|
GRAFT EPIFIX 2*3CM
|
Facility
|
OP
|
$7,175.60
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
27000054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,152.68 |
| Max. Negotiated Rate |
$6,888.58 |
| Rate for Payer: Aetna Commercial |
$5,525.21
|
| Rate for Payer: Anthem Medicaid |
$2,467.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,596.97
|
| Rate for Payer: Cash Price |
$3,587.80
|
| Rate for Payer: Cigna Commercial |
$5,955.75
|
| Rate for Payer: First Health Commercial |
$6,816.82
|
| Rate for Payer: Humana Commercial |
$6,099.26
|
| Rate for Payer: Humana KY Medicaid |
$2,467.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,492.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,883.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,295.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,152.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,517.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,314.53
|
| Rate for Payer: Ohio Health Group HMO |
$5,381.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,740.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,242.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,951.16
|
| Rate for Payer: PHCS Commercial |
$6,888.58
|
| Rate for Payer: United Healthcare All Payer |
$6,314.53
|
|
|
GRAFT EXCLDR CNTRA16*14.5*10 1
|
Facility
|
IP
|
$24,425.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,327.50 |
| Max. Negotiated Rate |
$23,448.00 |
| Rate for Payer: Aetna Commercial |
$18,807.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,051.50
|
| Rate for Payer: Cash Price |
$12,212.50
|
| Rate for Payer: Cigna Commercial |
$20,272.75
|
| Rate for Payer: First Health Commercial |
$23,203.75
|
| Rate for Payer: Humana Commercial |
$20,761.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,028.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,025.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,327.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,494.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,249.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,853.25
|
| Rate for Payer: PHCS Commercial |
$23,448.00
|
| Rate for Payer: United Healthcare All Payer |
$21,494.00
|
|
|
GRAFT EXCLDR CNTRA16*14.5*10 1
|
Facility
|
OP
|
$24,425.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,327.50 |
| Max. Negotiated Rate |
$23,448.00 |
| Rate for Payer: Aetna Commercial |
$18,807.25
|
| Rate for Payer: Anthem Medicaid |
$8,399.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,051.50
|
| Rate for Payer: Cash Price |
$12,212.50
|
| Rate for Payer: Cigna Commercial |
$20,272.75
|
| Rate for Payer: First Health Commercial |
$23,203.75
|
| Rate for Payer: Humana Commercial |
$20,761.25
|
| Rate for Payer: Humana KY Medicaid |
$8,399.76
|
| Rate for Payer: Kentucky WC Medicaid |
$8,485.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,028.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,025.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,327.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,568.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,494.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,249.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,853.25
|
| Rate for Payer: PHCS Commercial |
$23,448.00
|
| Rate for Payer: United Healthcare All Payer |
$21,494.00
|
|
|
GRAFT EXCLDR CONTRA16*12*10 12
|
Facility
|
IP
|
$23,213.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,964.12 |
| Max. Negotiated Rate |
$22,285.20 |
| Rate for Payer: Aetna Commercial |
$17,874.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,106.72
|
| Rate for Payer: Cash Price |
$11,606.88
|
| Rate for Payer: Cigna Commercial |
$19,267.41
|
| Rate for Payer: First Health Commercial |
$22,053.06
|
| Rate for Payer: Humana Commercial |
$19,731.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,035.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,131.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,964.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,428.10
|
| Rate for Payer: Ohio Health Group HMO |
$17,410.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,571.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,195.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,017.49
|
| Rate for Payer: PHCS Commercial |
$22,285.20
|
| Rate for Payer: United Healthcare All Payer |
$20,428.10
|
|
|
GRAFT EXCLDR CONTRA16*12*10 12
|
Facility
|
OP
|
$23,213.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,964.12 |
| Max. Negotiated Rate |
$22,285.20 |
| Rate for Payer: Aetna Commercial |
$17,874.59
|
| Rate for Payer: Anthem Medicaid |
$7,983.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,106.72
|
| Rate for Payer: Cash Price |
$11,606.88
|
| Rate for Payer: Cigna Commercial |
$19,267.41
|
| Rate for Payer: First Health Commercial |
$22,053.06
|
| Rate for Payer: Humana Commercial |
$19,731.69
|
| Rate for Payer: Humana KY Medicaid |
$7,983.21
|
| Rate for Payer: Kentucky WC Medicaid |
$8,064.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,035.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,131.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,964.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,143.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,428.10
|
| Rate for Payer: Ohio Health Group HMO |
$17,410.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,571.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,195.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,017.49
|
| Rate for Payer: PHCS Commercial |
$22,285.20
|
| Rate for Payer: United Healthcare All Payer |
$20,428.10
|
|
|
GRAFT EXCLDR CONTRA16*27*12 15
|
Facility
|
IP
|
$23,213.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,964.12 |
| Max. Negotiated Rate |
$22,285.20 |
| Rate for Payer: Aetna Commercial |
$17,874.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,106.72
|
| Rate for Payer: Cash Price |
$11,606.88
|
| Rate for Payer: Cigna Commercial |
$19,267.41
|
| Rate for Payer: First Health Commercial |
$22,053.06
|
| Rate for Payer: Humana Commercial |
$19,731.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,035.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,131.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,964.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,428.10
|
| Rate for Payer: Ohio Health Group HMO |
$17,410.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,571.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,195.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,017.49
|
| Rate for Payer: PHCS Commercial |
$22,285.20
|
| Rate for Payer: United Healthcare All Payer |
$20,428.10
|
|
|
GRAFT EXCLDR CONTRA16*27*12 15
|
Facility
|
OP
|
$23,213.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,964.12 |
| Max. Negotiated Rate |
$22,285.20 |
| Rate for Payer: Aetna Commercial |
$17,874.59
|
| Rate for Payer: Anthem Medicaid |
$7,983.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,106.72
|
| Rate for Payer: Cash Price |
$11,606.88
|
| Rate for Payer: Cigna Commercial |
$19,267.41
|
| Rate for Payer: First Health Commercial |
$22,053.06
|
| Rate for Payer: Humana Commercial |
$19,731.69
|
| Rate for Payer: Humana KY Medicaid |
$7,983.21
|
| Rate for Payer: Kentucky WC Medicaid |
$8,064.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,035.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,131.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,964.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,143.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,428.10
|
| Rate for Payer: Ohio Health Group HMO |
$17,410.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,571.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,195.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,017.49
|
| Rate for Payer: PHCS Commercial |
$22,285.20
|
| Rate for Payer: United Healthcare All Payer |
$20,428.10
|
|
|
GRAFT EXCLDR TRNK 28.5*14.5*16
|
Facility
|
IP
|
$74,514.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,354.44 |
| Max. Negotiated Rate |
$71,534.21 |
| Rate for Payer: Aetna Commercial |
$57,376.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,121.54
|
| Rate for Payer: Cash Price |
$37,257.40
|
| Rate for Payer: Cigna Commercial |
$61,847.28
|
| Rate for Payer: First Health Commercial |
$70,789.06
|
| Rate for Payer: Humana Commercial |
$63,337.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,102.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,991.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,354.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,573.02
|
| Rate for Payer: Ohio Health Group HMO |
$55,886.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59,611.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64,827.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,415.21
|
| Rate for Payer: PHCS Commercial |
$71,534.21
|
| Rate for Payer: United Healthcare All Payer |
$65,573.02
|
|
|
GRAFT EXCLDR TRNK 28.5*14.5*16
|
Facility
|
OP
|
$74,514.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,354.44 |
| Max. Negotiated Rate |
$71,534.21 |
| Rate for Payer: Aetna Commercial |
$57,376.40
|
| Rate for Payer: Anthem Medicaid |
$25,625.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,121.54
|
| Rate for Payer: Cash Price |
$37,257.40
|
| Rate for Payer: Cigna Commercial |
$61,847.28
|
| Rate for Payer: First Health Commercial |
$70,789.06
|
| Rate for Payer: Humana Commercial |
$63,337.58
|
| Rate for Payer: Humana KY Medicaid |
$25,625.64
|
| Rate for Payer: Kentucky WC Medicaid |
$25,886.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,102.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,991.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,354.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,139.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,573.02
|
| Rate for Payer: Ohio Health Group HMO |
$55,886.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59,611.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64,827.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,415.21
|
| Rate for Payer: PHCS Commercial |
$71,534.21
|
| Rate for Payer: United Healthcare All Payer |
$65,573.02
|
|
|
GRAFT EXCLUDER ILI 23*10*10 1
|
Facility
|
OP
|
$73,488.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,046.64 |
| Max. Negotiated Rate |
$70,549.25 |
| Rate for Payer: Aetna Commercial |
$56,586.38
|
| Rate for Payer: Anthem Medicaid |
$25,272.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,321.26
|
| Rate for Payer: Cash Price |
$36,744.40
|
| Rate for Payer: Cigna Commercial |
$60,995.70
|
| Rate for Payer: First Health Commercial |
$69,814.36
|
| Rate for Payer: Humana Commercial |
$62,465.48
|
| Rate for Payer: Humana KY Medicaid |
$25,272.80
|
| Rate for Payer: Kentucky WC Medicaid |
$25,530.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,260.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,234.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,046.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,779.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,670.14
|
| Rate for Payer: Ohio Health Group HMO |
$55,116.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,791.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,935.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,707.27
|
| Rate for Payer: PHCS Commercial |
$70,549.25
|
| Rate for Payer: United Healthcare All Payer |
$64,670.14
|
|
|
GRAFT EXCLUDER ILI 23*10*10 1
|
Facility
|
IP
|
$73,488.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,046.64 |
| Max. Negotiated Rate |
$70,549.25 |
| Rate for Payer: Aetna Commercial |
$56,586.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,321.26
|
| Rate for Payer: Cash Price |
$36,744.40
|
| Rate for Payer: Cigna Commercial |
$60,995.70
|
| Rate for Payer: First Health Commercial |
$69,814.36
|
| Rate for Payer: Humana Commercial |
$62,465.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,260.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,234.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,046.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,670.14
|
| Rate for Payer: Ohio Health Group HMO |
$55,116.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,791.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,935.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,707.27
|
| Rate for Payer: PHCS Commercial |
$70,549.25
|
| Rate for Payer: United Healthcare All Payer |
$64,670.14
|
|
|
GRAFT EXXCEL 5*70 STRAIGHT
|
Facility
|
OP
|
$5,195.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,558.50 |
| Max. Negotiated Rate |
$4,987.20 |
| Rate for Payer: Aetna Commercial |
$4,000.15
|
| Rate for Payer: Anthem Medicaid |
$1,786.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,052.10
|
| Rate for Payer: Cash Price |
$2,597.50
|
| Rate for Payer: Cigna Commercial |
$4,311.85
|
| Rate for Payer: First Health Commercial |
$4,935.25
|
| Rate for Payer: Humana Commercial |
$4,415.75
|
| Rate for Payer: Humana KY Medicaid |
$1,786.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,804.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,259.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,833.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,558.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,822.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,571.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,896.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,519.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,584.55
|
| Rate for Payer: PHCS Commercial |
$4,987.20
|
| Rate for Payer: United Healthcare All Payer |
$4,571.60
|
|
|
GRAFT EXXCEL 5*70 STRAIGHT
|
Facility
|
IP
|
$5,195.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,558.50 |
| Max. Negotiated Rate |
$4,987.20 |
| Rate for Payer: Aetna Commercial |
$4,000.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,052.10
|
| Rate for Payer: Cash Price |
$2,597.50
|
| Rate for Payer: Cigna Commercial |
$4,311.85
|
| Rate for Payer: First Health Commercial |
$4,935.25
|
| Rate for Payer: Humana Commercial |
$4,415.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,259.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,833.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,558.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,571.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,896.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,519.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,584.55
|
| Rate for Payer: PHCS Commercial |
$4,987.20
|
| Rate for Payer: United Healthcare All Payer |
$4,571.60
|
|
|
GRAFT EXXCEL 6*40*40 STR SUP
|
Facility
|
OP
|
$4,895.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,468.50 |
| Max. Negotiated Rate |
$4,699.20 |
| Rate for Payer: Aetna Commercial |
$3,769.15
|
| Rate for Payer: Anthem Medicaid |
$1,683.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,818.10
|
| Rate for Payer: Cash Price |
$2,447.50
|
| Rate for Payer: Cigna Commercial |
$4,062.85
|
| Rate for Payer: First Health Commercial |
$4,650.25
|
| Rate for Payer: Humana Commercial |
$4,160.75
|
| Rate for Payer: Humana KY Medicaid |
$1,683.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,700.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,013.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,612.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,468.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,717.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,307.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,916.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,258.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,377.55
|
| Rate for Payer: PHCS Commercial |
$4,699.20
|
| Rate for Payer: United Healthcare All Payer |
$4,307.60
|
|
|
GRAFT EXXCEL 6*40*40 STR SUP
|
Facility
|
IP
|
$4,895.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,468.50 |
| Max. Negotiated Rate |
$4,699.20 |
| Rate for Payer: Aetna Commercial |
$3,769.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,818.10
|
| Rate for Payer: Cash Price |
$2,447.50
|
| Rate for Payer: Cigna Commercial |
$4,062.85
|
| Rate for Payer: First Health Commercial |
$4,650.25
|
| Rate for Payer: Humana Commercial |
$4,160.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,013.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,612.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,468.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,307.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,916.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,258.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,377.55
|
| Rate for Payer: PHCS Commercial |
$4,699.20
|
| Rate for Payer: United Healthcare All Payer |
$4,307.60
|
|
|
GRAFT EXXCEL 6*40 THIN
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
GRAFT EXXCEL 6*40 THIN
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
GRAFT EXXCEL 6*70 THIN WALL
|
Facility
|
OP
|
$7,243.93
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,173.18 |
| Max. Negotiated Rate |
$6,954.17 |
| Rate for Payer: Aetna Commercial |
$5,577.83
|
| Rate for Payer: Anthem Medicaid |
$2,491.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,650.27
|
| Rate for Payer: Cash Price |
$3,621.96
|
| Rate for Payer: Cigna Commercial |
$6,012.46
|
| Rate for Payer: First Health Commercial |
$6,881.73
|
| Rate for Payer: Humana Commercial |
$6,157.34
|
| Rate for Payer: Humana KY Medicaid |
$2,491.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,516.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,940.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,346.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,173.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,541.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,374.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,432.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,795.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,302.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,998.31
|
| Rate for Payer: PHCS Commercial |
$6,954.17
|
| Rate for Payer: United Healthcare All Payer |
$6,374.66
|
|
|
GRAFT EXXCEL 6*70 THIN WALL
|
Facility
|
IP
|
$7,243.93
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,173.18 |
| Max. Negotiated Rate |
$6,954.17 |
| Rate for Payer: Aetna Commercial |
$5,577.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,650.27
|
| Rate for Payer: Cash Price |
$3,621.96
|
| Rate for Payer: Cigna Commercial |
$6,012.46
|
| Rate for Payer: First Health Commercial |
$6,881.73
|
| Rate for Payer: Humana Commercial |
$6,157.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,940.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,346.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,173.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,374.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,432.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,795.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,302.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,998.31
|
| Rate for Payer: PHCS Commercial |
$6,954.17
|
| Rate for Payer: United Healthcare All Payer |
$6,374.66
|
|
|
GRAFT FEM CONDYLE HEMI L LAT F
|
Facility
|
IP
|
$74,993.60
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,498.08 |
| Max. Negotiated Rate |
$71,993.86 |
| Rate for Payer: Aetna Commercial |
$57,745.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,495.01
|
| Rate for Payer: Cash Price |
$37,496.80
|
| Rate for Payer: Cigna Commercial |
$62,244.69
|
| Rate for Payer: First Health Commercial |
$71,243.92
|
| Rate for Payer: Humana Commercial |
$63,744.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,494.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,345.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,498.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,994.37
|
| Rate for Payer: Ohio Health Group HMO |
$56,245.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59,994.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,244.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,745.58
|
| Rate for Payer: PHCS Commercial |
$71,993.86
|
| Rate for Payer: United Healthcare All Payer |
$65,994.37
|
|
|
GRAFT FEM CONDYLE HEMI L LAT F
|
Facility
|
OP
|
$74,993.60
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,498.08 |
| Max. Negotiated Rate |
$71,993.86 |
| Rate for Payer: Aetna Commercial |
$57,745.07
|
| Rate for Payer: Anthem Medicaid |
$25,790.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,495.01
|
| Rate for Payer: Cash Price |
$37,496.80
|
| Rate for Payer: Cigna Commercial |
$62,244.69
|
| Rate for Payer: First Health Commercial |
$71,243.92
|
| Rate for Payer: Humana Commercial |
$63,744.56
|
| Rate for Payer: Humana KY Medicaid |
$25,790.30
|
| Rate for Payer: Kentucky WC Medicaid |
$26,052.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,494.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,345.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,498.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,307.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,994.37
|
| Rate for Payer: Ohio Health Group HMO |
$56,245.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59,994.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,244.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,745.58
|
| Rate for Payer: PHCS Commercial |
$71,993.86
|
| Rate for Payer: United Healthcare All Payer |
$65,994.37
|
|
|
GRAFT FLIXENE 4-7MM*35MM
|
Facility
|
IP
|
$8,623.92
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,587.18 |
| Max. Negotiated Rate |
$8,278.96 |
| Rate for Payer: Aetna Commercial |
$6,640.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,726.66
|
| Rate for Payer: Cash Price |
$4,311.96
|
| Rate for Payer: Cigna Commercial |
$7,157.85
|
| Rate for Payer: First Health Commercial |
$8,192.72
|
| Rate for Payer: Humana Commercial |
$7,330.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,071.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,364.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,587.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,589.05
|
| Rate for Payer: Ohio Health Group HMO |
$6,467.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,899.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,502.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,950.50
|
| Rate for Payer: PHCS Commercial |
$8,278.96
|
| Rate for Payer: United Healthcare All Payer |
$7,589.05
|
|
|
GRAFT FLIXENE 4-7MM*35MM
|
Facility
|
OP
|
$8,623.92
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,587.18 |
| Max. Negotiated Rate |
$8,278.96 |
| Rate for Payer: Aetna Commercial |
$6,640.42
|
| Rate for Payer: Anthem Medicaid |
$2,965.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,726.66
|
| Rate for Payer: Cash Price |
$4,311.96
|
| Rate for Payer: Cigna Commercial |
$7,157.85
|
| Rate for Payer: First Health Commercial |
$8,192.72
|
| Rate for Payer: Humana Commercial |
$7,330.33
|
| Rate for Payer: Humana KY Medicaid |
$2,965.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,995.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,071.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,364.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,587.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,025.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,589.05
|
| Rate for Payer: Ohio Health Group HMO |
$6,467.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,899.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,502.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,950.50
|
| Rate for Payer: PHCS Commercial |
$8,278.96
|
| Rate for Payer: United Healthcare All Payer |
$7,589.05
|
|
|
GRAFT FLIXENE 4-7MM*45CM TPR
|
Facility
|
OP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem Medicaid |
$2,839.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Humana KY Medicaid |
$2,839.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
GRAFT FLIXENE 4-7MM*45CM TPR
|
Facility
|
IP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
