|
GRAFT Z ILIAC LEG TFLE-8-105
|
Facility
|
OP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem Medicaid |
$4,984.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Humana KY Medicaid |
$4,984.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,035.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,084.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GRAFT Z ILIAC LEG TFLE-8-122
|
Facility
|
IP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GRAFT Z ILIAC LEG TFLE-8-122
|
Facility
|
OP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem Medicaid |
$4,984.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Humana KY Medicaid |
$4,984.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,035.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,084.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GRAFT Z ILIAC LEG TFLE-8-37
|
Facility
|
IP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GRAFT Z ILIAC LEG TFLE-8-37
|
Facility
|
OP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem Medicaid |
$4,984.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Humana KY Medicaid |
$4,984.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,035.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,084.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GRAFT Z ILIAC LEG TFLE-8-37-ZT
|
Facility
|
IP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GRAFT Z ILIAC LEG TFLE-8-37-ZT
|
Facility
|
OP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem Medicaid |
$4,984.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Humana KY Medicaid |
$4,984.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,035.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,084.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GRAFT Z ILIAC LEG TFLE-8-54
|
Facility
|
IP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GRAFT Z ILIAC LEG TFLE-8-54
|
Facility
|
OP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem Medicaid |
$4,984.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Humana KY Medicaid |
$4,984.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,035.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,084.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GRAFT Z ILIAC LEG TFLE-8-54-ZT
|
Facility
|
OP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem Medicaid |
$4,984.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Humana KY Medicaid |
$4,984.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,035.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,084.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GRAFT Z ILIAC LEG TFLE-8-54-ZT
|
Facility
|
IP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GRAFT Z ILIAC LEG TFLE-8-71
|
Facility
|
OP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem Medicaid |
$4,984.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Humana KY Medicaid |
$4,984.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,035.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,084.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GRAFT Z ILIAC LEG TFLE-8-71
|
Facility
|
IP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GRAFT Z ILIAC LEG TFLE-8-71-ZT
|
Facility
|
IP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GRAFT Z ILIAC LEG TFLE-8-71-ZT
|
Facility
|
OP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem Medicaid |
$4,984.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Humana KY Medicaid |
$4,984.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,035.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,084.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GRAFT Z ILIAC LEG TFLE-8-88
|
Facility
|
IP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GRAFT Z ILIAC LEG TFLE-8-88
|
Facility
|
OP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem Medicaid |
$4,984.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Humana KY Medicaid |
$4,984.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,035.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,084.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GRAFT Z ILIAC LEG TFLE-8-88-ZT
|
Facility
|
IP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GRAFT Z ILIAC LEG TFLE-8-88-ZT
|
Facility
|
OP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem Medicaid |
$4,984.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Humana KY Medicaid |
$4,984.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,035.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,084.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GRAFT Z ILIAC LEG ZSLE-13-56-Z
|
Facility
|
OP
|
$21,121.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,336.38 |
| Max. Negotiated Rate |
$20,276.40 |
| Rate for Payer: Aetna Commercial |
$16,263.36
|
| Rate for Payer: Anthem Medicaid |
$7,263.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,474.58
|
| Rate for Payer: Cash Price |
$10,560.62
|
| Rate for Payer: Cigna Commercial |
$17,530.64
|
| Rate for Payer: First Health Commercial |
$20,065.19
|
| Rate for Payer: Humana Commercial |
$17,953.06
|
| Rate for Payer: Humana KY Medicaid |
$7,263.60
|
| Rate for Payer: Kentucky WC Medicaid |
$7,337.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,319.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,587.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,336.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,409.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,586.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,840.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,897.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,375.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,573.66
|
| Rate for Payer: PHCS Commercial |
$20,276.40
|
| Rate for Payer: United Healthcare All Payer |
$18,586.70
|
|
|
GRAFT Z ILIAC LEG ZSLE-13-56-Z
|
Facility
|
IP
|
$21,121.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,336.38 |
| Max. Negotiated Rate |
$20,276.40 |
| Rate for Payer: Aetna Commercial |
$16,263.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,474.58
|
| Rate for Payer: Cash Price |
$10,560.62
|
| Rate for Payer: Cigna Commercial |
$17,530.64
|
| Rate for Payer: First Health Commercial |
$20,065.19
|
| Rate for Payer: Humana Commercial |
$17,953.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,319.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,587.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,336.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,586.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,840.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,897.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,375.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,573.66
|
| Rate for Payer: PHCS Commercial |
$20,276.40
|
| Rate for Payer: United Healthcare All Payer |
$18,586.70
|
|
|
GRAFT Z ILIAC LEG ZSLE-13-74-Z
|
Facility
|
OP
|
$21,121.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,336.38 |
| Max. Negotiated Rate |
$20,276.40 |
| Rate for Payer: Aetna Commercial |
$16,263.36
|
| Rate for Payer: Anthem Medicaid |
$7,263.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,474.58
|
| Rate for Payer: Cash Price |
$10,560.62
|
| Rate for Payer: Cigna Commercial |
$17,530.64
|
| Rate for Payer: First Health Commercial |
$20,065.19
|
| Rate for Payer: Humana Commercial |
$17,953.06
|
| Rate for Payer: Humana KY Medicaid |
$7,263.60
|
| Rate for Payer: Kentucky WC Medicaid |
$7,337.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,319.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,587.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,336.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,409.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,586.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,840.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,897.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,375.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,573.66
|
| Rate for Payer: PHCS Commercial |
$20,276.40
|
| Rate for Payer: United Healthcare All Payer |
$18,586.70
|
|
|
GRAFT Z ILIAC LEG ZSLE-13-74-Z
|
Facility
|
IP
|
$21,121.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,336.38 |
| Max. Negotiated Rate |
$20,276.40 |
| Rate for Payer: Aetna Commercial |
$16,263.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,474.58
|
| Rate for Payer: Cash Price |
$10,560.62
|
| Rate for Payer: Cigna Commercial |
$17,530.64
|
| Rate for Payer: First Health Commercial |
$20,065.19
|
| Rate for Payer: Humana Commercial |
$17,953.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,319.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,587.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,336.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,586.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,840.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,897.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,375.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,573.66
|
| Rate for Payer: PHCS Commercial |
$20,276.40
|
| Rate for Payer: United Healthcare All Payer |
$18,586.70
|
|
|
GRAFT Z ILIAC LEG ZSLE-13-90-Z
|
Facility
|
OP
|
$22,437.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,731.25 |
| Max. Negotiated Rate |
$21,540.00 |
| Rate for Payer: Aetna Commercial |
$17,276.88
|
| Rate for Payer: Anthem Medicaid |
$7,716.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,501.25
|
| Rate for Payer: Cash Price |
$11,218.75
|
| Rate for Payer: Cigna Commercial |
$18,623.12
|
| Rate for Payer: First Health Commercial |
$21,315.62
|
| Rate for Payer: Humana Commercial |
$19,071.88
|
| Rate for Payer: Humana KY Medicaid |
$7,716.26
|
| Rate for Payer: Kentucky WC Medicaid |
$7,794.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,398.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,558.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,731.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,871.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,745.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,828.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,520.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,481.88
|
| Rate for Payer: PHCS Commercial |
$21,540.00
|
| Rate for Payer: United Healthcare All Payer |
$19,745.00
|
|
|
GRAFT Z ILIAC LEG ZSLE-13-90-Z
|
Facility
|
IP
|
$22,437.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,731.25 |
| Max. Negotiated Rate |
$21,540.00 |
| Rate for Payer: Aetna Commercial |
$17,276.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,501.25
|
| Rate for Payer: Cash Price |
$11,218.75
|
| Rate for Payer: Cigna Commercial |
$18,623.12
|
| Rate for Payer: First Health Commercial |
$21,315.62
|
| Rate for Payer: Humana Commercial |
$19,071.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,398.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,558.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,731.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,745.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,828.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,520.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,481.88
|
| Rate for Payer: PHCS Commercial |
$21,540.00
|
| Rate for Payer: United Healthcare All Payer |
$19,745.00
|
|
