|
GRAFT AORTC EXT A34-34/C80-O20
|
Facility
|
IP
|
$21,856.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,556.88 |
| Max. Negotiated Rate |
$20,982.00 |
| Rate for Payer: Aetna Commercial |
$16,829.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,047.88
|
| Rate for Payer: Cash Price |
$10,928.12
|
| Rate for Payer: Cigna Commercial |
$18,140.69
|
| Rate for Payer: First Health Commercial |
$20,763.44
|
| Rate for Payer: Humana Commercial |
$18,577.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,922.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,129.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,556.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,233.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,392.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,014.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,080.81
|
| Rate for Payer: PHCS Commercial |
$20,982.00
|
| Rate for Payer: United Healthcare All Payer |
$19,233.50
|
|
|
GRAFT AORTC EXT A34-34/C80 V
|
Facility
|
IP
|
$24,871.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,461.38 |
| Max. Negotiated Rate |
$23,876.40 |
| Rate for Payer: Aetna Commercial |
$19,150.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,399.58
|
| Rate for Payer: Cash Price |
$12,435.62
|
| Rate for Payer: Cigna Commercial |
$20,643.14
|
| Rate for Payer: First Health Commercial |
$23,627.69
|
| Rate for Payer: Humana Commercial |
$21,140.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,394.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,354.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,461.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,886.70
|
| Rate for Payer: Ohio Health Group HMO |
$18,653.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,897.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,637.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,161.16
|
| Rate for Payer: PHCS Commercial |
$23,876.40
|
| Rate for Payer: United Healthcare All Payer |
$21,886.70
|
|
|
GRAFT AORTC EXT A34-34/C80 V
|
Facility
|
OP
|
$24,871.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,461.38 |
| Max. Negotiated Rate |
$23,876.40 |
| Rate for Payer: Aetna Commercial |
$19,150.86
|
| Rate for Payer: Anthem Medicaid |
$8,553.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,399.58
|
| Rate for Payer: Cash Price |
$12,435.62
|
| Rate for Payer: Cigna Commercial |
$20,643.14
|
| Rate for Payer: First Health Commercial |
$23,627.69
|
| Rate for Payer: Humana Commercial |
$21,140.56
|
| Rate for Payer: Humana KY Medicaid |
$8,553.22
|
| Rate for Payer: Kentucky WC Medicaid |
$8,640.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,394.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,354.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,461.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,724.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,886.70
|
| Rate for Payer: Ohio Health Group HMO |
$18,653.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,897.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,637.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,161.16
|
| Rate for Payer: PHCS Commercial |
$23,876.40
|
| Rate for Payer: United Healthcare All Payer |
$21,886.70
|
|
|
GRAFT AORT EXT A34-34/C100-O20
|
Facility
|
OP
|
$26,371.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,911.38 |
| Max. Negotiated Rate |
$25,316.40 |
| Rate for Payer: Aetna Commercial |
$20,305.86
|
| Rate for Payer: Anthem Medicaid |
$9,069.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,569.58
|
| Rate for Payer: Cash Price |
$13,185.62
|
| Rate for Payer: Cigna Commercial |
$21,888.14
|
| Rate for Payer: First Health Commercial |
$25,052.69
|
| Rate for Payer: Humana Commercial |
$22,415.56
|
| Rate for Payer: Humana KY Medicaid |
$9,069.07
|
| Rate for Payer: Kentucky WC Medicaid |
$9,161.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,624.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,461.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,911.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,251.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,206.70
|
| Rate for Payer: Ohio Health Group HMO |
$19,778.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,097.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,942.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,196.16
|
| Rate for Payer: PHCS Commercial |
$25,316.40
|
| Rate for Payer: United Healthcare All Payer |
$23,206.70
|
|
|
GRAFT AORT EXT A34-34/C100-O20
|
Facility
|
IP
|
$26,371.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,911.38 |
| Max. Negotiated Rate |
$25,316.40 |
| Rate for Payer: Aetna Commercial |
$20,305.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,569.58
|
| Rate for Payer: Cash Price |
$13,185.62
|
| Rate for Payer: Cigna Commercial |
$21,888.14
|
| Rate for Payer: First Health Commercial |
$25,052.69
|
| Rate for Payer: Humana Commercial |
$22,415.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,624.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,461.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,911.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,206.70
|
| Rate for Payer: Ohio Health Group HMO |
$19,778.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,097.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,942.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,196.16
|
| Rate for Payer: PHCS Commercial |
$25,316.40
|
| Rate for Payer: United Healthcare All Payer |
$23,206.70
|
|
|
GRAFT AORTIC BDY OVTN 20*80
|
Facility
|
OP
|
$33,125.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,937.50 |
| Max. Negotiated Rate |
$31,800.00 |
| Rate for Payer: Aetna Commercial |
$25,506.25
|
| Rate for Payer: Anthem Medicaid |
$11,391.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,837.50
|
| Rate for Payer: Cash Price |
$16,562.50
|
| Rate for Payer: Cigna Commercial |
$27,493.75
|
| Rate for Payer: First Health Commercial |
$31,468.75
|
| Rate for Payer: Humana Commercial |
$28,156.25
|
| Rate for Payer: Humana KY Medicaid |
$11,391.69
|
| Rate for Payer: Kentucky WC Medicaid |
$11,507.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,162.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,446.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,620.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,150.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,818.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,856.25
|
| Rate for Payer: PHCS Commercial |
$31,800.00
|
| Rate for Payer: United Healthcare All Payer |
$29,150.00
|
|
|
GRAFT AORTIC BDY OVTN 20*80
|
Facility
|
IP
|
$33,125.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,937.50 |
| Max. Negotiated Rate |
$31,800.00 |
| Rate for Payer: Aetna Commercial |
$25,506.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,837.50
|
| Rate for Payer: Cash Price |
$16,562.50
|
| Rate for Payer: Cigna Commercial |
$27,493.75
|
| Rate for Payer: First Health Commercial |
$31,468.75
|
| Rate for Payer: Humana Commercial |
$28,156.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,162.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,446.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,150.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,818.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,856.25
|
| Rate for Payer: PHCS Commercial |
$31,800.00
|
| Rate for Payer: United Healthcare All Payer |
$29,150.00
|
|
|
GRAFT AORTIC BDY OVTN 23*80
|
Facility
|
OP
|
$33,125.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,937.50 |
| Max. Negotiated Rate |
$31,800.00 |
| Rate for Payer: Aetna Commercial |
$25,506.25
|
| Rate for Payer: Anthem Medicaid |
$11,391.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,837.50
|
| Rate for Payer: Cash Price |
$16,562.50
|
| Rate for Payer: Cigna Commercial |
$27,493.75
|
| Rate for Payer: First Health Commercial |
$31,468.75
|
| Rate for Payer: Humana Commercial |
$28,156.25
|
| Rate for Payer: Humana KY Medicaid |
$11,391.69
|
| Rate for Payer: Kentucky WC Medicaid |
$11,507.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,162.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,446.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,620.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,150.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,818.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,856.25
|
| Rate for Payer: PHCS Commercial |
$31,800.00
|
| Rate for Payer: United Healthcare All Payer |
$29,150.00
|
|
|
GRAFT AORTIC BDY OVTN 23*80
|
Facility
|
IP
|
$33,125.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,937.50 |
| Max. Negotiated Rate |
$31,800.00 |
| Rate for Payer: Aetna Commercial |
$25,506.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,837.50
|
| Rate for Payer: Cash Price |
$16,562.50
|
| Rate for Payer: Cigna Commercial |
$27,493.75
|
| Rate for Payer: First Health Commercial |
$31,468.75
|
| Rate for Payer: Humana Commercial |
$28,156.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,162.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,446.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,150.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,818.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,856.25
|
| Rate for Payer: PHCS Commercial |
$31,800.00
|
| Rate for Payer: United Healthcare All Payer |
$29,150.00
|
|
|
GRAFT AORTIC BDY OVTN 26*80
|
Facility
|
IP
|
$33,125.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,937.50 |
| Max. Negotiated Rate |
$31,800.00 |
| Rate for Payer: Aetna Commercial |
$25,506.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,837.50
|
| Rate for Payer: Cash Price |
$16,562.50
|
| Rate for Payer: Cigna Commercial |
$27,493.75
|
| Rate for Payer: First Health Commercial |
$31,468.75
|
| Rate for Payer: Humana Commercial |
$28,156.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,162.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,446.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,150.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,818.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,856.25
|
| Rate for Payer: PHCS Commercial |
$31,800.00
|
| Rate for Payer: United Healthcare All Payer |
$29,150.00
|
|
|
GRAFT AORTIC BDY OVTN 26*80
|
Facility
|
OP
|
$33,125.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,937.50 |
| Max. Negotiated Rate |
$31,800.00 |
| Rate for Payer: Aetna Commercial |
$25,506.25
|
| Rate for Payer: Anthem Medicaid |
$11,391.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,837.50
|
| Rate for Payer: Cash Price |
$16,562.50
|
| Rate for Payer: Cigna Commercial |
$27,493.75
|
| Rate for Payer: First Health Commercial |
$31,468.75
|
| Rate for Payer: Humana Commercial |
$28,156.25
|
| Rate for Payer: Humana KY Medicaid |
$11,391.69
|
| Rate for Payer: Kentucky WC Medicaid |
$11,507.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,162.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,446.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,620.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,150.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,818.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,856.25
|
| Rate for Payer: PHCS Commercial |
$31,800.00
|
| Rate for Payer: United Healthcare All Payer |
$29,150.00
|
|
|
GRAFT AORTIC BDY OVTN 29*80
|
Facility
|
IP
|
$33,125.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,937.50 |
| Max. Negotiated Rate |
$31,800.00 |
| Rate for Payer: Aetna Commercial |
$25,506.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,837.50
|
| Rate for Payer: Cash Price |
$16,562.50
|
| Rate for Payer: Cigna Commercial |
$27,493.75
|
| Rate for Payer: First Health Commercial |
$31,468.75
|
| Rate for Payer: Humana Commercial |
$28,156.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,162.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,446.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,150.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,818.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,856.25
|
| Rate for Payer: PHCS Commercial |
$31,800.00
|
| Rate for Payer: United Healthcare All Payer |
$29,150.00
|
|
|
GRAFT AORTIC BDY OVTN 29*80
|
Facility
|
OP
|
$33,125.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,937.50 |
| Max. Negotiated Rate |
$31,800.00 |
| Rate for Payer: Aetna Commercial |
$25,506.25
|
| Rate for Payer: Anthem Medicaid |
$11,391.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,837.50
|
| Rate for Payer: Cash Price |
$16,562.50
|
| Rate for Payer: Cigna Commercial |
$27,493.75
|
| Rate for Payer: First Health Commercial |
$31,468.75
|
| Rate for Payer: Humana Commercial |
$28,156.25
|
| Rate for Payer: Humana KY Medicaid |
$11,391.69
|
| Rate for Payer: Kentucky WC Medicaid |
$11,507.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,162.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,446.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,620.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,150.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,818.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,856.25
|
| Rate for Payer: PHCS Commercial |
$31,800.00
|
| Rate for Payer: United Healthcare All Payer |
$29,150.00
|
|
|
GRAFT AORTIC BDY OVTN 34*80
|
Facility
|
OP
|
$33,125.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,937.50 |
| Max. Negotiated Rate |
$31,800.00 |
| Rate for Payer: Aetna Commercial |
$25,506.25
|
| Rate for Payer: Anthem Medicaid |
$11,391.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,837.50
|
| Rate for Payer: Cash Price |
$16,562.50
|
| Rate for Payer: Cigna Commercial |
$27,493.75
|
| Rate for Payer: First Health Commercial |
$31,468.75
|
| Rate for Payer: Humana Commercial |
$28,156.25
|
| Rate for Payer: Humana KY Medicaid |
$11,391.69
|
| Rate for Payer: Kentucky WC Medicaid |
$11,507.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,162.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,446.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,620.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,150.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,818.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,856.25
|
| Rate for Payer: PHCS Commercial |
$31,800.00
|
| Rate for Payer: United Healthcare All Payer |
$29,150.00
|
|
|
GRAFT AORTIC BDY OVTN 34*80
|
Facility
|
IP
|
$33,125.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,937.50 |
| Max. Negotiated Rate |
$31,800.00 |
| Rate for Payer: Aetna Commercial |
$25,506.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,837.50
|
| Rate for Payer: Cash Price |
$16,562.50
|
| Rate for Payer: Cigna Commercial |
$27,493.75
|
| Rate for Payer: First Health Commercial |
$31,468.75
|
| Rate for Payer: Humana Commercial |
$28,156.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,162.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,446.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,150.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,818.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,856.25
|
| Rate for Payer: PHCS Commercial |
$31,800.00
|
| Rate for Payer: United Healthcare All Payer |
$29,150.00
|
|
|
GRAFT AORTIC BDY OVTN IX 20*80
|
Facility
|
IP
|
$75,096.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,528.86 |
| Max. Negotiated Rate |
$72,092.35 |
| Rate for Payer: Aetna Commercial |
$57,824.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,575.04
|
| Rate for Payer: Cash Price |
$37,548.10
|
| Rate for Payer: Cigna Commercial |
$62,329.85
|
| Rate for Payer: First Health Commercial |
$71,341.39
|
| Rate for Payer: Humana Commercial |
$63,831.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,578.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,421.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,528.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,084.66
|
| Rate for Payer: Ohio Health Group HMO |
$56,322.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,076.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,816.38
|
| Rate for Payer: PHCS Commercial |
$72,092.35
|
| Rate for Payer: United Healthcare All Payer |
$66,084.66
|
|
|
GRAFT AORTIC BDY OVTN IX 20*80
|
Facility
|
OP
|
$75,096.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,528.86 |
| Max. Negotiated Rate |
$72,092.35 |
| Rate for Payer: Aetna Commercial |
$57,824.07
|
| Rate for Payer: Anthem Medicaid |
$25,825.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,575.04
|
| Rate for Payer: Cash Price |
$37,548.10
|
| Rate for Payer: Cigna Commercial |
$62,329.85
|
| Rate for Payer: First Health Commercial |
$71,341.39
|
| Rate for Payer: Humana Commercial |
$63,831.77
|
| Rate for Payer: Humana KY Medicaid |
$25,825.58
|
| Rate for Payer: Kentucky WC Medicaid |
$26,088.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,578.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,421.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,528.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,343.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,084.66
|
| Rate for Payer: Ohio Health Group HMO |
$56,322.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,076.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,816.38
|
| Rate for Payer: PHCS Commercial |
$72,092.35
|
| Rate for Payer: United Healthcare All Payer |
$66,084.66
|
|
|
GRAFT AORTIC BDY OVTN IX 23*80
|
Facility
|
IP
|
$82,696.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,808.86 |
| Max. Negotiated Rate |
$79,388.35 |
| Rate for Payer: Aetna Commercial |
$63,676.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,503.04
|
| Rate for Payer: Cash Price |
$41,348.10
|
| Rate for Payer: Cigna Commercial |
$68,637.85
|
| Rate for Payer: First Health Commercial |
$78,561.39
|
| Rate for Payer: Humana Commercial |
$70,291.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,810.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,029.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,808.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,772.66
|
| Rate for Payer: Ohio Health Group HMO |
$62,022.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,156.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,945.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,060.38
|
| Rate for Payer: PHCS Commercial |
$79,388.35
|
| Rate for Payer: United Healthcare All Payer |
$72,772.66
|
|
|
GRAFT AORTIC BDY OVTN IX 23*80
|
Facility
|
OP
|
$82,696.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,808.86 |
| Max. Negotiated Rate |
$79,388.35 |
| Rate for Payer: Aetna Commercial |
$63,676.07
|
| Rate for Payer: Anthem Medicaid |
$28,439.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,503.04
|
| Rate for Payer: Cash Price |
$41,348.10
|
| Rate for Payer: Cigna Commercial |
$68,637.85
|
| Rate for Payer: First Health Commercial |
$78,561.39
|
| Rate for Payer: Humana Commercial |
$70,291.77
|
| Rate for Payer: Humana KY Medicaid |
$28,439.22
|
| Rate for Payer: Kentucky WC Medicaid |
$28,728.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,810.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,029.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,808.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,009.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,772.66
|
| Rate for Payer: Ohio Health Group HMO |
$62,022.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,156.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,945.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,060.38
|
| Rate for Payer: PHCS Commercial |
$79,388.35
|
| Rate for Payer: United Healthcare All Payer |
$72,772.66
|
|
|
GRAFT AORTIC BDY OVTN IX 26*80
|
Facility
|
IP
|
$76,996.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,098.86 |
| Max. Negotiated Rate |
$73,916.35 |
| Rate for Payer: Aetna Commercial |
$59,287.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,057.04
|
| Rate for Payer: Cash Price |
$38,498.10
|
| Rate for Payer: Cigna Commercial |
$63,906.85
|
| Rate for Payer: First Health Commercial |
$73,146.39
|
| Rate for Payer: Humana Commercial |
$65,446.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,136.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,823.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,098.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,756.66
|
| Rate for Payer: Ohio Health Group HMO |
$57,747.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,596.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,986.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,127.38
|
| Rate for Payer: PHCS Commercial |
$73,916.35
|
| Rate for Payer: United Healthcare All Payer |
$67,756.66
|
|
|
GRAFT AORTIC BDY OVTN IX 26*80
|
Facility
|
OP
|
$76,996.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,098.86 |
| Max. Negotiated Rate |
$73,916.35 |
| Rate for Payer: Aetna Commercial |
$59,287.07
|
| Rate for Payer: Anthem Medicaid |
$26,478.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,057.04
|
| Rate for Payer: Cash Price |
$38,498.10
|
| Rate for Payer: Cigna Commercial |
$63,906.85
|
| Rate for Payer: First Health Commercial |
$73,146.39
|
| Rate for Payer: Humana Commercial |
$65,446.77
|
| Rate for Payer: Humana KY Medicaid |
$26,478.99
|
| Rate for Payer: Kentucky WC Medicaid |
$26,748.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,136.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,823.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,098.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,010.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,756.66
|
| Rate for Payer: Ohio Health Group HMO |
$57,747.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,596.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,986.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,127.38
|
| Rate for Payer: PHCS Commercial |
$73,916.35
|
| Rate for Payer: United Healthcare All Payer |
$67,756.66
|
|
|
GRAFT AORTIC BDY OVTN IX 34*80
|
Facility
|
OP
|
$75,096.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,528.86 |
| Max. Negotiated Rate |
$72,092.35 |
| Rate for Payer: Aetna Commercial |
$57,824.07
|
| Rate for Payer: Anthem Medicaid |
$25,825.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,575.04
|
| Rate for Payer: Cash Price |
$37,548.10
|
| Rate for Payer: Cigna Commercial |
$62,329.85
|
| Rate for Payer: First Health Commercial |
$71,341.39
|
| Rate for Payer: Humana Commercial |
$63,831.77
|
| Rate for Payer: Humana KY Medicaid |
$25,825.58
|
| Rate for Payer: Kentucky WC Medicaid |
$26,088.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,578.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,421.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,528.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,343.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,084.66
|
| Rate for Payer: Ohio Health Group HMO |
$56,322.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,076.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,816.38
|
| Rate for Payer: PHCS Commercial |
$72,092.35
|
| Rate for Payer: United Healthcare All Payer |
$66,084.66
|
|
|
GRAFT AORTIC BDY OVTN IX 34*80
|
Facility
|
IP
|
$75,096.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,528.86 |
| Max. Negotiated Rate |
$72,092.35 |
| Rate for Payer: Aetna Commercial |
$57,824.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,575.04
|
| Rate for Payer: Cash Price |
$37,548.10
|
| Rate for Payer: Cigna Commercial |
$62,329.85
|
| Rate for Payer: First Health Commercial |
$71,341.39
|
| Rate for Payer: Humana Commercial |
$63,831.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,578.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,421.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,528.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,084.66
|
| Rate for Payer: Ohio Health Group HMO |
$56,322.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,076.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,816.38
|
| Rate for Payer: PHCS Commercial |
$72,092.35
|
| Rate for Payer: United Healthcare All Payer |
$66,084.66
|
|
|
GRAFT AORTIC EXT A25-25/C55
|
Facility
|
IP
|
$26,371.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,911.38 |
| Max. Negotiated Rate |
$25,316.40 |
| Rate for Payer: Aetna Commercial |
$20,305.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,569.58
|
| Rate for Payer: Cash Price |
$13,185.62
|
| Rate for Payer: Cigna Commercial |
$21,888.14
|
| Rate for Payer: First Health Commercial |
$25,052.69
|
| Rate for Payer: Humana Commercial |
$22,415.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,624.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,461.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,911.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,206.70
|
| Rate for Payer: Ohio Health Group HMO |
$19,778.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,097.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,942.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,196.16
|
| Rate for Payer: PHCS Commercial |
$25,316.40
|
| Rate for Payer: United Healthcare All Payer |
$23,206.70
|
|
|
GRAFT AORTIC EXT A25-25/C55
|
Facility
|
OP
|
$26,371.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,911.38 |
| Max. Negotiated Rate |
$25,316.40 |
| Rate for Payer: Aetna Commercial |
$20,305.86
|
| Rate for Payer: Anthem Medicaid |
$9,069.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,569.58
|
| Rate for Payer: Cash Price |
$13,185.62
|
| Rate for Payer: Cigna Commercial |
$21,888.14
|
| Rate for Payer: First Health Commercial |
$25,052.69
|
| Rate for Payer: Humana Commercial |
$22,415.56
|
| Rate for Payer: Humana KY Medicaid |
$9,069.07
|
| Rate for Payer: Kentucky WC Medicaid |
$9,161.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,624.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,461.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,911.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,251.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,206.70
|
| Rate for Payer: Ohio Health Group HMO |
$19,778.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,097.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,942.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,196.16
|
| Rate for Payer: PHCS Commercial |
$25,316.40
|
| Rate for Payer: United Healthcare All Payer |
$23,206.70
|
|
