|
GRAFT Z ILIAC LEG TFLE-8-71
|
Facility
|
OP
|
$14,235.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.60 |
| Max. Negotiated Rate |
$13,665.98 |
| Rate for Payer: Aetna Commercial |
$10,961.26
|
| Rate for Payer: Anthem Medicaid |
$4,895.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.61
|
| Rate for Payer: Cash Price |
$7,117.70
|
| Rate for Payer: Cigna Commercial |
$11,815.38
|
| Rate for Payer: First Health Commercial |
$13,523.63
|
| Rate for Payer: Humana Commercial |
$12,100.09
|
| Rate for Payer: Humana KY Medicaid |
$4,895.55
|
| Rate for Payer: Kentucky WC Medicaid |
$4,945.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,673.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,993.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,527.15
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,847.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,412.97
|
| Rate for Payer: PHCS Commercial |
$13,665.98
|
| Rate for Payer: United Healthcare All Payer |
$12,527.15
|
|
|
GRAFT Z ILIAC LEG TFLE-8-71
|
Facility
|
IP
|
$14,235.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.60 |
| Max. Negotiated Rate |
$13,665.98 |
| Rate for Payer: Aetna Commercial |
$10,961.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.61
|
| Rate for Payer: Cash Price |
$7,117.70
|
| Rate for Payer: Cigna Commercial |
$11,815.38
|
| Rate for Payer: First Health Commercial |
$13,523.63
|
| Rate for Payer: Humana Commercial |
$12,100.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,673.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,527.15
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,847.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,412.97
|
| Rate for Payer: PHCS Commercial |
$13,665.98
|
| Rate for Payer: United Healthcare All Payer |
$12,527.15
|
|
|
GRAFT Z ILIAC LEG TFLE-8-71-ZT
|
Facility
|
OP
|
$14,235.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.60 |
| Max. Negotiated Rate |
$13,665.98 |
| Rate for Payer: Aetna Commercial |
$10,961.26
|
| Rate for Payer: Anthem Medicaid |
$4,895.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.61
|
| Rate for Payer: Cash Price |
$7,117.70
|
| Rate for Payer: Cigna Commercial |
$11,815.38
|
| Rate for Payer: First Health Commercial |
$13,523.63
|
| Rate for Payer: Humana Commercial |
$12,100.09
|
| Rate for Payer: Humana KY Medicaid |
$4,895.55
|
| Rate for Payer: Kentucky WC Medicaid |
$4,945.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,673.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,993.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,527.15
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,847.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,412.97
|
| Rate for Payer: PHCS Commercial |
$13,665.98
|
| Rate for Payer: United Healthcare All Payer |
$12,527.15
|
|
|
GRAFT Z ILIAC LEG TFLE-8-71-ZT
|
Facility
|
IP
|
$14,235.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.60 |
| Max. Negotiated Rate |
$13,665.98 |
| Rate for Payer: Aetna Commercial |
$10,961.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.61
|
| Rate for Payer: Cash Price |
$7,117.70
|
| Rate for Payer: Cigna Commercial |
$11,815.38
|
| Rate for Payer: First Health Commercial |
$13,523.63
|
| Rate for Payer: Humana Commercial |
$12,100.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,673.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,527.15
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,847.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,412.97
|
| Rate for Payer: PHCS Commercial |
$13,665.98
|
| Rate for Payer: United Healthcare All Payer |
$12,527.15
|
|
|
GRAFT Z ILIAC LEG TFLE-8-88
|
Facility
|
IP
|
$14,235.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.60 |
| Max. Negotiated Rate |
$13,665.98 |
| Rate for Payer: Aetna Commercial |
$10,961.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.61
|
| Rate for Payer: Cash Price |
$7,117.70
|
| Rate for Payer: Cigna Commercial |
$11,815.38
|
| Rate for Payer: First Health Commercial |
$13,523.63
|
| Rate for Payer: Humana Commercial |
$12,100.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,673.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,527.15
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,847.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,412.97
|
| Rate for Payer: PHCS Commercial |
$13,665.98
|
| Rate for Payer: United Healthcare All Payer |
$12,527.15
|
|
|
GRAFT Z ILIAC LEG TFLE-8-88
|
Facility
|
OP
|
$14,235.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.60 |
| Max. Negotiated Rate |
$13,665.98 |
| Rate for Payer: Aetna Commercial |
$10,961.26
|
| Rate for Payer: Anthem Medicaid |
$4,895.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.61
|
| Rate for Payer: Cash Price |
$7,117.70
|
| Rate for Payer: Cigna Commercial |
$11,815.38
|
| Rate for Payer: First Health Commercial |
$13,523.63
|
| Rate for Payer: Humana Commercial |
$12,100.09
|
| Rate for Payer: Humana KY Medicaid |
$4,895.55
|
| Rate for Payer: Kentucky WC Medicaid |
$4,945.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,673.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,993.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,527.15
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,847.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,412.97
|
| Rate for Payer: PHCS Commercial |
$13,665.98
|
| Rate for Payer: United Healthcare All Payer |
$12,527.15
|
|
|
GRAFT Z ILIAC LEG TFLE-8-88-ZT
|
Facility
|
IP
|
$14,235.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.60 |
| Max. Negotiated Rate |
$13,665.98 |
| Rate for Payer: Aetna Commercial |
$10,961.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.61
|
| Rate for Payer: Cash Price |
$7,117.70
|
| Rate for Payer: Cigna Commercial |
$11,815.38
|
| Rate for Payer: First Health Commercial |
$13,523.63
|
| Rate for Payer: Humana Commercial |
$12,100.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,673.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,527.15
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,847.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,412.97
|
| Rate for Payer: PHCS Commercial |
$13,665.98
|
| Rate for Payer: United Healthcare All Payer |
$12,527.15
|
|
|
GRAFT Z ILIAC LEG TFLE-8-88-ZT
|
Facility
|
OP
|
$14,235.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.60 |
| Max. Negotiated Rate |
$13,665.98 |
| Rate for Payer: Aetna Commercial |
$10,961.26
|
| Rate for Payer: Anthem Medicaid |
$4,895.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.61
|
| Rate for Payer: Cash Price |
$7,117.70
|
| Rate for Payer: Cigna Commercial |
$11,815.38
|
| Rate for Payer: First Health Commercial |
$13,523.63
|
| Rate for Payer: Humana Commercial |
$12,100.09
|
| Rate for Payer: Humana KY Medicaid |
$4,895.55
|
| Rate for Payer: Kentucky WC Medicaid |
$4,945.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,673.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,993.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,527.15
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,847.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,412.97
|
| Rate for Payer: PHCS Commercial |
$13,665.98
|
| Rate for Payer: United Healthcare All Payer |
$12,527.15
|
|
|
GRAFT Z ILIAC LEG ZSLE-13-56-Z
|
Facility
|
OP
|
$20,491.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,663.88 |
| Max. Negotiated Rate |
$19,671.70 |
| Rate for Payer: Aetna Commercial |
$15,778.34
|
| Rate for Payer: Anthem Medicaid |
$7,046.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,983.25
|
| Rate for Payer: Cash Price |
$10,245.67
|
| Rate for Payer: Cigna Commercial |
$17,007.82
|
| Rate for Payer: First Health Commercial |
$19,466.78
|
| Rate for Payer: Humana Commercial |
$17,417.65
|
| Rate for Payer: Humana KY Medicaid |
$7,046.98
|
| Rate for Payer: Kentucky WC Medicaid |
$7,118.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,802.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,122.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,147.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,188.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,032.39
|
| Rate for Payer: Ohio Health Group HMO |
$15,368.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,098.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,663.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,352.32
|
| Rate for Payer: PHCS Commercial |
$19,671.70
|
| Rate for Payer: United Healthcare All Payer |
$18,032.39
|
|
|
GRAFT Z ILIAC LEG ZSLE-13-56-Z
|
Facility
|
IP
|
$20,491.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,663.88 |
| Max. Negotiated Rate |
$19,671.70 |
| Rate for Payer: Aetna Commercial |
$15,778.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,983.25
|
| Rate for Payer: Cash Price |
$10,245.67
|
| Rate for Payer: Cigna Commercial |
$17,007.82
|
| Rate for Payer: First Health Commercial |
$19,466.78
|
| Rate for Payer: Humana Commercial |
$17,417.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,802.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,122.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,147.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,032.39
|
| Rate for Payer: Ohio Health Group HMO |
$15,368.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,098.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,663.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,352.32
|
| Rate for Payer: PHCS Commercial |
$19,671.70
|
| Rate for Payer: United Healthcare All Payer |
$18,032.39
|
|
|
GRAFT Z ILIAC LEG ZSLE-13-74-Z
|
Facility
|
IP
|
$20,491.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,663.88 |
| Max. Negotiated Rate |
$19,671.70 |
| Rate for Payer: Aetna Commercial |
$15,778.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,983.25
|
| Rate for Payer: Cash Price |
$10,245.67
|
| Rate for Payer: Cigna Commercial |
$17,007.82
|
| Rate for Payer: First Health Commercial |
$19,466.78
|
| Rate for Payer: Humana Commercial |
$17,417.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,802.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,122.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,147.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,032.39
|
| Rate for Payer: Ohio Health Group HMO |
$15,368.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,098.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,663.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,352.32
|
| Rate for Payer: PHCS Commercial |
$19,671.70
|
| Rate for Payer: United Healthcare All Payer |
$18,032.39
|
|
|
GRAFT Z ILIAC LEG ZSLE-13-74-Z
|
Facility
|
OP
|
$20,491.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,663.88 |
| Max. Negotiated Rate |
$19,671.70 |
| Rate for Payer: Aetna Commercial |
$15,778.34
|
| Rate for Payer: Anthem Medicaid |
$7,046.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,983.25
|
| Rate for Payer: Cash Price |
$10,245.67
|
| Rate for Payer: Cigna Commercial |
$17,007.82
|
| Rate for Payer: First Health Commercial |
$19,466.78
|
| Rate for Payer: Humana Commercial |
$17,417.65
|
| Rate for Payer: Humana KY Medicaid |
$7,046.98
|
| Rate for Payer: Kentucky WC Medicaid |
$7,118.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,802.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,122.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,147.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,188.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,032.39
|
| Rate for Payer: Ohio Health Group HMO |
$15,368.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,098.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,663.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,352.32
|
| Rate for Payer: PHCS Commercial |
$19,671.70
|
| Rate for Payer: United Healthcare All Payer |
$18,032.39
|
|
|
GRAFT Z ILIAC LEG ZSLE-13-90-Z
|
Facility
|
IP
|
$20,491.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,663.88 |
| Max. Negotiated Rate |
$19,671.70 |
| Rate for Payer: Aetna Commercial |
$15,778.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,983.25
|
| Rate for Payer: Cash Price |
$10,245.67
|
| Rate for Payer: Cigna Commercial |
$17,007.82
|
| Rate for Payer: First Health Commercial |
$19,466.78
|
| Rate for Payer: Humana Commercial |
$17,417.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,802.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,122.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,147.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,032.39
|
| Rate for Payer: Ohio Health Group HMO |
$15,368.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,098.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,663.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,352.32
|
| Rate for Payer: PHCS Commercial |
$19,671.70
|
| Rate for Payer: United Healthcare All Payer |
$18,032.39
|
|
|
GRAFT Z ILIAC LEG ZSLE-13-90-Z
|
Facility
|
OP
|
$20,491.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,663.88 |
| Max. Negotiated Rate |
$19,671.70 |
| Rate for Payer: Aetna Commercial |
$15,778.34
|
| Rate for Payer: Anthem Medicaid |
$7,046.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,983.25
|
| Rate for Payer: Cash Price |
$10,245.67
|
| Rate for Payer: Cigna Commercial |
$17,007.82
|
| Rate for Payer: First Health Commercial |
$19,466.78
|
| Rate for Payer: Humana Commercial |
$17,417.65
|
| Rate for Payer: Humana KY Medicaid |
$7,046.98
|
| Rate for Payer: Kentucky WC Medicaid |
$7,118.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,802.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,122.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,147.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,188.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,032.39
|
| Rate for Payer: Ohio Health Group HMO |
$15,368.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,098.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,663.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,352.32
|
| Rate for Payer: PHCS Commercial |
$19,671.70
|
| Rate for Payer: United Healthcare All Payer |
$18,032.39
|
|
|
GRAFT Z ILIAC LEG ZSLE-16-39-Z
|
Facility
|
OP
|
$20,962.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.09 |
| Max. Negotiated Rate |
$20,123.71 |
| Rate for Payer: Aetna Commercial |
$16,140.89
|
| Rate for Payer: Anthem Medicaid |
$7,208.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,350.52
|
| Rate for Payer: Cash Price |
$10,481.10
|
| Rate for Payer: Cigna Commercial |
$17,398.63
|
| Rate for Payer: First Health Commercial |
$19,914.09
|
| Rate for Payer: Humana Commercial |
$17,817.87
|
| Rate for Payer: Humana KY Medicaid |
$7,208.90
|
| Rate for Payer: Kentucky WC Medicaid |
$7,282.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,470.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,288.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,353.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,446.74
|
| Rate for Payer: Ohio Health Group HMO |
$15,721.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,725.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,498.28
|
| Rate for Payer: PHCS Commercial |
$20,123.71
|
| Rate for Payer: United Healthcare All Payer |
$18,446.74
|
|
|
GRAFT Z ILIAC LEG ZSLE-16-39-Z
|
Facility
|
IP
|
$20,962.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.09 |
| Max. Negotiated Rate |
$20,123.71 |
| Rate for Payer: Aetna Commercial |
$16,140.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,350.52
|
| Rate for Payer: Cash Price |
$10,481.10
|
| Rate for Payer: Cigna Commercial |
$17,398.63
|
| Rate for Payer: First Health Commercial |
$19,914.09
|
| Rate for Payer: Humana Commercial |
$17,817.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,470.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,288.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,446.74
|
| Rate for Payer: Ohio Health Group HMO |
$15,721.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,725.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,498.28
|
| Rate for Payer: PHCS Commercial |
$20,123.71
|
| Rate for Payer: United Healthcare All Payer |
$18,446.74
|
|
|
GRAFT Z ILIAC LEG ZSLE-16-56-Z
|
Facility
|
OP
|
$20,491.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,663.88 |
| Max. Negotiated Rate |
$19,671.70 |
| Rate for Payer: Aetna Commercial |
$15,778.34
|
| Rate for Payer: Anthem Medicaid |
$7,046.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,983.25
|
| Rate for Payer: Cash Price |
$10,245.67
|
| Rate for Payer: Cigna Commercial |
$17,007.82
|
| Rate for Payer: First Health Commercial |
$19,466.78
|
| Rate for Payer: Humana Commercial |
$17,417.65
|
| Rate for Payer: Humana KY Medicaid |
$7,046.98
|
| Rate for Payer: Kentucky WC Medicaid |
$7,118.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,802.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,122.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,147.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,188.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,032.39
|
| Rate for Payer: Ohio Health Group HMO |
$15,368.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,098.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,663.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,352.32
|
| Rate for Payer: PHCS Commercial |
$19,671.70
|
| Rate for Payer: United Healthcare All Payer |
$18,032.39
|
|
|
GRAFT Z ILIAC LEG ZSLE-16-56-Z
|
Facility
|
IP
|
$20,491.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,663.88 |
| Max. Negotiated Rate |
$19,671.70 |
| Rate for Payer: Aetna Commercial |
$15,778.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,983.25
|
| Rate for Payer: Cash Price |
$10,245.67
|
| Rate for Payer: Cigna Commercial |
$17,007.82
|
| Rate for Payer: First Health Commercial |
$19,466.78
|
| Rate for Payer: Humana Commercial |
$17,417.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,802.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,122.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,147.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,032.39
|
| Rate for Payer: Ohio Health Group HMO |
$15,368.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,098.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,663.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,352.32
|
| Rate for Payer: PHCS Commercial |
$19,671.70
|
| Rate for Payer: United Healthcare All Payer |
$18,032.39
|
|
|
GRAFT Z ILIAC LEG ZSLE-16-74-Z
|
Facility
|
OP
|
$20,962.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.09 |
| Max. Negotiated Rate |
$20,123.71 |
| Rate for Payer: Aetna Commercial |
$16,140.89
|
| Rate for Payer: Anthem Medicaid |
$7,208.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,350.52
|
| Rate for Payer: Cash Price |
$10,481.10
|
| Rate for Payer: Cigna Commercial |
$17,398.63
|
| Rate for Payer: First Health Commercial |
$19,914.09
|
| Rate for Payer: Humana Commercial |
$17,817.87
|
| Rate for Payer: Humana KY Medicaid |
$7,208.90
|
| Rate for Payer: Kentucky WC Medicaid |
$7,282.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,470.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,288.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,353.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,446.74
|
| Rate for Payer: Ohio Health Group HMO |
$15,721.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,725.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,498.28
|
| Rate for Payer: PHCS Commercial |
$20,123.71
|
| Rate for Payer: United Healthcare All Payer |
$18,446.74
|
|
|
GRAFT Z ILIAC LEG ZSLE-16-74-Z
|
Facility
|
IP
|
$20,962.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.09 |
| Max. Negotiated Rate |
$20,123.71 |
| Rate for Payer: Aetna Commercial |
$16,140.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,350.52
|
| Rate for Payer: Cash Price |
$10,481.10
|
| Rate for Payer: Cigna Commercial |
$17,398.63
|
| Rate for Payer: First Health Commercial |
$19,914.09
|
| Rate for Payer: Humana Commercial |
$17,817.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,470.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,288.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,446.74
|
| Rate for Payer: Ohio Health Group HMO |
$15,721.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,725.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,498.28
|
| Rate for Payer: PHCS Commercial |
$20,123.71
|
| Rate for Payer: United Healthcare All Payer |
$18,446.74
|
|
|
GRAFT Z ILIAC LEG ZSLE-16-90-Z
|
Facility
|
OP
|
$19,819.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,576.57 |
| Max. Negotiated Rate |
$19,026.96 |
| Rate for Payer: Aetna Commercial |
$15,261.21
|
| Rate for Payer: Anthem Medicaid |
$6,816.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,459.40
|
| Rate for Payer: Cash Price |
$9,909.88
|
| Rate for Payer: Cigna Commercial |
$16,450.39
|
| Rate for Payer: First Health Commercial |
$18,828.76
|
| Rate for Payer: Humana Commercial |
$16,846.79
|
| Rate for Payer: Humana KY Medicaid |
$6,816.01
|
| Rate for Payer: Kentucky WC Medicaid |
$6,885.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,252.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,626.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,945.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,952.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,441.38
|
| Rate for Payer: Ohio Health Group HMO |
$14,864.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,963.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,576.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,144.12
|
| Rate for Payer: PHCS Commercial |
$19,026.96
|
| Rate for Payer: United Healthcare All Payer |
$17,441.38
|
|
|
GRAFT Z ILIAC LEG ZSLE-16-90-Z
|
Facility
|
IP
|
$19,819.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,576.57 |
| Max. Negotiated Rate |
$19,026.96 |
| Rate for Payer: Aetna Commercial |
$15,261.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,459.40
|
| Rate for Payer: Cash Price |
$9,909.88
|
| Rate for Payer: Cigna Commercial |
$16,450.39
|
| Rate for Payer: First Health Commercial |
$18,828.76
|
| Rate for Payer: Humana Commercial |
$16,846.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,252.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,626.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,945.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,441.38
|
| Rate for Payer: Ohio Health Group HMO |
$14,864.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,963.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,576.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,144.12
|
| Rate for Payer: PHCS Commercial |
$19,026.96
|
| Rate for Payer: United Healthcare All Payer |
$17,441.38
|
|
|
GRAFT Z ILIAC LEG ZSLE-20-39-Z
|
Facility
|
IP
|
$18,160.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,360.90 |
| Max. Negotiated Rate |
$17,434.37 |
| Rate for Payer: Aetna Commercial |
$13,983.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,165.42
|
| Rate for Payer: Cash Price |
$9,080.40
|
| Rate for Payer: Cigna Commercial |
$15,073.46
|
| Rate for Payer: First Health Commercial |
$17,252.76
|
| Rate for Payer: Humana Commercial |
$15,436.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,891.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,402.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,448.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,981.50
|
| Rate for Payer: Ohio Health Group HMO |
$13,620.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,632.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,360.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,629.85
|
| Rate for Payer: PHCS Commercial |
$17,434.37
|
| Rate for Payer: United Healthcare All Payer |
$15,981.50
|
|
|
GRAFT Z ILIAC LEG ZSLE-20-39-Z
|
Facility
|
OP
|
$18,160.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,360.90 |
| Max. Negotiated Rate |
$17,434.37 |
| Rate for Payer: Aetna Commercial |
$13,983.82
|
| Rate for Payer: Anthem Medicaid |
$6,245.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,165.42
|
| Rate for Payer: Cash Price |
$9,080.40
|
| Rate for Payer: Cigna Commercial |
$15,073.46
|
| Rate for Payer: First Health Commercial |
$17,252.76
|
| Rate for Payer: Humana Commercial |
$15,436.68
|
| Rate for Payer: Humana KY Medicaid |
$6,245.50
|
| Rate for Payer: Kentucky WC Medicaid |
$6,309.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,891.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,402.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,448.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,370.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,981.50
|
| Rate for Payer: Ohio Health Group HMO |
$13,620.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,632.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,360.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,629.85
|
| Rate for Payer: PHCS Commercial |
$17,434.37
|
| Rate for Payer: United Healthcare All Payer |
$15,981.50
|
|
|
GRAFT Z ILIAC LEG ZSLE-20-56-Z
|
Facility
|
IP
|
$20,962.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.09 |
| Max. Negotiated Rate |
$20,123.71 |
| Rate for Payer: Aetna Commercial |
$16,140.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,350.52
|
| Rate for Payer: Cash Price |
$10,481.10
|
| Rate for Payer: Cigna Commercial |
$17,398.63
|
| Rate for Payer: First Health Commercial |
$19,914.09
|
| Rate for Payer: Humana Commercial |
$17,817.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,470.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,288.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,446.74
|
| Rate for Payer: Ohio Health Group HMO |
$15,721.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,725.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,498.28
|
| Rate for Payer: PHCS Commercial |
$20,123.71
|
| Rate for Payer: United Healthcare All Payer |
$18,446.74
|
|
