|
GRAFT ILI LMB OVTN 14*18*100-J
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
GRAFT ILI LMB OVTN 14*18*100-J
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem Medicaid |
$6,878.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Humana KY Medicaid |
$6,878.00
|
| Rate for Payer: Kentucky WC Medicaid |
$6,948.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,016.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
GRAFTING OF AUTOLOGOUS FAT HARVESTED BY LIPOSUCTION TECHNIQUE TO TRUNK, BREASTS, SCALP, ARMS, AND/OR LEGS; 50 CC OR LESS INJECTATE
|
Facility
|
OP
|
$4,735.72
|
|
|
Service Code
|
CPT 15771
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,382.66 |
| Max. Negotiated Rate |
$4,735.72 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,382.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,735.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,566.59
|
| Rate for Payer: Humana Medicare Advantage |
$3,382.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,059.19
|
|
|
GRAFT INTERING 4-7X45CM
|
Facility
|
IP
|
$4,291.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,287.38 |
| Max. Negotiated Rate |
$4,119.60 |
| Rate for Payer: Aetna Commercial |
$3,304.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,347.18
|
| Rate for Payer: Cash Price |
$2,145.62
|
| Rate for Payer: Cigna Commercial |
$3,561.74
|
| Rate for Payer: First Health Commercial |
$4,076.69
|
| Rate for Payer: Humana Commercial |
$3,647.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,518.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,166.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,287.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,776.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,218.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,433.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,733.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,960.96
|
| Rate for Payer: PHCS Commercial |
$4,119.60
|
| Rate for Payer: United Healthcare All Payer |
$3,776.30
|
|
|
GRAFT INTERING 4-7X45CM
|
Facility
|
OP
|
$4,291.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,287.38 |
| Max. Negotiated Rate |
$4,119.60 |
| Rate for Payer: Aetna Commercial |
$3,304.26
|
| Rate for Payer: Anthem Medicaid |
$1,475.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,347.18
|
| Rate for Payer: Cash Price |
$2,145.62
|
| Rate for Payer: Cigna Commercial |
$3,561.74
|
| Rate for Payer: First Health Commercial |
$4,076.69
|
| Rate for Payer: Humana Commercial |
$3,647.56
|
| Rate for Payer: Humana KY Medicaid |
$1,475.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,490.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,518.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,166.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,287.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,505.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,776.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,218.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,433.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,733.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,960.96
|
| Rate for Payer: PHCS Commercial |
$4,119.60
|
| Rate for Payer: United Healthcare All Payer |
$3,776.30
|
|
|
GRAFT INTUITRAK BI 22-13-100BL
|
Facility
|
OP
|
$72,421.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,726.30 |
| Max. Negotiated Rate |
$69,524.16 |
| Rate for Payer: Aetna Commercial |
$55,764.17
|
| Rate for Payer: Anthem Medicaid |
$24,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,488.38
|
| Rate for Payer: Cash Price |
$36,210.50
|
| Rate for Payer: Cigna Commercial |
$60,109.43
|
| Rate for Payer: First Health Commercial |
$68,799.95
|
| Rate for Payer: Humana Commercial |
$61,557.85
|
| Rate for Payer: Humana KY Medicaid |
$24,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$25,159.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,385.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,446.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,726.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,405.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,730.48
|
| Rate for Payer: Ohio Health Group HMO |
$54,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,936.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,006.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,970.49
|
| Rate for Payer: PHCS Commercial |
$69,524.16
|
| Rate for Payer: United Healthcare All Payer |
$63,730.48
|
|
|
GRAFT INTUITRAK BI 22-13-100BL
|
Facility
|
IP
|
$72,421.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,726.30 |
| Max. Negotiated Rate |
$69,524.16 |
| Rate for Payer: Aetna Commercial |
$55,764.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,488.38
|
| Rate for Payer: Cash Price |
$36,210.50
|
| Rate for Payer: Cigna Commercial |
$60,109.43
|
| Rate for Payer: First Health Commercial |
$68,799.95
|
| Rate for Payer: Humana Commercial |
$61,557.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,385.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,446.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,726.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,730.48
|
| Rate for Payer: Ohio Health Group HMO |
$54,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,936.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,006.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,970.49
|
| Rate for Payer: PHCS Commercial |
$69,524.16
|
| Rate for Payer: United Healthcare All Payer |
$63,730.48
|
|
|
GRAFT INTUITRAK BI 22-13-120BL
|
Facility
|
IP
|
$72,421.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,726.30 |
| Max. Negotiated Rate |
$69,524.16 |
| Rate for Payer: Aetna Commercial |
$55,764.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,488.38
|
| Rate for Payer: Cash Price |
$36,210.50
|
| Rate for Payer: Cigna Commercial |
$60,109.43
|
| Rate for Payer: First Health Commercial |
$68,799.95
|
| Rate for Payer: Humana Commercial |
$61,557.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,385.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,446.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,726.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,730.48
|
| Rate for Payer: Ohio Health Group HMO |
$54,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,936.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,006.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,970.49
|
| Rate for Payer: PHCS Commercial |
$69,524.16
|
| Rate for Payer: United Healthcare All Payer |
$63,730.48
|
|
|
GRAFT INTUITRAK BI 22-13-120BL
|
Facility
|
OP
|
$72,421.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,726.30 |
| Max. Negotiated Rate |
$69,524.16 |
| Rate for Payer: Aetna Commercial |
$55,764.17
|
| Rate for Payer: Anthem Medicaid |
$24,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,488.38
|
| Rate for Payer: Cash Price |
$36,210.50
|
| Rate for Payer: Cigna Commercial |
$60,109.43
|
| Rate for Payer: First Health Commercial |
$68,799.95
|
| Rate for Payer: Humana Commercial |
$61,557.85
|
| Rate for Payer: Humana KY Medicaid |
$24,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$25,159.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,385.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,446.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,726.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,405.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,730.48
|
| Rate for Payer: Ohio Health Group HMO |
$54,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,936.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,006.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,970.49
|
| Rate for Payer: PHCS Commercial |
$69,524.16
|
| Rate for Payer: United Healthcare All Payer |
$63,730.48
|
|
|
GRAFT INTUITRAK BI 22-16-100BL
|
Facility
|
IP
|
$70,521.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,156.30 |
| Max. Negotiated Rate |
$67,700.16 |
| Rate for Payer: Aetna Commercial |
$54,301.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,006.38
|
| Rate for Payer: Cash Price |
$35,260.50
|
| Rate for Payer: Cigna Commercial |
$58,532.43
|
| Rate for Payer: First Health Commercial |
$66,994.95
|
| Rate for Payer: Humana Commercial |
$59,942.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,827.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,044.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,156.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,058.48
|
| Rate for Payer: Ohio Health Group HMO |
$52,890.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,353.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,659.49
|
| Rate for Payer: PHCS Commercial |
$67,700.16
|
| Rate for Payer: United Healthcare All Payer |
$62,058.48
|
|
|
GRAFT INTUITRAK BI 22-16-100BL
|
Facility
|
OP
|
$70,521.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,156.30 |
| Max. Negotiated Rate |
$67,700.16 |
| Rate for Payer: Aetna Commercial |
$54,301.17
|
| Rate for Payer: Anthem Medicaid |
$24,252.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,006.38
|
| Rate for Payer: Cash Price |
$35,260.50
|
| Rate for Payer: Cigna Commercial |
$58,532.43
|
| Rate for Payer: First Health Commercial |
$66,994.95
|
| Rate for Payer: Humana Commercial |
$59,942.85
|
| Rate for Payer: Humana KY Medicaid |
$24,252.17
|
| Rate for Payer: Kentucky WC Medicaid |
$24,499.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,827.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,044.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,156.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,738.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,058.48
|
| Rate for Payer: Ohio Health Group HMO |
$52,890.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,353.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,659.49
|
| Rate for Payer: PHCS Commercial |
$67,700.16
|
| Rate for Payer: United Healthcare All Payer |
$62,058.48
|
|
|
GRAFT INTUITRAK BI 22-16-120BL
|
Facility
|
IP
|
$68,621.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,586.30 |
| Max. Negotiated Rate |
$65,876.16 |
| Rate for Payer: Aetna Commercial |
$52,838.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,524.38
|
| Rate for Payer: Cash Price |
$34,310.50
|
| Rate for Payer: Cigna Commercial |
$56,955.43
|
| Rate for Payer: First Health Commercial |
$65,189.95
|
| Rate for Payer: Humana Commercial |
$58,327.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,269.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,642.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,586.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,386.48
|
| Rate for Payer: Ohio Health Group HMO |
$51,465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,700.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,348.49
|
| Rate for Payer: PHCS Commercial |
$65,876.16
|
| Rate for Payer: United Healthcare All Payer |
$60,386.48
|
|
|
GRAFT INTUITRAK BI 22-16-120BL
|
Facility
|
OP
|
$68,621.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,586.30 |
| Max. Negotiated Rate |
$65,876.16 |
| Rate for Payer: Aetna Commercial |
$52,838.17
|
| Rate for Payer: Anthem Medicaid |
$23,598.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,524.38
|
| Rate for Payer: Cash Price |
$34,310.50
|
| Rate for Payer: Cigna Commercial |
$56,955.43
|
| Rate for Payer: First Health Commercial |
$65,189.95
|
| Rate for Payer: Humana Commercial |
$58,327.85
|
| Rate for Payer: Humana KY Medicaid |
$23,598.76
|
| Rate for Payer: Kentucky WC Medicaid |
$23,838.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,269.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,642.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,586.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,072.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,386.48
|
| Rate for Payer: Ohio Health Group HMO |
$51,465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,700.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,348.49
|
| Rate for Payer: PHCS Commercial |
$65,876.16
|
| Rate for Payer: United Healthcare All Payer |
$60,386.48
|
|
|
GRAFT INTUITRAK BI 25-13-100BL
|
Facility
|
OP
|
$72,421.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,726.30 |
| Max. Negotiated Rate |
$69,524.16 |
| Rate for Payer: Aetna Commercial |
$55,764.17
|
| Rate for Payer: Anthem Medicaid |
$24,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,488.38
|
| Rate for Payer: Cash Price |
$36,210.50
|
| Rate for Payer: Cigna Commercial |
$60,109.43
|
| Rate for Payer: First Health Commercial |
$68,799.95
|
| Rate for Payer: Humana Commercial |
$61,557.85
|
| Rate for Payer: Humana KY Medicaid |
$24,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$25,159.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,385.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,446.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,726.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,405.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,730.48
|
| Rate for Payer: Ohio Health Group HMO |
$54,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,936.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,006.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,970.49
|
| Rate for Payer: PHCS Commercial |
$69,524.16
|
| Rate for Payer: United Healthcare All Payer |
$63,730.48
|
|
|
GRAFT INTUITRAK BI 25-13-100BL
|
Facility
|
IP
|
$72,421.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,726.30 |
| Max. Negotiated Rate |
$69,524.16 |
| Rate for Payer: Aetna Commercial |
$55,764.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,488.38
|
| Rate for Payer: Cash Price |
$36,210.50
|
| Rate for Payer: Cigna Commercial |
$60,109.43
|
| Rate for Payer: First Health Commercial |
$68,799.95
|
| Rate for Payer: Humana Commercial |
$61,557.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,385.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,446.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,726.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,730.48
|
| Rate for Payer: Ohio Health Group HMO |
$54,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,936.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,006.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,970.49
|
| Rate for Payer: PHCS Commercial |
$69,524.16
|
| Rate for Payer: United Healthcare All Payer |
$63,730.48
|
|
|
GRAFT INTUITRAK BI 25-13-120BL
|
Facility
|
IP
|
$70,521.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,156.30 |
| Max. Negotiated Rate |
$67,700.16 |
| Rate for Payer: Aetna Commercial |
$54,301.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,006.38
|
| Rate for Payer: Cash Price |
$35,260.50
|
| Rate for Payer: Cigna Commercial |
$58,532.43
|
| Rate for Payer: First Health Commercial |
$66,994.95
|
| Rate for Payer: Humana Commercial |
$59,942.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,827.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,044.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,156.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,058.48
|
| Rate for Payer: Ohio Health Group HMO |
$52,890.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,353.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,659.49
|
| Rate for Payer: PHCS Commercial |
$67,700.16
|
| Rate for Payer: United Healthcare All Payer |
$62,058.48
|
|
|
GRAFT INTUITRAK BI 25-13-120BL
|
Facility
|
OP
|
$70,521.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,156.30 |
| Max. Negotiated Rate |
$67,700.16 |
| Rate for Payer: Aetna Commercial |
$54,301.17
|
| Rate for Payer: Anthem Medicaid |
$24,252.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,006.38
|
| Rate for Payer: Cash Price |
$35,260.50
|
| Rate for Payer: Cigna Commercial |
$58,532.43
|
| Rate for Payer: First Health Commercial |
$66,994.95
|
| Rate for Payer: Humana Commercial |
$59,942.85
|
| Rate for Payer: Humana KY Medicaid |
$24,252.17
|
| Rate for Payer: Kentucky WC Medicaid |
$24,499.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,827.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,044.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,156.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,738.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,058.48
|
| Rate for Payer: Ohio Health Group HMO |
$52,890.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,353.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,659.49
|
| Rate for Payer: PHCS Commercial |
$67,700.16
|
| Rate for Payer: United Healthcare All Payer |
$62,058.48
|
|
|
GRAFT INTUITRAK BI 25-16-100BL
|
Facility
|
OP
|
$70,521.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,156.30 |
| Max. Negotiated Rate |
$67,700.16 |
| Rate for Payer: Aetna Commercial |
$54,301.17
|
| Rate for Payer: Anthem Medicaid |
$24,252.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,006.38
|
| Rate for Payer: Cash Price |
$35,260.50
|
| Rate for Payer: Cigna Commercial |
$58,532.43
|
| Rate for Payer: First Health Commercial |
$66,994.95
|
| Rate for Payer: Humana Commercial |
$59,942.85
|
| Rate for Payer: Humana KY Medicaid |
$24,252.17
|
| Rate for Payer: Kentucky WC Medicaid |
$24,499.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,827.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,044.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,156.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,738.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,058.48
|
| Rate for Payer: Ohio Health Group HMO |
$52,890.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,353.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,659.49
|
| Rate for Payer: PHCS Commercial |
$67,700.16
|
| Rate for Payer: United Healthcare All Payer |
$62,058.48
|
|
|
GRAFT INTUITRAK BI 25-16-100BL
|
Facility
|
IP
|
$70,521.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,156.30 |
| Max. Negotiated Rate |
$67,700.16 |
| Rate for Payer: Aetna Commercial |
$54,301.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,006.38
|
| Rate for Payer: Cash Price |
$35,260.50
|
| Rate for Payer: Cigna Commercial |
$58,532.43
|
| Rate for Payer: First Health Commercial |
$66,994.95
|
| Rate for Payer: Humana Commercial |
$59,942.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,827.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,044.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,156.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,058.48
|
| Rate for Payer: Ohio Health Group HMO |
$52,890.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,353.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,659.49
|
| Rate for Payer: PHCS Commercial |
$67,700.16
|
| Rate for Payer: United Healthcare All Payer |
$62,058.48
|
|
|
GRAFT INTUITRAK BI 25-16-135BL
|
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 INTUITRAK BI 25-16-135BL
|
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 INTUITRAK BI 25-16-155BL
|
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 INTUITRAK BI 25-16-155BL
|
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 INTUITRAK BI 28-13-100BL
|
Facility
|
IP
|
$72,421.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,726.30 |
| Max. Negotiated Rate |
$69,524.16 |
| Rate for Payer: Aetna Commercial |
$55,764.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,488.38
|
| Rate for Payer: Cash Price |
$36,210.50
|
| Rate for Payer: Cigna Commercial |
$60,109.43
|
| Rate for Payer: First Health Commercial |
$68,799.95
|
| Rate for Payer: Humana Commercial |
$61,557.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,385.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,446.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,726.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,730.48
|
| Rate for Payer: Ohio Health Group HMO |
$54,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,936.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,006.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,970.49
|
| Rate for Payer: PHCS Commercial |
$69,524.16
|
| Rate for Payer: United Healthcare All Payer |
$63,730.48
|
|
|
GRAFT INTUITRAK BI 28-13-100BL
|
Facility
|
OP
|
$72,421.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,726.30 |
| Max. Negotiated Rate |
$69,524.16 |
| Rate for Payer: Aetna Commercial |
$55,764.17
|
| Rate for Payer: Anthem Medicaid |
$24,905.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,488.38
|
| Rate for Payer: Cash Price |
$36,210.50
|
| Rate for Payer: Cigna Commercial |
$60,109.43
|
| Rate for Payer: First Health Commercial |
$68,799.95
|
| Rate for Payer: Humana Commercial |
$61,557.85
|
| Rate for Payer: Humana KY Medicaid |
$24,905.58
|
| Rate for Payer: Kentucky WC Medicaid |
$25,159.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,385.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,446.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,726.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,405.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,730.48
|
| Rate for Payer: Ohio Health Group HMO |
$54,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,936.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,006.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,970.49
|
| Rate for Payer: PHCS Commercial |
$69,524.16
|
| Rate for Payer: United Healthcare All Payer |
$63,730.48
|
|
