|
GRAFT Z PROX ZTEG-2P-32-120-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-32-120-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-32-140-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-32-140-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-32-200-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-32-200-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: Anthem Medicaid |
$24,258.71
|
| 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: 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-34-127-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-34-127-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-34-152-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-34-152-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-34-202-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-34-202-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-36-127-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-36-127-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-36-152-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-36-152-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-36-202-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-36-202-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-38-127-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-38-127-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-38-152-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-38-152-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-38-202-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: Anthem Medicaid |
$24,258.71
|
| 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: 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-38-202-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-40-108-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
|
|
