|
GRAFT Z PROX ZTEG-2P-40-108-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-40-135-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-40-135-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-40-162-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-40-162-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-40-216-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-40-216-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-42-108-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-42-108-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
|
|
|
GRAFT Z PROX ZTEG-2P-42-135-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-42-135-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-42-162-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-42-162-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-42-216-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-42-216-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 RENU ANC AX1-1-36-116
|
Facility
|
OP
|
$29,287.85
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,807.42 |
| Max. Negotiated Rate |
$28,116.34 |
| Rate for Payer: Aetna Commercial |
$22,551.64
|
| Rate for Payer: Anthem Medicaid |
$10,072.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,844.52
|
| Rate for Payer: Cash Price |
$14,643.92
|
| Rate for Payer: Cigna Commercial |
$24,308.92
|
| Rate for Payer: First Health Commercial |
$27,823.46
|
| Rate for Payer: Humana Commercial |
$24,894.67
|
| Rate for Payer: Humana KY Medicaid |
$10,072.09
|
| Rate for Payer: Kentucky WC Medicaid |
$10,174.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,016.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,614.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,786.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,274.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,773.31
|
| Rate for Payer: Ohio Health Group HMO |
$21,965.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,857.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,807.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,079.23
|
| Rate for Payer: PHCS Commercial |
$28,116.34
|
| Rate for Payer: United Healthcare All Payer |
$25,773.31
|
|
|
GRAFT Z RENU ANC AX1-1-36-116
|
Facility
|
IP
|
$29,287.85
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,807.42 |
| Max. Negotiated Rate |
$28,116.34 |
| Rate for Payer: Aetna Commercial |
$22,551.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,844.52
|
| Rate for Payer: Cash Price |
$14,643.92
|
| Rate for Payer: Cigna Commercial |
$24,308.92
|
| Rate for Payer: First Health Commercial |
$27,823.46
|
| Rate for Payer: Humana Commercial |
$24,894.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,016.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,614.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,786.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,773.31
|
| Rate for Payer: Ohio Health Group HMO |
$21,965.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,857.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,807.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,079.23
|
| Rate for Payer: PHCS Commercial |
$28,116.34
|
| Rate for Payer: United Healthcare All Payer |
$25,773.31
|
|
|
GRAFT Z RENU ANC AX1-2-22-113
|
Facility
|
OP
|
$27,886.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,625.21 |
| Max. Negotiated Rate |
$26,770.80 |
| Rate for Payer: Aetna Commercial |
$21,472.41
|
| Rate for Payer: Anthem Medicaid |
$9,590.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,751.28
|
| Rate for Payer: Cash Price |
$13,943.12
|
| Rate for Payer: Cigna Commercial |
$23,145.59
|
| Rate for Payer: First Health Commercial |
$26,491.94
|
| Rate for Payer: Humana Commercial |
$23,703.31
|
| Rate for Payer: Humana KY Medicaid |
$9,590.08
|
| Rate for Payer: Kentucky WC Medicaid |
$9,687.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,866.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,580.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,365.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,782.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,539.90
|
| Rate for Payer: Ohio Health Group HMO |
$20,914.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,577.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,625.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,644.74
|
| Rate for Payer: PHCS Commercial |
$26,770.80
|
| Rate for Payer: United Healthcare All Payer |
$24,539.90
|
|
|
GRAFT Z RENU ANC AX1-2-22-113
|
Facility
|
IP
|
$27,886.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,625.21 |
| Max. Negotiated Rate |
$26,770.80 |
| Rate for Payer: Aetna Commercial |
$21,472.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,751.28
|
| Rate for Payer: Cash Price |
$13,943.12
|
| Rate for Payer: Cigna Commercial |
$23,145.59
|
| Rate for Payer: First Health Commercial |
$26,491.94
|
| Rate for Payer: Humana Commercial |
$23,703.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,866.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,580.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,365.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,539.90
|
| Rate for Payer: Ohio Health Group HMO |
$20,914.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,577.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,625.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,644.74
|
| Rate for Payer: PHCS Commercial |
$26,770.80
|
| Rate for Payer: United Healthcare All Payer |
$24,539.90
|
|
|
GRAFT Z RENU ANC AX1-2-24-113
|
Facility
|
IP
|
$27,886.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,625.21 |
| Max. Negotiated Rate |
$26,770.80 |
| Rate for Payer: Aetna Commercial |
$21,472.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,751.28
|
| Rate for Payer: Cash Price |
$13,943.12
|
| Rate for Payer: Cigna Commercial |
$23,145.59
|
| Rate for Payer: First Health Commercial |
$26,491.94
|
| Rate for Payer: Humana Commercial |
$23,703.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,866.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,580.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,365.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,539.90
|
| Rate for Payer: Ohio Health Group HMO |
$20,914.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,577.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,625.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,644.74
|
| Rate for Payer: PHCS Commercial |
$26,770.80
|
| Rate for Payer: United Healthcare All Payer |
$24,539.90
|
|
|
GRAFT Z RENU ANC AX1-2-24-113
|
Facility
|
OP
|
$27,886.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,625.21 |
| Max. Negotiated Rate |
$26,770.80 |
| Rate for Payer: Aetna Commercial |
$21,472.41
|
| Rate for Payer: Anthem Medicaid |
$9,590.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,751.28
|
| Rate for Payer: Cash Price |
$13,943.12
|
| Rate for Payer: Cigna Commercial |
$23,145.59
|
| Rate for Payer: First Health Commercial |
$26,491.94
|
| Rate for Payer: Humana Commercial |
$23,703.31
|
| Rate for Payer: Humana KY Medicaid |
$9,590.08
|
| Rate for Payer: Kentucky WC Medicaid |
$9,687.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,866.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,580.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,365.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,782.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,539.90
|
| Rate for Payer: Ohio Health Group HMO |
$20,914.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,577.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,625.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,644.74
|
| Rate for Payer: PHCS Commercial |
$26,770.80
|
| Rate for Payer: United Healthcare All Payer |
$24,539.90
|
|
|
GRAFT Z RENU ANC AX1-2-28-113
|
Facility
|
IP
|
$27,886.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,625.21 |
| Max. Negotiated Rate |
$26,770.80 |
| Rate for Payer: Aetna Commercial |
$21,472.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,751.28
|
| Rate for Payer: Cash Price |
$13,943.12
|
| Rate for Payer: Cigna Commercial |
$23,145.59
|
| Rate for Payer: First Health Commercial |
$26,491.94
|
| Rate for Payer: Humana Commercial |
$23,703.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,866.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,580.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,365.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,539.90
|
| Rate for Payer: Ohio Health Group HMO |
$20,914.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,577.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,625.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,644.74
|
| Rate for Payer: PHCS Commercial |
$26,770.80
|
| Rate for Payer: United Healthcare All Payer |
$24,539.90
|
|
|
GRAFT Z RENU ANC AX1-2-28-113
|
Facility
|
OP
|
$27,886.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,625.21 |
| Max. Negotiated Rate |
$26,770.80 |
| Rate for Payer: Aetna Commercial |
$21,472.41
|
| Rate for Payer: Anthem Medicaid |
$9,590.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,751.28
|
| Rate for Payer: Cash Price |
$13,943.12
|
| Rate for Payer: Cigna Commercial |
$23,145.59
|
| Rate for Payer: First Health Commercial |
$26,491.94
|
| Rate for Payer: Humana Commercial |
$23,703.31
|
| Rate for Payer: Humana KY Medicaid |
$9,590.08
|
| Rate for Payer: Kentucky WC Medicaid |
$9,687.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,866.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,580.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,365.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,782.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,539.90
|
| Rate for Payer: Ohio Health Group HMO |
$20,914.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,577.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,625.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,644.74
|
| Rate for Payer: PHCS Commercial |
$26,770.80
|
| Rate for Payer: United Healthcare All Payer |
$24,539.90
|
|
|
GRAFT Z RENU ANC AX1-2-30-113
|
Facility
|
OP
|
$27,886.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,625.21 |
| Max. Negotiated Rate |
$26,770.80 |
| Rate for Payer: Aetna Commercial |
$21,472.41
|
| Rate for Payer: Anthem Medicaid |
$9,590.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,751.28
|
| Rate for Payer: Cash Price |
$13,943.12
|
| Rate for Payer: Cigna Commercial |
$23,145.59
|
| Rate for Payer: First Health Commercial |
$26,491.94
|
| Rate for Payer: Humana Commercial |
$23,703.31
|
| Rate for Payer: Humana KY Medicaid |
$9,590.08
|
| Rate for Payer: Kentucky WC Medicaid |
$9,687.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,866.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,580.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,365.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,782.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,539.90
|
| Rate for Payer: Ohio Health Group HMO |
$20,914.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,577.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,625.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,644.74
|
| Rate for Payer: PHCS Commercial |
$26,770.80
|
| Rate for Payer: United Healthcare All Payer |
$24,539.90
|
|
|
GRAFT Z RENU ANC AX1-2-30-113
|
Facility
|
IP
|
$27,886.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,625.21 |
| Max. Negotiated Rate |
$26,770.80 |
| Rate for Payer: Aetna Commercial |
$21,472.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,751.28
|
| Rate for Payer: Cash Price |
$13,943.12
|
| Rate for Payer: Cigna Commercial |
$23,145.59
|
| Rate for Payer: First Health Commercial |
$26,491.94
|
| Rate for Payer: Humana Commercial |
$23,703.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,866.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,580.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,365.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,539.90
|
| Rate for Payer: Ohio Health Group HMO |
$20,914.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,577.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,625.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,644.74
|
| Rate for Payer: PHCS Commercial |
$26,770.80
|
| Rate for Payer: United Healthcare All Payer |
$24,539.90
|
|
