|
GRAFT Z ILIAC LEG ZSLE-20-56-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-20-74-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-20-74-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-20-90-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-20-90-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-24-39-Z
|
Facility
|
IP
|
$17,754.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,308.02 |
| Max. Negotiated Rate |
$17,043.84 |
| Rate for Payer: Aetna Commercial |
$13,670.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,848.12
|
| Rate for Payer: Cash Price |
$8,877.00
|
| Rate for Payer: Cigna Commercial |
$14,735.82
|
| Rate for Payer: First Health Commercial |
$16,866.30
|
| Rate for Payer: Humana Commercial |
$15,090.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,558.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,102.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,326.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,623.52
|
| Rate for Payer: Ohio Health Group HMO |
$13,315.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,550.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,308.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,503.74
|
| Rate for Payer: PHCS Commercial |
$17,043.84
|
| Rate for Payer: United Healthcare All Payer |
$15,623.52
|
|
|
GRAFT Z ILIAC LEG ZSLE-24-39-Z
|
Facility
|
OP
|
$17,754.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,308.02 |
| Max. Negotiated Rate |
$17,043.84 |
| Rate for Payer: Aetna Commercial |
$13,670.58
|
| Rate for Payer: Anthem Medicaid |
$6,105.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,848.12
|
| Rate for Payer: Cash Price |
$8,877.00
|
| Rate for Payer: Cigna Commercial |
$14,735.82
|
| Rate for Payer: First Health Commercial |
$16,866.30
|
| Rate for Payer: Humana Commercial |
$15,090.90
|
| Rate for Payer: Humana KY Medicaid |
$6,105.60
|
| Rate for Payer: Kentucky WC Medicaid |
$6,167.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,558.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,102.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,326.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,228.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,623.52
|
| Rate for Payer: Ohio Health Group HMO |
$13,315.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,550.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,308.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,503.74
|
| Rate for Payer: PHCS Commercial |
$17,043.84
|
| Rate for Payer: United Healthcare All Payer |
$15,623.52
|
|
|
GRAFT Z ILIAC LEG ZSLE-24-56-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-24-56-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-24-74-Z
|
Facility
|
OP
|
$18,579.62
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.35 |
| Max. Negotiated Rate |
$17,836.44 |
| Rate for Payer: Aetna Commercial |
$14,306.31
|
| Rate for Payer: Anthem Medicaid |
$6,389.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,492.10
|
| Rate for Payer: Cash Price |
$9,289.81
|
| Rate for Payer: Cigna Commercial |
$15,421.08
|
| Rate for Payer: First Health Commercial |
$17,650.64
|
| Rate for Payer: Humana Commercial |
$15,792.68
|
| Rate for Payer: Humana KY Medicaid |
$6,389.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6,454.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,235.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,711.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,573.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,517.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,350.07
|
| Rate for Payer: Ohio Health Group HMO |
$13,934.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,715.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,759.68
|
| Rate for Payer: PHCS Commercial |
$17,836.44
|
| Rate for Payer: United Healthcare All Payer |
$16,350.07
|
|
|
GRAFT Z ILIAC LEG ZSLE-24-74-Z
|
Facility
|
IP
|
$18,579.62
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.35 |
| Max. Negotiated Rate |
$17,836.44 |
| Rate for Payer: Aetna Commercial |
$14,306.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,492.10
|
| Rate for Payer: Cash Price |
$9,289.81
|
| Rate for Payer: Cigna Commercial |
$15,421.08
|
| Rate for Payer: First Health Commercial |
$17,650.64
|
| Rate for Payer: Humana Commercial |
$15,792.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,235.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,711.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,573.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,350.07
|
| Rate for Payer: Ohio Health Group HMO |
$13,934.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,715.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,759.68
|
| Rate for Payer: PHCS Commercial |
$17,836.44
|
| Rate for Payer: United Healthcare All Payer |
$16,350.07
|
|
|
GRAFT Z MAIN BDY EXT ESBE3239Z
|
Facility
|
OP
|
$10,822.65
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,406.94 |
| Max. Negotiated Rate |
$10,389.74 |
| Rate for Payer: Aetna Commercial |
$8,333.44
|
| Rate for Payer: Anthem Medicaid |
$3,721.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,441.67
|
| Rate for Payer: Cash Price |
$5,411.32
|
| Rate for Payer: Cigna Commercial |
$8,982.80
|
| Rate for Payer: First Health Commercial |
$10,281.52
|
| Rate for Payer: Humana Commercial |
$9,199.25
|
| Rate for Payer: Humana KY Medicaid |
$3,721.91
|
| Rate for Payer: Kentucky WC Medicaid |
$3,759.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,874.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,987.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,246.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,796.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,523.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,116.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,164.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,406.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,355.02
|
| Rate for Payer: PHCS Commercial |
$10,389.74
|
| Rate for Payer: United Healthcare All Payer |
$9,523.93
|
|
|
GRAFT Z MAIN BDY EXT ESBE3239Z
|
Facility
|
IP
|
$10,822.65
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,406.94 |
| Max. Negotiated Rate |
$10,389.74 |
| Rate for Payer: Aetna Commercial |
$8,333.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,441.67
|
| Rate for Payer: Cash Price |
$5,411.32
|
| Rate for Payer: Cigna Commercial |
$8,982.80
|
| Rate for Payer: First Health Commercial |
$10,281.52
|
| Rate for Payer: Humana Commercial |
$9,199.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,874.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,987.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,246.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,523.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,116.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,164.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,406.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,355.02
|
| Rate for Payer: PHCS Commercial |
$10,389.74
|
| Rate for Payer: United Healthcare All Payer |
$9,523.93
|
|
|
GRAFT Z MAIN BDY TFFB-22-82-ZT
|
Facility
|
IP
|
$35,671.70
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,637.32 |
| Max. Negotiated Rate |
$34,244.83 |
| Rate for Payer: Aetna Commercial |
$27,467.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,823.93
|
| Rate for Payer: Cash Price |
$17,835.85
|
| Rate for Payer: Cigna Commercial |
$29,607.51
|
| Rate for Payer: First Health Commercial |
$33,888.12
|
| Rate for Payer: Humana Commercial |
$30,320.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,250.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,325.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,701.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,391.10
|
| Rate for Payer: Ohio Health Group HMO |
$26,753.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,134.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,637.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,058.23
|
| Rate for Payer: PHCS Commercial |
$34,244.83
|
| Rate for Payer: United Healthcare All Payer |
$31,391.10
|
|
|
GRAFT Z MAIN BDY TFFB-22-82-ZT
|
Facility
|
OP
|
$35,671.70
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,637.32 |
| Max. Negotiated Rate |
$34,244.83 |
| Rate for Payer: Aetna Commercial |
$27,467.21
|
| Rate for Payer: Anthem Medicaid |
$12,267.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,823.93
|
| Rate for Payer: Cash Price |
$17,835.85
|
| Rate for Payer: Cigna Commercial |
$29,607.51
|
| Rate for Payer: First Health Commercial |
$33,888.12
|
| Rate for Payer: Humana Commercial |
$30,320.94
|
| Rate for Payer: Humana KY Medicaid |
$12,267.50
|
| Rate for Payer: Kentucky WC Medicaid |
$12,392.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,250.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,325.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,701.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,513.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,391.10
|
| Rate for Payer: Ohio Health Group HMO |
$26,753.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,134.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,637.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,058.23
|
| Rate for Payer: PHCS Commercial |
$34,244.83
|
| Rate for Payer: United Healthcare All Payer |
$31,391.10
|
|
|
GRAFT Z MAIN BDY TFFB-22-96-ZT
|
Facility
|
IP
|
$36,598.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,757.84 |
| Max. Negotiated Rate |
$35,134.85 |
| Rate for Payer: Aetna Commercial |
$28,181.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,547.06
|
| Rate for Payer: Cash Price |
$18,299.40
|
| Rate for Payer: Cigna Commercial |
$30,377.00
|
| Rate for Payer: First Health Commercial |
$34,768.86
|
| Rate for Payer: Humana Commercial |
$31,108.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,011.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,009.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,979.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,206.94
|
| Rate for Payer: Ohio Health Group HMO |
$27,449.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,319.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,345.63
|
| Rate for Payer: PHCS Commercial |
$35,134.85
|
| Rate for Payer: United Healthcare All Payer |
$32,206.94
|
|
|
GRAFT Z MAIN BDY TFFB-22-96-ZT
|
Facility
|
OP
|
$36,598.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,757.84 |
| Max. Negotiated Rate |
$35,134.85 |
| Rate for Payer: Aetna Commercial |
$28,181.08
|
| Rate for Payer: Anthem Medicaid |
$12,586.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,547.06
|
| Rate for Payer: Cash Price |
$18,299.40
|
| Rate for Payer: Cigna Commercial |
$30,377.00
|
| Rate for Payer: First Health Commercial |
$34,768.86
|
| Rate for Payer: Humana Commercial |
$31,108.98
|
| Rate for Payer: Humana KY Medicaid |
$12,586.33
|
| Rate for Payer: Kentucky WC Medicaid |
$12,714.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,011.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,009.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,979.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,838.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,206.94
|
| Rate for Payer: Ohio Health Group HMO |
$27,449.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,319.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,345.63
|
| Rate for Payer: PHCS Commercial |
$35,134.85
|
| Rate for Payer: United Healthcare All Payer |
$32,206.94
|
|
|
GRAFT Z MAIN BDY TFFB-24-82-ZT
|
Facility
|
OP
|
$40,586.68
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,276.27 |
| Max. Negotiated Rate |
$38,963.21 |
| Rate for Payer: Aetna Commercial |
$31,251.74
|
| Rate for Payer: Anthem Medicaid |
$13,957.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,657.61
|
| Rate for Payer: Cash Price |
$20,293.34
|
| Rate for Payer: Cigna Commercial |
$33,686.94
|
| Rate for Payer: First Health Commercial |
$38,557.35
|
| Rate for Payer: Humana Commercial |
$34,498.68
|
| Rate for Payer: Humana KY Medicaid |
$13,957.76
|
| Rate for Payer: Kentucky WC Medicaid |
$14,099.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,281.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,176.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,237.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,716.28
|
| Rate for Payer: Ohio Health Group HMO |
$30,440.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,117.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,276.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,581.87
|
| Rate for Payer: PHCS Commercial |
$38,963.21
|
| Rate for Payer: United Healthcare All Payer |
$35,716.28
|
|
|
GRAFT Z MAIN BDY TFFB-24-82-ZT
|
Facility
|
IP
|
$40,586.68
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,276.27 |
| Max. Negotiated Rate |
$38,963.21 |
| Rate for Payer: Aetna Commercial |
$31,251.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,657.61
|
| Rate for Payer: Cash Price |
$20,293.34
|
| Rate for Payer: Cigna Commercial |
$33,686.94
|
| Rate for Payer: First Health Commercial |
$38,557.35
|
| Rate for Payer: Humana Commercial |
$34,498.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,281.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,176.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,716.28
|
| Rate for Payer: Ohio Health Group HMO |
$30,440.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,117.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,276.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,581.87
|
| Rate for Payer: PHCS Commercial |
$38,963.21
|
| Rate for Payer: United Healthcare All Payer |
$35,716.28
|
|
|
GRAFT Z MAIN BDY TFFB-24-96-ZT
|
Facility
|
IP
|
$36,598.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,757.84 |
| Max. Negotiated Rate |
$35,134.85 |
| Rate for Payer: Aetna Commercial |
$28,181.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,547.06
|
| Rate for Payer: Cash Price |
$18,299.40
|
| Rate for Payer: Cigna Commercial |
$30,377.00
|
| Rate for Payer: First Health Commercial |
$34,768.86
|
| Rate for Payer: Humana Commercial |
$31,108.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,011.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,009.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,979.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,206.94
|
| Rate for Payer: Ohio Health Group HMO |
$27,449.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,319.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,345.63
|
| Rate for Payer: PHCS Commercial |
$35,134.85
|
| Rate for Payer: United Healthcare All Payer |
$32,206.94
|
|
|
GRAFT Z MAIN BDY TFFB-24-96-ZT
|
Facility
|
OP
|
$36,598.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,757.84 |
| Max. Negotiated Rate |
$35,134.85 |
| Rate for Payer: Aetna Commercial |
$28,181.08
|
| Rate for Payer: Anthem Medicaid |
$12,586.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,547.06
|
| Rate for Payer: Cash Price |
$18,299.40
|
| Rate for Payer: Cigna Commercial |
$30,377.00
|
| Rate for Payer: First Health Commercial |
$34,768.86
|
| Rate for Payer: Humana Commercial |
$31,108.98
|
| Rate for Payer: Humana KY Medicaid |
$12,586.33
|
| Rate for Payer: Kentucky WC Medicaid |
$12,714.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,011.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,009.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,979.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,838.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,206.94
|
| Rate for Payer: Ohio Health Group HMO |
$27,449.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,319.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,345.63
|
| Rate for Payer: PHCS Commercial |
$35,134.85
|
| Rate for Payer: United Healthcare All Payer |
$32,206.94
|
|
|
GRAFT Z MAIN BDY TFFB-30-82-ZT
|
Facility
|
IP
|
$40,586.68
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,276.27 |
| Max. Negotiated Rate |
$38,963.21 |
| Rate for Payer: Aetna Commercial |
$31,251.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,657.61
|
| Rate for Payer: Cash Price |
$20,293.34
|
| Rate for Payer: Cigna Commercial |
$33,686.94
|
| Rate for Payer: First Health Commercial |
$38,557.35
|
| Rate for Payer: Humana Commercial |
$34,498.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,281.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,176.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,716.28
|
| Rate for Payer: Ohio Health Group HMO |
$30,440.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,117.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,276.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,581.87
|
| Rate for Payer: PHCS Commercial |
$38,963.21
|
| Rate for Payer: United Healthcare All Payer |
$35,716.28
|
|
|
GRAFT Z MAIN BDY TFFB-30-82-ZT
|
Facility
|
OP
|
$40,586.68
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,276.27 |
| Max. Negotiated Rate |
$38,963.21 |
| Rate for Payer: Aetna Commercial |
$31,251.74
|
| Rate for Payer: Anthem Medicaid |
$13,957.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,657.61
|
| Rate for Payer: Cash Price |
$20,293.34
|
| Rate for Payer: Cigna Commercial |
$33,686.94
|
| Rate for Payer: First Health Commercial |
$38,557.35
|
| Rate for Payer: Humana Commercial |
$34,498.68
|
| Rate for Payer: Humana KY Medicaid |
$13,957.76
|
| Rate for Payer: Kentucky WC Medicaid |
$14,099.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,281.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,176.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,237.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,716.28
|
| Rate for Payer: Ohio Health Group HMO |
$30,440.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,117.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,276.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,581.87
|
| Rate for Payer: PHCS Commercial |
$38,963.21
|
| Rate for Payer: United Healthcare All Payer |
$35,716.28
|
|
|
GRAFT Z MAIN BODY TFB-30-117
|
Facility
|
IP
|
$31,810.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,135.30 |
| Max. Negotiated Rate |
$30,537.60 |
| Rate for Payer: Aetna Commercial |
$24,493.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,811.80
|
| Rate for Payer: Cash Price |
$15,905.00
|
| Rate for Payer: Cigna Commercial |
$26,402.30
|
| Rate for Payer: First Health Commercial |
$30,219.50
|
| Rate for Payer: Humana Commercial |
$27,038.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,084.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,475.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,543.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,992.80
|
| Rate for Payer: Ohio Health Group HMO |
$23,857.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,135.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,861.10
|
| Rate for Payer: PHCS Commercial |
$30,537.60
|
| Rate for Payer: United Healthcare All Payer |
$27,992.80
|
|
|
GRAFT Z MAIN BODY TFB-30-117
|
Facility
|
OP
|
$31,810.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,135.30 |
| Max. Negotiated Rate |
$30,537.60 |
| Rate for Payer: Aetna Commercial |
$24,493.70
|
| Rate for Payer: Anthem Medicaid |
$10,939.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,811.80
|
| Rate for Payer: Cash Price |
$15,905.00
|
| Rate for Payer: Cigna Commercial |
$26,402.30
|
| Rate for Payer: First Health Commercial |
$30,219.50
|
| Rate for Payer: Humana Commercial |
$27,038.50
|
| Rate for Payer: Humana KY Medicaid |
$10,939.46
|
| Rate for Payer: Kentucky WC Medicaid |
$11,050.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,084.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,475.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,543.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,158.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,992.80
|
| Rate for Payer: Ohio Health Group HMO |
$23,857.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,135.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,861.10
|
| Rate for Payer: PHCS Commercial |
$30,537.60
|
| Rate for Payer: United Healthcare All Payer |
$27,992.80
|
|
