|
GRAFT Z MAIN BODY TFFB-32-96-Z
|
Facility
|
OP
|
$39,544.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,140.77 |
| Max. Negotiated Rate |
$37,962.58 |
| Rate for Payer: Aetna Commercial |
$30,449.15
|
| Rate for Payer: Anthem Medicaid |
$13,599.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,844.59
|
| Rate for Payer: Cash Price |
$19,772.18
|
| Rate for Payer: Cigna Commercial |
$32,821.81
|
| Rate for Payer: First Health Commercial |
$37,567.13
|
| Rate for Payer: Humana Commercial |
$33,612.70
|
| Rate for Payer: Humana KY Medicaid |
$13,599.30
|
| Rate for Payer: Kentucky WC Medicaid |
$13,737.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,426.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,183.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,863.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,872.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,799.03
|
| Rate for Payer: Ohio Health Group HMO |
$29,658.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,908.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,140.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,258.75
|
| Rate for Payer: PHCS Commercial |
$37,962.58
|
| Rate for Payer: United Healthcare All Payer |
$34,799.03
|
|
|
GRAFT Z MAIN BODY TFFB-36-113
|
Facility
|
IP
|
$34,773.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,520.59 |
| Max. Negotiated Rate |
$33,382.85 |
| Rate for Payer: Aetna Commercial |
$26,775.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,123.56
|
| Rate for Payer: Cash Price |
$17,386.90
|
| Rate for Payer: Cigna Commercial |
$28,862.25
|
| Rate for Payer: First Health Commercial |
$33,035.11
|
| Rate for Payer: Humana Commercial |
$29,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,514.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,663.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,432.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,600.94
|
| Rate for Payer: Ohio Health Group HMO |
$26,080.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,954.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,520.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,779.88
|
| Rate for Payer: PHCS Commercial |
$33,382.85
|
| Rate for Payer: United Healthcare All Payer |
$30,600.94
|
|
|
GRAFT Z MAIN BODY TFFB-36-113
|
Facility
|
OP
|
$34,773.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,520.59 |
| Max. Negotiated Rate |
$33,382.85 |
| Rate for Payer: Aetna Commercial |
$26,775.83
|
| Rate for Payer: Anthem Medicaid |
$11,958.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,123.56
|
| Rate for Payer: Cash Price |
$17,386.90
|
| Rate for Payer: Cigna Commercial |
$28,862.25
|
| Rate for Payer: First Health Commercial |
$33,035.11
|
| Rate for Payer: Humana Commercial |
$29,557.73
|
| Rate for Payer: Humana KY Medicaid |
$11,958.71
|
| Rate for Payer: Kentucky WC Medicaid |
$12,080.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,514.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,663.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,432.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,198.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,600.94
|
| Rate for Payer: Ohio Health Group HMO |
$26,080.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,954.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,520.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,779.88
|
| Rate for Payer: PHCS Commercial |
$33,382.85
|
| Rate for Payer: United Healthcare All Payer |
$30,600.94
|
|
|
GRAFT Z MAIN BODY TFFB-36-131
|
Facility
|
OP
|
$34,773.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,520.59 |
| Max. Negotiated Rate |
$33,382.85 |
| Rate for Payer: Aetna Commercial |
$26,775.83
|
| Rate for Payer: Anthem Medicaid |
$11,958.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,123.56
|
| Rate for Payer: Cash Price |
$17,386.90
|
| Rate for Payer: Cigna Commercial |
$28,862.25
|
| Rate for Payer: First Health Commercial |
$33,035.11
|
| Rate for Payer: Humana Commercial |
$29,557.73
|
| Rate for Payer: Humana KY Medicaid |
$11,958.71
|
| Rate for Payer: Kentucky WC Medicaid |
$12,080.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,514.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,663.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,432.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,198.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,600.94
|
| Rate for Payer: Ohio Health Group HMO |
$26,080.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,954.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,520.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,779.88
|
| Rate for Payer: PHCS Commercial |
$33,382.85
|
| Rate for Payer: United Healthcare All Payer |
$30,600.94
|
|
|
GRAFT Z MAIN BODY TFFB-36-131
|
Facility
|
IP
|
$34,773.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,520.59 |
| Max. Negotiated Rate |
$33,382.85 |
| Rate for Payer: Aetna Commercial |
$26,775.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,123.56
|
| Rate for Payer: Cash Price |
$17,386.90
|
| Rate for Payer: Cigna Commercial |
$28,862.25
|
| Rate for Payer: First Health Commercial |
$33,035.11
|
| Rate for Payer: Humana Commercial |
$29,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,514.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,663.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,432.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,600.94
|
| Rate for Payer: Ohio Health Group HMO |
$26,080.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,954.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,520.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,779.88
|
| Rate for Payer: PHCS Commercial |
$33,382.85
|
| Rate for Payer: United Healthcare All Payer |
$30,600.94
|
|
|
GRAFT Z MAIN BODY TFFB-36-149
|
Facility
|
IP
|
$34,773.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,520.59 |
| Max. Negotiated Rate |
$33,382.85 |
| Rate for Payer: Aetna Commercial |
$26,775.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,123.56
|
| Rate for Payer: Cash Price |
$17,386.90
|
| Rate for Payer: Cigna Commercial |
$28,862.25
|
| Rate for Payer: First Health Commercial |
$33,035.11
|
| Rate for Payer: Humana Commercial |
$29,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,514.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,663.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,432.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,600.94
|
| Rate for Payer: Ohio Health Group HMO |
$26,080.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,954.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,520.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,779.88
|
| Rate for Payer: PHCS Commercial |
$33,382.85
|
| Rate for Payer: United Healthcare All Payer |
$30,600.94
|
|
|
GRAFT Z MAIN BODY TFFB-36-149
|
Facility
|
OP
|
$34,773.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,520.59 |
| Max. Negotiated Rate |
$33,382.85 |
| Rate for Payer: Aetna Commercial |
$26,775.83
|
| Rate for Payer: Anthem Medicaid |
$11,958.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,123.56
|
| Rate for Payer: Cash Price |
$17,386.90
|
| Rate for Payer: Cigna Commercial |
$28,862.25
|
| Rate for Payer: First Health Commercial |
$33,035.11
|
| Rate for Payer: Humana Commercial |
$29,557.73
|
| Rate for Payer: Humana KY Medicaid |
$11,958.71
|
| Rate for Payer: Kentucky WC Medicaid |
$12,080.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,514.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,663.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,432.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,198.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,600.94
|
| Rate for Payer: Ohio Health Group HMO |
$26,080.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,954.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,520.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,779.88
|
| Rate for Payer: PHCS Commercial |
$33,382.85
|
| Rate for Payer: United Healthcare All Payer |
$30,600.94
|
|
|
GRAFT Z MAIN BODY TFFB-36-95-Z
|
Facility
|
OP
|
$66,576.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,654.93 |
| Max. Negotiated Rate |
$63,913.34 |
| Rate for Payer: Aetna Commercial |
$51,263.83
|
| Rate for Payer: Anthem Medicaid |
$22,895.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51,929.59
|
| Rate for Payer: Cash Price |
$33,288.20
|
| Rate for Payer: Cigna Commercial |
$55,258.41
|
| Rate for Payer: First Health Commercial |
$63,247.58
|
| Rate for Payer: Humana Commercial |
$56,589.94
|
| Rate for Payer: Humana KY Medicaid |
$22,895.62
|
| Rate for Payer: Kentucky WC Medicaid |
$23,128.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54,592.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49,133.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,972.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,355.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$58,587.23
|
| Rate for Payer: Ohio Health Group HMO |
$49,932.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,315.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,654.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,638.68
|
| Rate for Payer: PHCS Commercial |
$63,913.34
|
| Rate for Payer: United Healthcare All Payer |
$58,587.23
|
|
|
GRAFT Z MAIN BODY TFFB-36-95-Z
|
Facility
|
IP
|
$66,576.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,654.93 |
| Max. Negotiated Rate |
$63,913.34 |
| Rate for Payer: Aetna Commercial |
$51,263.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51,929.59
|
| Rate for Payer: Cash Price |
$33,288.20
|
| Rate for Payer: Cigna Commercial |
$55,258.41
|
| Rate for Payer: First Health Commercial |
$63,247.58
|
| Rate for Payer: Humana Commercial |
$56,589.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54,592.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49,133.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,972.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$58,587.23
|
| Rate for Payer: Ohio Health Group HMO |
$49,932.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,315.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,654.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,638.68
|
| Rate for Payer: PHCS Commercial |
$63,913.34
|
| Rate for Payer: United Healthcare All Payer |
$58,587.23
|
|
|
GRAFT Z OCCLUDERS ESP-16-20
|
Facility
|
OP
|
$9,687.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.38 |
| Max. Negotiated Rate |
$9,300.05 |
| Rate for Payer: Aetna Commercial |
$7,459.41
|
| Rate for Payer: Anthem Medicaid |
$3,331.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,556.29
|
| Rate for Payer: Cash Price |
$4,843.77
|
| Rate for Payer: Cigna Commercial |
$8,040.67
|
| Rate for Payer: First Health Commercial |
$9,203.17
|
| Rate for Payer: Humana Commercial |
$8,234.42
|
| Rate for Payer: Humana KY Medicaid |
$3,331.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,365.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,149.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,398.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,525.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,003.14
|
| Rate for Payer: PHCS Commercial |
$9,300.05
|
| Rate for Payer: United Healthcare All Payer |
$8,525.04
|
|
|
GRAFT Z OCCLUDERS ESP-16-20
|
Facility
|
IP
|
$9,687.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.38 |
| Max. Negotiated Rate |
$9,300.05 |
| Rate for Payer: Aetna Commercial |
$7,459.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,556.29
|
| Rate for Payer: Cash Price |
$4,843.77
|
| Rate for Payer: Cigna Commercial |
$8,040.67
|
| Rate for Payer: First Health Commercial |
$9,203.17
|
| Rate for Payer: Humana Commercial |
$8,234.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,149.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,525.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,003.14
|
| Rate for Payer: PHCS Commercial |
$9,300.05
|
| Rate for Payer: United Healthcare All Payer |
$8,525.04
|
|
|
GRAFT Z OCCLUDERS ESP-24-20
|
Facility
|
IP
|
$4,580.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.40 |
| Max. Negotiated Rate |
$4,396.80 |
| Rate for Payer: Aetna Commercial |
$3,526.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,572.40
|
| Rate for Payer: Cash Price |
$2,290.00
|
| Rate for Payer: Cigna Commercial |
$3,801.40
|
| Rate for Payer: First Health Commercial |
$4,351.00
|
| Rate for Payer: Humana Commercial |
$3,893.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,755.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,380.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,374.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,030.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,435.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$916.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$595.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,419.80
|
| Rate for Payer: PHCS Commercial |
$4,396.80
|
| Rate for Payer: United Healthcare All Payer |
$4,030.40
|
|
|
GRAFT Z OCCLUDERS ESP-24-20
|
Facility
|
OP
|
$4,580.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.40 |
| Max. Negotiated Rate |
$4,396.80 |
| Rate for Payer: Aetna Commercial |
$3,526.60
|
| Rate for Payer: Anthem Medicaid |
$1,575.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,572.40
|
| Rate for Payer: Cash Price |
$2,290.00
|
| Rate for Payer: Cigna Commercial |
$3,801.40
|
| Rate for Payer: First Health Commercial |
$4,351.00
|
| Rate for Payer: Humana Commercial |
$3,893.00
|
| Rate for Payer: Humana KY Medicaid |
$1,575.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,591.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,755.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,380.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,374.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,606.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,030.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,435.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$916.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$595.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,419.80
|
| Rate for Payer: PHCS Commercial |
$4,396.80
|
| Rate for Payer: United Healthcare All Payer |
$4,030.40
|
|
|
GRAFT Z PROX ZTEG-2P-28-120-US
|
Facility
|
OP
|
$70,540.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,170.20 |
| Max. Negotiated Rate |
$67,718.40 |
| Rate for Payer: Aetna Commercial |
$54,315.80
|
| Rate for Payer: Anthem Medicaid |
$24,258.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,021.20
|
| Rate for Payer: Cash Price |
$35,270.00
|
| Rate for Payer: Cigna Commercial |
$58,548.20
|
| Rate for Payer: First Health Commercial |
$67,013.00
|
| Rate for Payer: Humana Commercial |
$59,959.00
|
| Rate for Payer: Humana KY Medicaid |
$24,258.71
|
| Rate for Payer: Kentucky WC Medicaid |
$24,505.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,842.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,058.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,162.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,745.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,075.20
|
| Rate for Payer: Ohio Health Group HMO |
$52,905.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,170.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,867.40
|
| Rate for Payer: PHCS Commercial |
$67,718.40
|
| Rate for Payer: United Healthcare All Payer |
$62,075.20
|
|
|
GRAFT Z PROX ZTEG-2P-28-120-US
|
Facility
|
IP
|
$70,540.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,170.20 |
| Max. Negotiated Rate |
$67,718.40 |
| Rate for Payer: Aetna Commercial |
$54,315.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,021.20
|
| Rate for Payer: Cash Price |
$35,270.00
|
| Rate for Payer: Cigna Commercial |
$58,548.20
|
| Rate for Payer: First Health Commercial |
$67,013.00
|
| Rate for Payer: Humana Commercial |
$59,959.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,842.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,058.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,162.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,075.20
|
| Rate for Payer: Ohio Health Group HMO |
$52,905.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,170.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,867.40
|
| Rate for Payer: PHCS Commercial |
$67,718.40
|
| Rate for Payer: United Healthcare All Payer |
$62,075.20
|
|
|
GRAFT Z PROX ZTEG-2P-28-140-US
|
Facility
|
IP
|
$70,540.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,170.20 |
| Max. Negotiated Rate |
$67,718.40 |
| Rate for Payer: Aetna Commercial |
$54,315.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,021.20
|
| Rate for Payer: Cash Price |
$35,270.00
|
| Rate for Payer: Cigna Commercial |
$58,548.20
|
| Rate for Payer: First Health Commercial |
$67,013.00
|
| Rate for Payer: Humana Commercial |
$59,959.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,842.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,058.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,162.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,075.20
|
| Rate for Payer: Ohio Health Group HMO |
$52,905.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,170.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,867.40
|
| Rate for Payer: PHCS Commercial |
$67,718.40
|
| Rate for Payer: United Healthcare All Payer |
$62,075.20
|
|
|
GRAFT Z PROX ZTEG-2P-28-140-US
|
Facility
|
OP
|
$70,540.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,170.20 |
| Max. Negotiated Rate |
$67,718.40 |
| Rate for Payer: Aetna Commercial |
$54,315.80
|
| Rate for Payer: Anthem Medicaid |
$24,258.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,021.20
|
| Rate for Payer: Cash Price |
$35,270.00
|
| Rate for Payer: Cigna Commercial |
$58,548.20
|
| Rate for Payer: First Health Commercial |
$67,013.00
|
| Rate for Payer: Humana Commercial |
$59,959.00
|
| Rate for Payer: Humana KY Medicaid |
$24,258.71
|
| Rate for Payer: Kentucky WC Medicaid |
$24,505.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,842.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,058.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,162.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,745.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,075.20
|
| Rate for Payer: Ohio Health Group HMO |
$52,905.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,170.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,867.40
|
| Rate for Payer: PHCS Commercial |
$67,718.40
|
| Rate for Payer: United Healthcare All Payer |
$62,075.20
|
|
|
GRAFT Z PROX ZTEG-2P-28-200-US
|
Facility
|
IP
|
$70,540.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,170.20 |
| Max. Negotiated Rate |
$67,718.40 |
| Rate for Payer: Aetna Commercial |
$54,315.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,021.20
|
| Rate for Payer: Cash Price |
$35,270.00
|
| Rate for Payer: Cigna Commercial |
$58,548.20
|
| Rate for Payer: First Health Commercial |
$67,013.00
|
| Rate for Payer: Humana Commercial |
$59,959.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,842.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,058.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,162.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,075.20
|
| Rate for Payer: Ohio Health Group HMO |
$52,905.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,170.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,867.40
|
| Rate for Payer: PHCS Commercial |
$67,718.40
|
| Rate for Payer: United Healthcare All Payer |
$62,075.20
|
|
|
GRAFT Z PROX ZTEG-2P-28-200-US
|
Facility
|
OP
|
$70,540.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,170.20 |
| Max. Negotiated Rate |
$67,718.40 |
| Rate for Payer: Aetna Commercial |
$54,315.80
|
| Rate for Payer: Anthem Medicaid |
$24,258.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,021.20
|
| Rate for Payer: Cash Price |
$35,270.00
|
| Rate for Payer: Cigna Commercial |
$58,548.20
|
| Rate for Payer: First Health Commercial |
$67,013.00
|
| Rate for Payer: Humana Commercial |
$59,959.00
|
| Rate for Payer: Humana KY Medicaid |
$24,258.71
|
| Rate for Payer: Kentucky WC Medicaid |
$24,505.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,842.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,058.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,162.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,745.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,075.20
|
| Rate for Payer: Ohio Health Group HMO |
$52,905.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,170.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,867.40
|
| Rate for Payer: PHCS Commercial |
$67,718.40
|
| Rate for Payer: United Healthcare All Payer |
$62,075.20
|
|
|
GRAFT Z PROX ZTEG-2P-30-120-US
|
Facility
|
IP
|
$70,540.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,170.20 |
| Max. Negotiated Rate |
$67,718.40 |
| Rate for Payer: Aetna Commercial |
$54,315.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,021.20
|
| Rate for Payer: Cash Price |
$35,270.00
|
| Rate for Payer: Cigna Commercial |
$58,548.20
|
| Rate for Payer: First Health Commercial |
$67,013.00
|
| Rate for Payer: Humana Commercial |
$59,959.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,842.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,058.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,162.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,075.20
|
| Rate for Payer: Ohio Health Group HMO |
$52,905.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,170.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,867.40
|
| Rate for Payer: PHCS Commercial |
$67,718.40
|
| Rate for Payer: United Healthcare All Payer |
$62,075.20
|
|
|
GRAFT Z PROX ZTEG-2P-30-120-US
|
Facility
|
OP
|
$70,540.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,170.20 |
| Max. Negotiated Rate |
$67,718.40 |
| Rate for Payer: Aetna Commercial |
$54,315.80
|
| Rate for Payer: Anthem Medicaid |
$24,258.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,021.20
|
| Rate for Payer: Cash Price |
$35,270.00
|
| Rate for Payer: Cigna Commercial |
$58,548.20
|
| Rate for Payer: First Health Commercial |
$67,013.00
|
| Rate for Payer: Humana Commercial |
$59,959.00
|
| Rate for Payer: Humana KY Medicaid |
$24,258.71
|
| Rate for Payer: Kentucky WC Medicaid |
$24,505.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,842.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,058.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,162.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,745.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,075.20
|
| Rate for Payer: Ohio Health Group HMO |
$52,905.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,170.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,867.40
|
| Rate for Payer: PHCS Commercial |
$67,718.40
|
| Rate for Payer: United Healthcare All Payer |
$62,075.20
|
|
|
GRAFT Z PROX ZTEG-2P-30-140-US
|
Facility
|
OP
|
$70,540.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,170.20 |
| Max. Negotiated Rate |
$67,718.40 |
| Rate for Payer: Aetna Commercial |
$54,315.80
|
| Rate for Payer: Anthem Medicaid |
$24,258.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,021.20
|
| Rate for Payer: Cash Price |
$35,270.00
|
| Rate for Payer: Cigna Commercial |
$58,548.20
|
| Rate for Payer: First Health Commercial |
$67,013.00
|
| Rate for Payer: Humana Commercial |
$59,959.00
|
| Rate for Payer: Humana KY Medicaid |
$24,258.71
|
| Rate for Payer: Kentucky WC Medicaid |
$24,505.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,842.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,058.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,162.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,745.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,075.20
|
| Rate for Payer: Ohio Health Group HMO |
$52,905.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,170.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,867.40
|
| Rate for Payer: PHCS Commercial |
$67,718.40
|
| Rate for Payer: United Healthcare All Payer |
$62,075.20
|
|
|
GRAFT Z PROX ZTEG-2P-30-140-US
|
Facility
|
IP
|
$70,540.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,170.20 |
| Max. Negotiated Rate |
$67,718.40 |
| Rate for Payer: Aetna Commercial |
$54,315.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,021.20
|
| Rate for Payer: Cash Price |
$35,270.00
|
| Rate for Payer: Cigna Commercial |
$58,548.20
|
| Rate for Payer: First Health Commercial |
$67,013.00
|
| Rate for Payer: Humana Commercial |
$59,959.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,842.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,058.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,162.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,075.20
|
| Rate for Payer: Ohio Health Group HMO |
$52,905.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,170.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,867.40
|
| Rate for Payer: PHCS Commercial |
$67,718.40
|
| Rate for Payer: United Healthcare All Payer |
$62,075.20
|
|
|
GRAFT Z PROX ZTEG-2P-30-200-US
|
Facility
|
IP
|
$70,540.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,170.20 |
| Max. Negotiated Rate |
$67,718.40 |
| Rate for Payer: Aetna Commercial |
$54,315.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,021.20
|
| Rate for Payer: Cash Price |
$35,270.00
|
| Rate for Payer: Cigna Commercial |
$58,548.20
|
| Rate for Payer: First Health Commercial |
$67,013.00
|
| Rate for Payer: Humana Commercial |
$59,959.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,842.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,058.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,162.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,075.20
|
| Rate for Payer: Ohio Health Group HMO |
$52,905.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,170.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,867.40
|
| Rate for Payer: PHCS Commercial |
$67,718.40
|
| Rate for Payer: United Healthcare All Payer |
$62,075.20
|
|
|
GRAFT Z PROX ZTEG-2P-30-200-US
|
Facility
|
OP
|
$70,540.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,170.20 |
| Max. Negotiated Rate |
$67,718.40 |
| Rate for Payer: Aetna Commercial |
$54,315.80
|
| Rate for Payer: Anthem Medicaid |
$24,258.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,021.20
|
| Rate for Payer: Cash Price |
$35,270.00
|
| Rate for Payer: Cigna Commercial |
$58,548.20
|
| Rate for Payer: First Health Commercial |
$67,013.00
|
| Rate for Payer: Humana Commercial |
$59,959.00
|
| Rate for Payer: Humana KY Medicaid |
$24,258.71
|
| Rate for Payer: Kentucky WC Medicaid |
$24,505.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,842.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,058.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,162.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,745.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,075.20
|
| Rate for Payer: Ohio Health Group HMO |
$52,905.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,170.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,867.40
|
| Rate for Payer: PHCS Commercial |
$67,718.40
|
| Rate for Payer: United Healthcare All Payer |
$62,075.20
|
|
