|
GRAFT TW FEP RINGED 6*40CM
|
Facility
|
IP
|
$4,347.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.25 |
| Max. Negotiated Rate |
$4,173.60 |
| Rate for Payer: Aetna Commercial |
$3,347.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,391.05
|
| Rate for Payer: Cash Price |
$2,173.75
|
| Rate for Payer: Cigna Commercial |
$3,608.43
|
| Rate for Payer: First Health Commercial |
$4,130.12
|
| Rate for Payer: Humana Commercial |
$3,695.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,564.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,208.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,304.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,825.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,260.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,478.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,782.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,999.78
|
| Rate for Payer: PHCS Commercial |
$4,173.60
|
| Rate for Payer: United Healthcare All Payer |
$3,825.80
|
|
|
GRAFT TW FEP RINGED 6*40CM
|
Facility
|
OP
|
$4,347.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.25 |
| Max. Negotiated Rate |
$4,173.60 |
| Rate for Payer: Aetna Commercial |
$3,347.57
|
| Rate for Payer: Anthem Medicaid |
$1,495.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,391.05
|
| Rate for Payer: Cash Price |
$2,173.75
|
| Rate for Payer: Cigna Commercial |
$3,608.43
|
| Rate for Payer: First Health Commercial |
$4,130.12
|
| Rate for Payer: Humana Commercial |
$3,695.38
|
| Rate for Payer: Humana KY Medicaid |
$1,495.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,510.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,564.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,208.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,304.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,525.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,825.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,260.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,478.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,782.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,999.78
|
| Rate for Payer: PHCS Commercial |
$4,173.60
|
| Rate for Payer: United Healthcare All Payer |
$3,825.80
|
|
|
GRAFT TW FEP RINGED 6*70CM
|
Facility
|
IP
|
$7,613.60
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$7,309.06 |
| Rate for Payer: Aetna Commercial |
$5,862.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,938.61
|
| Rate for Payer: Cash Price |
$3,806.80
|
| Rate for Payer: Cigna Commercial |
$6,319.29
|
| Rate for Payer: First Health Commercial |
$7,232.92
|
| Rate for Payer: Humana Commercial |
$6,471.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,618.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,699.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,090.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,623.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,253.38
|
| Rate for Payer: PHCS Commercial |
$7,309.06
|
| Rate for Payer: United Healthcare All Payer |
$6,699.97
|
|
|
GRAFT TW FEP RINGED 6*70CM
|
Facility
|
OP
|
$7,613.60
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.08 |
| Max. Negotiated Rate |
$7,309.06 |
| Rate for Payer: Aetna Commercial |
$5,862.47
|
| Rate for Payer: Anthem Medicaid |
$2,618.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,938.61
|
| Rate for Payer: Cash Price |
$3,806.80
|
| Rate for Payer: Cigna Commercial |
$6,319.29
|
| Rate for Payer: First Health Commercial |
$7,232.92
|
| Rate for Payer: Humana Commercial |
$6,471.56
|
| Rate for Payer: Humana KY Medicaid |
$2,618.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,644.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,618.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,670.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,699.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,090.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,623.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,253.38
|
| Rate for Payer: PHCS Commercial |
$7,309.06
|
| Rate for Payer: United Healthcare All Payer |
$6,699.97
|
|
|
GRAFT TW FEP RINGED 8*40CM
|
Facility
|
OP
|
$4,752.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.75 |
| Max. Negotiated Rate |
$4,562.40 |
| Rate for Payer: Aetna Commercial |
$3,659.43
|
| Rate for Payer: Anthem Medicaid |
$1,634.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,706.95
|
| Rate for Payer: Cash Price |
$2,376.25
|
| Rate for Payer: Cigna Commercial |
$3,944.57
|
| Rate for Payer: First Health Commercial |
$4,514.88
|
| Rate for Payer: Humana Commercial |
$4,039.62
|
| Rate for Payer: Humana KY Medicaid |
$1,634.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,651.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,897.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,507.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,425.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,667.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,182.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,564.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,802.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,134.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,279.22
|
| Rate for Payer: PHCS Commercial |
$4,562.40
|
| Rate for Payer: United Healthcare All Payer |
$4,182.20
|
|
|
GRAFT TW FEP RINGED 8*40CM
|
Facility
|
IP
|
$4,752.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.75 |
| Max. Negotiated Rate |
$4,562.40 |
| Rate for Payer: Aetna Commercial |
$3,659.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,706.95
|
| Rate for Payer: Cash Price |
$2,376.25
|
| Rate for Payer: Cigna Commercial |
$3,944.57
|
| Rate for Payer: First Health Commercial |
$4,514.88
|
| Rate for Payer: Humana Commercial |
$4,039.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,897.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,507.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,425.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,182.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,564.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,802.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,134.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,279.22
|
| Rate for Payer: PHCS Commercial |
$4,562.40
|
| Rate for Payer: United Healthcare All Payer |
$4,182.20
|
|
|
GRAFT TW FEP RINGED 8*70CM
|
Facility
|
IP
|
$7,825.30
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,347.59 |
| Max. Negotiated Rate |
$7,512.29 |
| Rate for Payer: Aetna Commercial |
$6,025.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,103.73
|
| Rate for Payer: Cash Price |
$3,912.65
|
| Rate for Payer: Cigna Commercial |
$6,495.00
|
| Rate for Payer: First Health Commercial |
$7,434.03
|
| Rate for Payer: Humana Commercial |
$6,651.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,416.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,775.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,347.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,886.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,868.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,260.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,808.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,399.46
|
| Rate for Payer: PHCS Commercial |
$7,512.29
|
| Rate for Payer: United Healthcare All Payer |
$6,886.26
|
|
|
GRAFT TW FEP RINGED 8*70CM
|
Facility
|
OP
|
$7,825.30
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,347.59 |
| Max. Negotiated Rate |
$7,512.29 |
| Rate for Payer: Aetna Commercial |
$6,025.48
|
| Rate for Payer: Anthem Medicaid |
$2,691.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,103.73
|
| Rate for Payer: Cash Price |
$3,912.65
|
| Rate for Payer: Cigna Commercial |
$6,495.00
|
| Rate for Payer: First Health Commercial |
$7,434.03
|
| Rate for Payer: Humana Commercial |
$6,651.51
|
| Rate for Payer: Humana KY Medicaid |
$2,691.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,718.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,416.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,775.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,347.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,745.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,886.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,868.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,260.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,808.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,399.46
|
| Rate for Payer: PHCS Commercial |
$7,512.29
|
| Rate for Payer: United Healthcare All Payer |
$6,886.26
|
|
|
GRAFT TW RINGED 8*90CM
|
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 TW RINGED 8*90CM
|
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 TW STRETCH 10*40CM
|
Facility
|
OP
|
$4,096.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.88 |
| Max. Negotiated Rate |
$3,932.40 |
| Rate for Payer: Aetna Commercial |
$3,154.11
|
| Rate for Payer: Anthem Medicaid |
$1,408.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,195.07
|
| Rate for Payer: Cash Price |
$2,048.12
|
| Rate for Payer: Cigna Commercial |
$3,399.89
|
| Rate for Payer: First Health Commercial |
$3,891.44
|
| Rate for Payer: Humana Commercial |
$3,481.81
|
| Rate for Payer: Humana KY Medicaid |
$1,408.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,423.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,358.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,023.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,228.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,436.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,604.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,072.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,277.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,563.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,826.41
|
| Rate for Payer: PHCS Commercial |
$3,932.40
|
| Rate for Payer: United Healthcare All Payer |
$3,604.70
|
|
|
GRAFT TW STRETCH 10*40CM
|
Facility
|
IP
|
$4,096.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.88 |
| Max. Negotiated Rate |
$3,932.40 |
| Rate for Payer: Aetna Commercial |
$3,154.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,195.07
|
| Rate for Payer: Cash Price |
$2,048.12
|
| Rate for Payer: Cigna Commercial |
$3,399.89
|
| Rate for Payer: First Health Commercial |
$3,891.44
|
| Rate for Payer: Humana Commercial |
$3,481.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,358.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,023.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,228.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,604.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,072.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,277.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,563.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,826.41
|
| Rate for Payer: PHCS Commercial |
$3,932.40
|
| Rate for Payer: United Healthcare All Payer |
$3,604.70
|
|
|
GRAFT TW STRETCH 4*70CM
|
Facility
|
OP
|
$5,573.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,672.12 |
| Max. Negotiated Rate |
$5,350.80 |
| Rate for Payer: Aetna Commercial |
$4,291.79
|
| Rate for Payer: Anthem Medicaid |
$1,916.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.52
|
| Rate for Payer: Cash Price |
$2,786.88
|
| Rate for Payer: Cigna Commercial |
$4,626.21
|
| Rate for Payer: First Health Commercial |
$5,295.06
|
| Rate for Payer: Humana Commercial |
$4,737.69
|
| Rate for Payer: Humana KY Medicaid |
$1,916.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,936.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,955.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.90
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,459.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,849.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.89
|
| Rate for Payer: PHCS Commercial |
$5,350.80
|
| Rate for Payer: United Healthcare All Payer |
$4,904.90
|
|
|
GRAFT TW STRETCH 4*70CM
|
Facility
|
IP
|
$5,573.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,672.12 |
| Max. Negotiated Rate |
$5,350.80 |
| Rate for Payer: Aetna Commercial |
$4,291.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.52
|
| Rate for Payer: Cash Price |
$2,786.88
|
| Rate for Payer: Cigna Commercial |
$4,626.21
|
| Rate for Payer: First Health Commercial |
$5,295.06
|
| Rate for Payer: Humana Commercial |
$4,737.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.90
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,459.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,849.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.89
|
| Rate for Payer: PHCS Commercial |
$5,350.80
|
| Rate for Payer: United Healthcare All Payer |
$4,904.90
|
|
|
GRAFT TW STRETCH 5*70CM
|
Facility
|
OP
|
$4,715.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.50 |
| Max. Negotiated Rate |
$4,526.40 |
| Rate for Payer: Aetna Commercial |
$3,630.55
|
| Rate for Payer: Anthem Medicaid |
$1,621.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,677.70
|
| Rate for Payer: Cash Price |
$2,357.50
|
| Rate for Payer: Cigna Commercial |
$3,913.45
|
| Rate for Payer: First Health Commercial |
$4,479.25
|
| Rate for Payer: Humana Commercial |
$4,007.75
|
| Rate for Payer: Humana KY Medicaid |
$1,621.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,637.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,866.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,479.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,414.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,654.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,149.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,772.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,102.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,253.35
|
| Rate for Payer: PHCS Commercial |
$4,526.40
|
| Rate for Payer: United Healthcare All Payer |
$4,149.20
|
|
|
GRAFT TW STRETCH 5*70CM
|
Facility
|
IP
|
$4,715.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.50 |
| Max. Negotiated Rate |
$4,526.40 |
| Rate for Payer: Aetna Commercial |
$3,630.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,677.70
|
| Rate for Payer: Cash Price |
$2,357.50
|
| Rate for Payer: Cigna Commercial |
$3,913.45
|
| Rate for Payer: First Health Commercial |
$4,479.25
|
| Rate for Payer: Humana Commercial |
$4,007.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,866.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,479.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,414.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,149.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,772.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,102.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,253.35
|
| Rate for Payer: PHCS Commercial |
$4,526.40
|
| Rate for Payer: United Healthcare All Payer |
$4,149.20
|
|
|
GRAFT TW STRETCH 6*70CM
|
Facility
|
OP
|
$4,793.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,438.12 |
| Max. Negotiated Rate |
$4,602.00 |
| Rate for Payer: Aetna Commercial |
$3,691.19
|
| Rate for Payer: Anthem Medicaid |
$1,648.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,739.12
|
| Rate for Payer: Cash Price |
$2,396.88
|
| Rate for Payer: Cigna Commercial |
$3,978.81
|
| Rate for Payer: First Health Commercial |
$4,554.06
|
| Rate for Payer: Humana Commercial |
$4,074.69
|
| Rate for Payer: Humana KY Medicaid |
$1,648.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,665.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,681.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,835.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,170.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,307.69
|
| Rate for Payer: PHCS Commercial |
$4,602.00
|
| Rate for Payer: United Healthcare All Payer |
$4,218.50
|
|
|
GRAFT TW STRETCH 6*70CM
|
Facility
|
IP
|
$4,793.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,438.12 |
| Max. Negotiated Rate |
$4,602.00 |
| Rate for Payer: Aetna Commercial |
$3,691.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,739.12
|
| Rate for Payer: Cash Price |
$2,396.88
|
| Rate for Payer: Cigna Commercial |
$3,978.81
|
| Rate for Payer: First Health Commercial |
$4,554.06
|
| Rate for Payer: Humana Commercial |
$4,074.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,835.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,170.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,307.69
|
| Rate for Payer: PHCS Commercial |
$4,602.00
|
| Rate for Payer: United Healthcare All Payer |
$4,218.50
|
|
|
GRAFT VASC INTERING 6*20 THIN
|
Facility
|
OP
|
$3,395.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.50 |
| Max. Negotiated Rate |
$3,259.20 |
| Rate for Payer: Aetna Commercial |
$2,614.15
|
| Rate for Payer: Anthem Medicaid |
$1,167.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,648.10
|
| Rate for Payer: Cash Price |
$1,697.50
|
| Rate for Payer: Cigna Commercial |
$2,817.85
|
| Rate for Payer: First Health Commercial |
$3,225.25
|
| Rate for Payer: Humana Commercial |
$2,885.75
|
| Rate for Payer: Humana KY Medicaid |
$1,167.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,179.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,783.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,505.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,018.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,190.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,987.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,546.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,716.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,953.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,342.55
|
| Rate for Payer: PHCS Commercial |
$3,259.20
|
| Rate for Payer: United Healthcare All Payer |
$2,987.60
|
|
|
GRAFT VASC INTERING 6*20 THIN
|
Facility
|
IP
|
$3,395.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.50 |
| Max. Negotiated Rate |
$3,259.20 |
| Rate for Payer: Aetna Commercial |
$2,614.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,648.10
|
| Rate for Payer: Cash Price |
$1,697.50
|
| Rate for Payer: Cigna Commercial |
$2,817.85
|
| Rate for Payer: First Health Commercial |
$3,225.25
|
| Rate for Payer: Humana Commercial |
$2,885.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,783.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,505.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,018.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,987.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,546.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,716.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,953.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,342.55
|
| Rate for Payer: PHCS Commercial |
$3,259.20
|
| Rate for Payer: United Healthcare All Payer |
$2,987.60
|
|
|
GRAFT VASC INTERING 6*40 THIN
|
Facility
|
OP
|
$4,988.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.62 |
| Max. Negotiated Rate |
$4,789.20 |
| Rate for Payer: Aetna Commercial |
$3,841.34
|
| Rate for Payer: Anthem Medicaid |
$1,715.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,891.22
|
| Rate for Payer: Cash Price |
$2,494.38
|
| Rate for Payer: Cigna Commercial |
$4,140.66
|
| Rate for Payer: First Health Commercial |
$4,739.31
|
| Rate for Payer: Humana Commercial |
$4,240.44
|
| Rate for Payer: Humana KY Medicaid |
$1,715.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1,733.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,090.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,496.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,750.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,390.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,741.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,991.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,340.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,442.24
|
| Rate for Payer: PHCS Commercial |
$4,789.20
|
| Rate for Payer: United Healthcare All Payer |
$4,390.10
|
|
|
GRAFT VASC INTERING 6*40 THIN
|
Facility
|
IP
|
$4,988.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.62 |
| Max. Negotiated Rate |
$4,789.20 |
| Rate for Payer: Aetna Commercial |
$3,841.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,891.22
|
| Rate for Payer: Cash Price |
$2,494.38
|
| Rate for Payer: Cigna Commercial |
$4,140.66
|
| Rate for Payer: First Health Commercial |
$4,739.31
|
| Rate for Payer: Humana Commercial |
$4,240.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,090.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,496.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,390.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,741.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,991.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,340.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,442.24
|
| Rate for Payer: PHCS Commercial |
$4,789.20
|
| Rate for Payer: United Healthcare All Payer |
$4,390.10
|
|
|
GRAFT VASC INTERING 6*45 STD
|
Facility
|
OP
|
$5,045.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,513.50 |
| Max. Negotiated Rate |
$4,843.20 |
| Rate for Payer: Aetna Commercial |
$3,884.65
|
| Rate for Payer: Anthem Medicaid |
$1,734.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,935.10
|
| Rate for Payer: Cash Price |
$2,522.50
|
| Rate for Payer: Cigna Commercial |
$4,187.35
|
| Rate for Payer: First Health Commercial |
$4,792.75
|
| Rate for Payer: Humana Commercial |
$4,288.25
|
| Rate for Payer: Humana KY Medicaid |
$1,734.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,752.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,136.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,723.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,513.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,769.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,439.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,783.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,389.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,481.05
|
| Rate for Payer: PHCS Commercial |
$4,843.20
|
| Rate for Payer: United Healthcare All Payer |
$4,439.60
|
|
|
GRAFT VASC INTERING 6*45 STD
|
Facility
|
IP
|
$5,045.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,513.50 |
| Max. Negotiated Rate |
$4,843.20 |
| Rate for Payer: Aetna Commercial |
$3,884.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,935.10
|
| Rate for Payer: Cash Price |
$2,522.50
|
| Rate for Payer: Cigna Commercial |
$4,187.35
|
| Rate for Payer: First Health Commercial |
$4,792.75
|
| Rate for Payer: Humana Commercial |
$4,288.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,136.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,723.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,513.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,439.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,783.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,389.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,481.05
|
| Rate for Payer: PHCS Commercial |
$4,843.20
|
| Rate for Payer: United Healthcare All Payer |
$4,439.60
|
|
|
GRAFT VASC INTERING 8*40 THIN
|
Facility
|
IP
|
$4,988.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.62 |
| Max. Negotiated Rate |
$4,789.20 |
| Rate for Payer: Aetna Commercial |
$3,841.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,891.22
|
| Rate for Payer: Cash Price |
$2,494.38
|
| Rate for Payer: Cigna Commercial |
$4,140.66
|
| Rate for Payer: First Health Commercial |
$4,739.31
|
| Rate for Payer: Humana Commercial |
$4,240.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,090.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,681.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,496.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,390.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,741.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,991.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,340.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,442.24
|
| Rate for Payer: PHCS Commercial |
$4,789.20
|
| Rate for Payer: United Healthcare All Payer |
$4,390.10
|
|
