Price |
$2,403.75
|
| Rate for Payer: Cigna Commercial |
$3,990.22
|
| Rate for Payer: First Health Commercial |
$4,567.12
|
| Rate for Payer: Humana Commercial |
$4,086.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,942.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,442.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,230.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$961.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,490.32
|
| Rate for Payer: PHCS Commercial |
$4,615.20
|
| Rate for Payer: United Healthcare All Payer |
$4,230.60
|
|
|
GRAFT VASC INTERING 6*20 THIN
|
Facility
|
OP
|
$3,502.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$455.26 |
| Max. Negotiated Rate |
$3,361.92 |
| Rate for Payer: Aetna Commercial |
$2,696.54
|
| Rate for Payer: Anthem Medicaid |
$1,204.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,731.56
|
| Rate for Payer: Cash Price |
$1,751.00
|
| Rate for Payer: Cigna Commercial |
$2,906.66
|
| Rate for Payer: First Health Commercial |
$3,326.90
|
| Rate for Payer: Humana Commercial |
$2,976.70
|
| Rate for Payer: Humana KY Medicaid |
$1,204.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,216.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,871.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,584.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,228.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,081.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,626.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,085.62
|
| Rate for Payer: PHCS Commercial |
$3,361.92
|
| Rate for Payer: United Healthcare All Payer |
$3,081.76
|
|
|
GRAFT VASC INTERING 6*20 THIN
|
Facility
|
IP
|
$3,502.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$455.26 |
| Max. Negotiated Rate |
$3,361.92 |
| Rate for Payer: Aetna Commercial |
$2,696.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,731.56
|
| Rate for Payer: Cash Price |
$1,751.00
|
| Rate for Payer: Cigna Commercial |
$2,906.66
|
| Rate for Payer: First Health Commercial |
$3,326.90
|
| Rate for Payer: Humana Commercial |
$2,976.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,871.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,584.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,081.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,626.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,085.62
|
| Rate for Payer: PHCS Commercial |
$3,361.92
|
| Rate for Payer: United Healthcare All Payer |
$3,081.76
|
|
|
GRAFT VASC INTERING 6*40 THIN
|
Facility
|
IP
|
$4,989.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$648.64 |
| Max. Negotiated Rate |
$4,789.92 |
| Rate for Payer: Aetna Commercial |
$3,841.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,891.81
|
| Rate for Payer: Cash Price |
$2,494.75
|
| Rate for Payer: Cigna Commercial |
$4,141.28
|
| Rate for Payer: First Health Commercial |
$4,740.02
|
| Rate for Payer: Humana Commercial |
$4,241.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,091.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,682.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,496.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,390.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,742.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$997.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$648.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,546.74
|
| Rate for Payer: PHCS Commercial |
$4,789.92
|
| Rate for Payer: United Healthcare All Payer |
$4,390.76
|
|
|
GRAFT VASC INTERING 6*40 THIN
|
Facility
|
OP
|
$4,989.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$648.64 |
| Max. Negotiated Rate |
$4,789.92 |
| Rate for Payer: Aetna Commercial |
$3,841.92
|
| Rate for Payer: Anthem Medicaid |
$1,715.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,891.81
|
| Rate for Payer: Cash Price |
$2,494.75
|
| Rate for Payer: Cigna Commercial |
$4,141.28
|
| Rate for Payer: First Health Commercial |
$4,740.02
|
| Rate for Payer: Humana Commercial |
$4,241.08
|
| Rate for Payer: Humana KY Medicaid |
$1,715.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,733.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,091.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,682.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,496.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,750.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,390.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,742.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$997.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$648.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,546.74
|
| Rate for Payer: PHCS Commercial |
$4,789.92
|
| Rate for Payer: United Healthcare All Payer |
$4,390.76
|
|
|
GRAFT VASC INTERING 6*45 STD
|
Facility
|
OP
|
$4,573.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.49 |
| Max. Negotiated Rate |
$4,390.08 |
| Rate for Payer: Aetna Commercial |
$3,521.21
|
| Rate for Payer: Anthem Medicaid |
$1,572.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,566.94
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cigna Commercial |
$3,795.59
|
| Rate for Payer: First Health Commercial |
$4,344.35
|
| Rate for Payer: Humana Commercial |
$3,887.05
|
| Rate for Payer: Humana KY Medicaid |
$1,572.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,588.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,749.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,374.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,371.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,604.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,417.63
|
| Rate for Payer: PHCS Commercial |
$4,390.08
|
| Rate for Payer: United Healthcare All Payer |
$4,024.24
|
|
|
GRAFT VASC INTERING 6*45 STD
|
Facility
|
IP
|
$4,573.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.49 |
| Max. Negotiated Rate |
$4,390.08 |
| Rate for Payer: Aetna Commercial |
$3,521.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,566.94
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cigna Commercial |
$3,795.59
|
| Rate for Payer: First Health Commercial |
$4,344.35
|
| Rate for Payer: Humana Commercial |
$3,887.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,749.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,374.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,371.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,417.63
|
| Rate for Payer: PHCS Commercial |
$4,390.08
|
| Rate for Payer: United Healthcare All Payer |
$4,024.24
|
|
|
GRAFT VASC INTERING 8*40 THIN
|
Facility
|
IP
|
$4,989.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$648.64 |
| Max. Negotiated Rate |
$4,789.92 |
| Rate for Payer: Aetna Commercial |
$3,841.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,891.81
|
| Rate for Payer: Cash Price |
$2,494.75
|
| Rate for Payer: Cigna Commercial |
$4,141.28
|
| Rate for Payer: First Health Commercial |
$4,740.02
|
| Rate for Payer: Humana Commercial |
$4,241.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,091.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,682.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,496.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,390.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,742.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$997.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$648.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,546.74
|
| Rate for Payer: PHCS Commercial |
$4,789.92
|
| Rate for Payer: United Healthcare All Payer |
$4,390.76
|
|
|
GRAFT VASC INTERING 8*40 THIN
|
Facility
|
OP
|
$4,989.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$648.64 |
| Max. Negotiated Rate |
$4,789.92 |
| Rate for Payer: Aetna Commercial |
$3,841.92
|
| Rate for Payer: Anthem Medicaid |
$1,715.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,891.81
|
| Rate for Payer: Cash Price |
$2,494.75
|
| Rate for Payer: Cigna Commercial |
$4,141.28
|
| Rate for Payer: First Health Commercial |
$4,740.02
|
| Rate for Payer: Humana Commercial |
$4,241.08
|
| Rate for Payer: Humana KY Medicaid |
$1,715.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,733.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,091.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,682.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,496.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,750.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,390.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,742.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$997.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$648.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,546.74
|
| Rate for Payer: PHCS Commercial |
$4,789.92
|
| Rate for Payer: United Healthcare All Payer |
$4,390.76
|
|
|
GRAFT VASCULAR INTERING 6*60
|
Facility
|
IP
|
$7,205.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$936.72 |
| Max. Negotiated Rate |
$6,917.33 |
| Rate for Payer: Aetna Commercial |
$5,548.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,620.33
|
| Rate for Payer: Cash Price |
$3,602.78
|
| Rate for Payer: Cigna Commercial |
$5,980.61
|
| Rate for Payer: First Health Commercial |
$6,845.27
|
| Rate for Payer: Humana Commercial |
$6,124.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,908.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,317.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,161.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,340.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,404.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$936.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,233.72
|
| Rate for Payer: PHCS Commercial |
$6,917.33
|
| Rate for Payer: United Healthcare All Payer |
$6,340.88
|
|
|
GRAFT VASCULAR INTERING 6*60
|
Facility
|
OP
|
$7,205.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$936.72 |
| Max. Negotiated Rate |
$6,917.33 |
| Rate for Payer: Aetna Commercial |
$5,548.27
|
| Rate for Payer: Anthem Medicaid |
$2,477.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,620.33
|
| Rate for Payer: Cash Price |
$3,602.78
|
| Rate for Payer: Cigna Commercial |
$5,980.61
|
| Rate for Payer: First Health Commercial |
$6,845.27
|
| Rate for Payer: Humana Commercial |
$6,124.72
|
| Rate for Payer: Humana KY Medicaid |
$2,477.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,503.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,908.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,317.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,161.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,527.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,340.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,404.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$936.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,233.72
|
| Rate for Payer: PHCS Commercial |
$6,917.33
|
| Rate for Payer: United Healthcare All Payer |
$6,340.88
|
|
|
GRAFT VASCULAR INTERING 8*60
|
Facility
|
OP
|
$7,201.90
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$936.25 |
| Max. Negotiated Rate |
$6,913.82 |
| Rate for Payer: Aetna Commercial |
$5,545.46
|
| Rate for Payer: Anthem Medicaid |
$2,476.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,617.48
|
| Rate for Payer: Cash Price |
$3,600.95
|
| Rate for Payer: Cigna Commercial |
$5,977.58
|
| Rate for Payer: First Health Commercial |
$6,841.80
|
| Rate for Payer: Humana Commercial |
$6,121.62
|
| Rate for Payer: Humana KY Medicaid |
$2,476.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,501.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,905.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,315.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,160.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,526.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,337.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,401.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$936.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,232.59
|
| Rate for Payer: PHCS Commercial |
$6,913.82
|
| Rate for Payer: United Healthcare All Payer |
$6,337.67
|
|
|
GRAFT VASCULAR INTERING 8*60
|
Facility
|
IP
|
$7,201.90
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$936.25 |
| Max. Negotiated Rate |
$6,913.82 |
| Rate for Payer: Aetna Commercial |
$5,545.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,617.48
|
| Rate for Payer: Cash Price |
$3,600.95
|
| Rate for Payer: Cigna Commercial |
$5,977.58
|
| Rate for Payer: First Health Commercial |
$6,841.80
|
| Rate for Payer: Humana Commercial |
$6,121.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,905.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,315.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,160.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,337.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,401.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$936.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,232.59
|
| Rate for Payer: PHCS Commercial |
$6,913.82
|
| Rate for Payer: United Healthcare All Payer |
$6,337.67
|
|
|
GRAFT VECTRA DIALYSIS 5MM*40CM
|
Facility
|
OP
|
$6,709.15
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.19 |
| Max. Negotiated Rate |
$6,440.78 |
| Rate for Payer: Aetna Commercial |
$5,166.05
|
| Rate for Payer: Anthem Medicaid |
$2,307.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,233.14
|
| Rate for Payer: Cash Price |
$3,354.57
|
| Rate for Payer: Cigna Commercial |
$5,568.59
|
| Rate for Payer: First Health Commercial |
$6,373.69
|
| Rate for Payer: Humana Commercial |
$5,702.78
|
| Rate for Payer: Humana KY Medicaid |
$2,307.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,330.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,501.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,951.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,012.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,353.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,904.05
|
| Rate for Payer: Ohio Health Group HMO |
$5,031.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,079.84
|
| Rate for Payer: PHCS Commercial |
$6,440.78
|
| Rate for Payer: United Healthcare All Payer |
$5,904.05
|
|
|
GRAFT VECTRA DIALYSIS 5MM*40CM
|
Facility
|
IP
|
$6,709.15
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$872.19 |
| Max. Negotiated Rate |
$6,440.78 |
| Rate for Payer: Aetna Commercial |
$5,166.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,233.14
|
| Rate for Payer: Cash Price |
$3,354.57
|
| Rate for Payer: Cigna Commercial |
$5,568.59
|
| Rate for Payer: First Health Commercial |
$6,373.69
|
| Rate for Payer: Humana Commercial |
$5,702.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,501.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,951.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,012.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,904.05
|
| Rate for Payer: Ohio Health Group HMO |
$5,031.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,079.84
|
| Rate for Payer: PHCS Commercial |
$6,440.78
|
| Rate for Payer: United Healthcare All Payer |
$5,904.05
|
|
|
GRAFT VECTRA DIALYSIS 6*40
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
GRAFT VECTRA DIALYSIS 6*40
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
GRAFT Z CONVERTER ZT
|
Facility
|
OP
|
$13,484.49
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,752.98 |
| Max. Negotiated Rate |
$12,945.11 |
| Rate for Payer: Aetna Commercial |
$10,383.06
|
| Rate for Payer: Anthem Medicaid |
$4,637.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,517.90
|
| Rate for Payer: Cash Price |
$6,742.24
|
| Rate for Payer: Cigna Commercial |
$11,192.13
|
| Rate for Payer: First Health Commercial |
$12,810.27
|
| Rate for Payer: Humana Commercial |
$11,461.82
|
| Rate for Payer: Humana KY Medicaid |
$4,637.32
|
| Rate for Payer: Kentucky WC Medicaid |
$4,684.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,057.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,951.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,045.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,730.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,866.35
|
| Rate for Payer: Ohio Health Group HMO |
$10,113.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,696.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,752.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,180.19
|
| Rate for Payer: PHCS Commercial |
$12,945.11
|
| Rate for Payer: United Healthcare All Payer |
$11,866.35
|
|
|
GRAFT Z CONVERTER ZT
|
Facility
|
IP
|
$13,484.49
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,752.98 |
| Max. Negotiated Rate |
$12,945.11 |
| Rate for Payer: Aetna Commercial |
$10,383.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,517.90
|
| Rate for Payer: Cash Price |
$6,742.24
|
| Rate for Payer: Cigna Commercial |
$11,192.13
|
| Rate for Payer: First Health Commercial |
$12,810.27
|
| Rate for Payer: Humana Commercial |
$11,461.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,057.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,951.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,045.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,866.35
|
| Rate for Payer: Ohio Health Group HMO |
$10,113.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,696.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,752.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,180.19
|
| Rate for Payer: PHCS Commercial |
$12,945.11
|
| Rate for Payer: United Healthcare All Payer |
$11,866.35
|
|
