|
GRAFT Z MAIN BDY TFFB-22-82-ZT
|
Facility
|
OP
|
$36,717.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,015.25 |
| Max. Negotiated Rate |
$35,248.80 |
| Rate for Payer: Aetna Commercial |
$28,272.47
|
| Rate for Payer: Anthem Medicaid |
$12,627.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,639.65
|
| Rate for Payer: Cash Price |
$18,358.75
|
| Rate for Payer: Cigna Commercial |
$30,475.53
|
| Rate for Payer: First Health Commercial |
$34,881.62
|
| Rate for Payer: Humana Commercial |
$31,209.88
|
| Rate for Payer: Humana KY Medicaid |
$12,627.15
|
| Rate for Payer: Kentucky WC Medicaid |
$12,755.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,108.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,097.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,015.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,880.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,311.40
|
| Rate for Payer: Ohio Health Group HMO |
$27,538.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,374.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,944.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,335.08
|
| Rate for Payer: PHCS Commercial |
$35,248.80
|
| Rate for Payer: United Healthcare All Payer |
$32,311.40
|
|
|
GRAFT Z MAIN BDY TFFB-22-96-ZT
|
Facility
|
OP
|
$37,670.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,301.00 |
| Max. Negotiated Rate |
$36,163.20 |
| Rate for Payer: Aetna Commercial |
$29,005.90
|
| Rate for Payer: Anthem Medicaid |
$12,954.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,382.60
|
| Rate for Payer: Cash Price |
$18,835.00
|
| Rate for Payer: Cigna Commercial |
$31,266.10
|
| Rate for Payer: First Health Commercial |
$35,786.50
|
| Rate for Payer: Humana Commercial |
$32,019.50
|
| Rate for Payer: Humana KY Medicaid |
$12,954.71
|
| Rate for Payer: Kentucky WC Medicaid |
$13,086.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,889.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,800.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,214.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,149.60
|
| Rate for Payer: Ohio Health Group HMO |
$28,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,772.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,992.30
|
| Rate for Payer: PHCS Commercial |
$36,163.20
|
| Rate for Payer: United Healthcare All Payer |
$33,149.60
|
|
|
GRAFT Z MAIN BDY TFFB-22-96-ZT
|
Facility
|
IP
|
$37,670.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,301.00 |
| Max. Negotiated Rate |
$36,163.20 |
| Rate for Payer: Aetna Commercial |
$29,005.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,382.60
|
| Rate for Payer: Cash Price |
$18,835.00
|
| Rate for Payer: Cigna Commercial |
$31,266.10
|
| Rate for Payer: First Health Commercial |
$35,786.50
|
| Rate for Payer: Humana Commercial |
$32,019.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,889.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,800.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,149.60
|
| Rate for Payer: Ohio Health Group HMO |
$28,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,772.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,992.30
|
| Rate for Payer: PHCS Commercial |
$36,163.20
|
| Rate for Payer: United Healthcare All Payer |
$33,149.60
|
|
|
GRAFT Z MAIN BDY TFFB-24-82-ZT
|
Facility
|
IP
|
$41,767.14
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,530.14 |
| Max. Negotiated Rate |
$40,096.45 |
| Rate for Payer: Aetna Commercial |
$32,160.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,578.37
|
| Rate for Payer: Cash Price |
$20,883.57
|
| Rate for Payer: Cigna Commercial |
$34,666.73
|
| Rate for Payer: First Health Commercial |
$39,678.78
|
| Rate for Payer: Humana Commercial |
$35,502.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,249.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,824.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,530.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,755.08
|
| Rate for Payer: Ohio Health Group HMO |
$31,325.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,413.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,337.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,819.33
|
| Rate for Payer: PHCS Commercial |
$40,096.45
|
| Rate for Payer: United Healthcare All Payer |
$36,755.08
|
|
|
GRAFT Z MAIN BDY TFFB-24-82-ZT
|
Facility
|
OP
|
$41,767.14
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,530.14 |
| Max. Negotiated Rate |
$40,096.45 |
| Rate for Payer: Aetna Commercial |
$32,160.70
|
| Rate for Payer: Anthem Medicaid |
$14,363.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,578.37
|
| Rate for Payer: Cash Price |
$20,883.57
|
| Rate for Payer: Cigna Commercial |
$34,666.73
|
| Rate for Payer: First Health Commercial |
$39,678.78
|
| Rate for Payer: Humana Commercial |
$35,502.07
|
| Rate for Payer: Humana KY Medicaid |
$14,363.72
|
| Rate for Payer: Kentucky WC Medicaid |
$14,509.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,249.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,824.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,530.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,651.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,755.08
|
| Rate for Payer: Ohio Health Group HMO |
$31,325.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,413.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,337.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,819.33
|
| Rate for Payer: PHCS Commercial |
$40,096.45
|
| Rate for Payer: United Healthcare All Payer |
$36,755.08
|
|
|
GRAFT Z MAIN BDY TFFB-24-96-ZT
|
Facility
|
OP
|
$37,670.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,301.00 |
| Max. Negotiated Rate |
$36,163.20 |
| Rate for Payer: Aetna Commercial |
$29,005.90
|
| Rate for Payer: Anthem Medicaid |
$12,954.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,382.60
|
| Rate for Payer: Cash Price |
$18,835.00
|
| Rate for Payer: Cigna Commercial |
$31,266.10
|
| Rate for Payer: First Health Commercial |
$35,786.50
|
| Rate for Payer: Humana Commercial |
$32,019.50
|
| Rate for Payer: Humana KY Medicaid |
$12,954.71
|
| Rate for Payer: Kentucky WC Medicaid |
$13,086.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,889.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,800.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,214.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,149.60
|
| Rate for Payer: Ohio Health Group HMO |
$28,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,772.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,992.30
|
| Rate for Payer: PHCS Commercial |
$36,163.20
|
| Rate for Payer: United Healthcare All Payer |
$33,149.60
|
|
|
GRAFT Z MAIN BDY TFFB-24-96-ZT
|
Facility
|
IP
|
$37,670.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,301.00 |
| Max. Negotiated Rate |
$36,163.20 |
| Rate for Payer: Aetna Commercial |
$29,005.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,382.60
|
| Rate for Payer: Cash Price |
$18,835.00
|
| Rate for Payer: Cigna Commercial |
$31,266.10
|
| Rate for Payer: First Health Commercial |
$35,786.50
|
| Rate for Payer: Humana Commercial |
$32,019.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,889.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,800.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,149.60
|
| Rate for Payer: Ohio Health Group HMO |
$28,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,772.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,992.30
|
| Rate for Payer: PHCS Commercial |
$36,163.20
|
| Rate for Payer: United Healthcare All Payer |
$33,149.60
|
|
|
GRAFT Z MAIN BDY TFFB-30-82-ZT
|
Facility
|
OP
|
$41,767.14
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,530.14 |
| Max. Negotiated Rate |
$40,096.45 |
| Rate for Payer: Aetna Commercial |
$32,160.70
|
| Rate for Payer: Anthem Medicaid |
$14,363.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,578.37
|
| Rate for Payer: Cash Price |
$20,883.57
|
| Rate for Payer: Cigna Commercial |
$34,666.73
|
| Rate for Payer: First Health Commercial |
$39,678.78
|
| Rate for Payer: Humana Commercial |
$35,502.07
|
| Rate for Payer: Humana KY Medicaid |
$14,363.72
|
| Rate for Payer: Kentucky WC Medicaid |
$14,509.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,249.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,824.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,530.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,651.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,755.08
|
| Rate for Payer: Ohio Health Group HMO |
$31,325.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,413.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,337.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,819.33
|
| Rate for Payer: PHCS Commercial |
$40,096.45
|
| Rate for Payer: United Healthcare All Payer |
$36,755.08
|
|
|
GRAFT Z MAIN BDY TFFB-30-82-ZT
|
Facility
|
IP
|
$41,767.14
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,530.14 |
| Max. Negotiated Rate |
$40,096.45 |
| Rate for Payer: Aetna Commercial |
$32,160.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,578.37
|
| Rate for Payer: Cash Price |
$20,883.57
|
| Rate for Payer: Cigna Commercial |
$34,666.73
|
| Rate for Payer: First Health Commercial |
$39,678.78
|
| Rate for Payer: Humana Commercial |
$35,502.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,249.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,824.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,530.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,755.08
|
| Rate for Payer: Ohio Health Group HMO |
$31,325.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,413.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,337.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,819.33
|
| Rate for Payer: PHCS Commercial |
$40,096.45
|
| Rate for Payer: United Healthcare All Payer |
$36,755.08
|
|
|
GRAFT Z MAIN BODY TFB-30-117
|
Facility
|
OP
|
$32,750.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,825.00 |
| Max. Negotiated Rate |
$31,440.00 |
| Rate for Payer: Aetna Commercial |
$25,217.50
|
| Rate for Payer: Anthem Medicaid |
$11,262.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,545.00
|
| Rate for Payer: Cash Price |
$16,375.00
|
| Rate for Payer: Cigna Commercial |
$27,182.50
|
| Rate for Payer: First Health Commercial |
$31,112.50
|
| Rate for Payer: Humana Commercial |
$27,837.50
|
| Rate for Payer: Humana KY Medicaid |
$11,262.73
|
| Rate for Payer: Kentucky WC Medicaid |
$11,377.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,855.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,169.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,825.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,488.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,820.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,492.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,597.50
|
| Rate for Payer: PHCS Commercial |
$31,440.00
|
| Rate for Payer: United Healthcare All Payer |
$28,820.00
|
|
|
GRAFT Z MAIN BODY TFB-30-117
|
Facility
|
IP
|
$32,750.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,825.00 |
| Max. Negotiated Rate |
$31,440.00 |
| Rate for Payer: Aetna Commercial |
$25,217.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,545.00
|
| Rate for Payer: Cash Price |
$16,375.00
|
| Rate for Payer: Cigna Commercial |
$27,182.50
|
| Rate for Payer: First Health Commercial |
$31,112.50
|
| Rate for Payer: Humana Commercial |
$27,837.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,855.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,169.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,825.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,820.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,492.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,597.50
|
| Rate for Payer: PHCS Commercial |
$31,440.00
|
| Rate for Payer: United Healthcare All Payer |
$28,820.00
|
|
|
GRAFT Z MAIN BODY TFFB-22-111
|
Facility
|
IP
|
$35,795.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,738.50 |
| Max. Negotiated Rate |
$34,363.20 |
| Rate for Payer: Aetna Commercial |
$27,562.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,920.10
|
| Rate for Payer: Cash Price |
$17,897.50
|
| Rate for Payer: Cigna Commercial |
$29,709.85
|
| Rate for Payer: First Health Commercial |
$34,005.25
|
| Rate for Payer: Humana Commercial |
$30,425.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,351.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,416.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,738.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,499.60
|
| Rate for Payer: Ohio Health Group HMO |
$26,846.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,141.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,698.55
|
| Rate for Payer: PHCS Commercial |
$34,363.20
|
| Rate for Payer: United Healthcare All Payer |
$31,499.60
|
|
|
GRAFT Z MAIN BODY TFFB-22-111
|
Facility
|
OP
|
$35,795.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,738.50 |
| Max. Negotiated Rate |
$34,363.20 |
| Rate for Payer: Aetna Commercial |
$27,562.15
|
| Rate for Payer: Anthem Medicaid |
$12,309.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,920.10
|
| Rate for Payer: Cash Price |
$17,897.50
|
| Rate for Payer: Cigna Commercial |
$29,709.85
|
| Rate for Payer: First Health Commercial |
$34,005.25
|
| Rate for Payer: Humana Commercial |
$30,425.75
|
| Rate for Payer: Humana KY Medicaid |
$12,309.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,435.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,351.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,416.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,738.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,556.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,499.60
|
| Rate for Payer: Ohio Health Group HMO |
$26,846.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,141.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,698.55
|
| Rate for Payer: PHCS Commercial |
$34,363.20
|
| Rate for Payer: United Healthcare All Payer |
$31,499.60
|
|
|
GRAFT Z MAIN BODY TFFB-22-125
|
Facility
|
IP
|
$35,795.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,738.50 |
| Max. Negotiated Rate |
$34,363.20 |
| Rate for Payer: Aetna Commercial |
$27,562.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,920.10
|
| Rate for Payer: Cash Price |
$17,897.50
|
| Rate for Payer: Cigna Commercial |
$29,709.85
|
| Rate for Payer: First Health Commercial |
$34,005.25
|
| Rate for Payer: Humana Commercial |
$30,425.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,351.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,416.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,738.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,499.60
|
| Rate for Payer: Ohio Health Group HMO |
$26,846.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,141.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,698.55
|
| Rate for Payer: PHCS Commercial |
$34,363.20
|
| Rate for Payer: United Healthcare All Payer |
$31,499.60
|
|
|
GRAFT Z MAIN BODY TFFB-22-125
|
Facility
|
OP
|
$35,795.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,738.50 |
| Max. Negotiated Rate |
$34,363.20 |
| Rate for Payer: Aetna Commercial |
$27,562.15
|
| Rate for Payer: Anthem Medicaid |
$12,309.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,920.10
|
| Rate for Payer: Cash Price |
$17,897.50
|
| Rate for Payer: Cigna Commercial |
$29,709.85
|
| Rate for Payer: First Health Commercial |
$34,005.25
|
| Rate for Payer: Humana Commercial |
$30,425.75
|
| Rate for Payer: Humana KY Medicaid |
$12,309.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,435.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,351.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,416.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,738.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,556.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,499.60
|
| Rate for Payer: Ohio Health Group HMO |
$26,846.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,141.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,698.55
|
| Rate for Payer: PHCS Commercial |
$34,363.20
|
| Rate for Payer: United Healthcare All Payer |
$31,499.60
|
|
|
GRAFT Z MAIN BODY TFFB-22-140
|
Facility
|
OP
|
$35,795.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,738.50 |
| Max. Negotiated Rate |
$34,363.20 |
| Rate for Payer: Aetna Commercial |
$27,562.15
|
| Rate for Payer: Anthem Medicaid |
$12,309.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,920.10
|
| Rate for Payer: Cash Price |
$17,897.50
|
| Rate for Payer: Cigna Commercial |
$29,709.85
|
| Rate for Payer: First Health Commercial |
$34,005.25
|
| Rate for Payer: Humana Commercial |
$30,425.75
|
| Rate for Payer: Humana KY Medicaid |
$12,309.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,435.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,351.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,416.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,738.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,556.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,499.60
|
| Rate for Payer: Ohio Health Group HMO |
$26,846.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,141.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,698.55
|
| Rate for Payer: PHCS Commercial |
$34,363.20
|
| Rate for Payer: United Healthcare All Payer |
$31,499.60
|
|
|
GRAFT Z MAIN BODY TFFB-22-140
|
Facility
|
IP
|
$35,795.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,738.50 |
| Max. Negotiated Rate |
$34,363.20 |
| Rate for Payer: Aetna Commercial |
$27,562.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,920.10
|
| Rate for Payer: Cash Price |
$17,897.50
|
| Rate for Payer: Cigna Commercial |
$29,709.85
|
| Rate for Payer: First Health Commercial |
$34,005.25
|
| Rate for Payer: Humana Commercial |
$30,425.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,351.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,416.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,738.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,499.60
|
| Rate for Payer: Ohio Health Group HMO |
$26,846.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,141.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,698.55
|
| Rate for Payer: PHCS Commercial |
$34,363.20
|
| Rate for Payer: United Healthcare All Payer |
$31,499.60
|
|
|
GRAFT Z MAIN BODY TFFB-22-82
|
Facility
|
OP
|
$35,795.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,738.50 |
| Max. Negotiated Rate |
$34,363.20 |
| Rate for Payer: Aetna Commercial |
$27,562.15
|
| Rate for Payer: Anthem Medicaid |
$12,309.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,920.10
|
| Rate for Payer: Cash Price |
$17,897.50
|
| Rate for Payer: Cigna Commercial |
$29,709.85
|
| Rate for Payer: First Health Commercial |
$34,005.25
|
| Rate for Payer: Humana Commercial |
$30,425.75
|
| Rate for Payer: Humana KY Medicaid |
$12,309.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,435.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,351.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,416.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,738.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,556.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,499.60
|
| Rate for Payer: Ohio Health Group HMO |
$26,846.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,141.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,698.55
|
| Rate for Payer: PHCS Commercial |
$34,363.20
|
| Rate for Payer: United Healthcare All Payer |
$31,499.60
|
|
|
GRAFT Z MAIN BODY TFFB-22-82
|
Facility
|
IP
|
$35,795.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,738.50 |
| Max. Negotiated Rate |
$34,363.20 |
| Rate for Payer: Aetna Commercial |
$27,562.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,920.10
|
| Rate for Payer: Cash Price |
$17,897.50
|
| Rate for Payer: Cigna Commercial |
$29,709.85
|
| Rate for Payer: First Health Commercial |
$34,005.25
|
| Rate for Payer: Humana Commercial |
$30,425.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,351.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,416.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,738.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,499.60
|
| Rate for Payer: Ohio Health Group HMO |
$26,846.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,141.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,698.55
|
| Rate for Payer: PHCS Commercial |
$34,363.20
|
| Rate for Payer: United Healthcare All Payer |
$31,499.60
|
|
|
GRAFT Z MAIN BODY TFFB-22-96
|
Facility
|
IP
|
$35,795.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,738.50 |
| Max. Negotiated Rate |
$34,363.20 |
| Rate for Payer: Aetna Commercial |
$27,562.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,920.10
|
| Rate for Payer: Cash Price |
$17,897.50
|
| Rate for Payer: Cigna Commercial |
$29,709.85
|
| Rate for Payer: First Health Commercial |
$34,005.25
|
| Rate for Payer: Humana Commercial |
$30,425.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,351.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,416.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,738.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,499.60
|
| Rate for Payer: Ohio Health Group HMO |
$26,846.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,141.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,698.55
|
| Rate for Payer: PHCS Commercial |
$34,363.20
|
| Rate for Payer: United Healthcare All Payer |
$31,499.60
|
|
|
GRAFT Z MAIN BODY TFFB-22-96
|
Facility
|
OP
|
$35,795.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,738.50 |
| Max. Negotiated Rate |
$34,363.20 |
| Rate for Payer: Aetna Commercial |
$27,562.15
|
| Rate for Payer: Anthem Medicaid |
$12,309.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,920.10
|
| Rate for Payer: Cash Price |
$17,897.50
|
| Rate for Payer: Cigna Commercial |
$29,709.85
|
| Rate for Payer: First Health Commercial |
$34,005.25
|
| Rate for Payer: Humana Commercial |
$30,425.75
|
| Rate for Payer: Humana KY Medicaid |
$12,309.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,435.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,351.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,416.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,738.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,556.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,499.60
|
| Rate for Payer: Ohio Health Group HMO |
$26,846.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,141.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,698.55
|
| Rate for Payer: PHCS Commercial |
$34,363.20
|
| Rate for Payer: United Healthcare All Payer |
$31,499.60
|
|
|
GRAFT Z MAIN BODY TFFB-24-111
|
Facility
|
IP
|
$35,795.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,738.50 |
| Max. Negotiated Rate |
$34,363.20 |
| Rate for Payer: Aetna Commercial |
$27,562.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,920.10
|
| Rate for Payer: Cash Price |
$17,897.50
|
| Rate for Payer: Cigna Commercial |
$29,709.85
|
| Rate for Payer: First Health Commercial |
$34,005.25
|
| Rate for Payer: Humana Commercial |
$30,425.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,351.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,416.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,738.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,499.60
|
| Rate for Payer: Ohio Health Group HMO |
$26,846.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,141.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,698.55
|
| Rate for Payer: PHCS Commercial |
$34,363.20
|
| Rate for Payer: United Healthcare All Payer |
$31,499.60
|
|
|
GRAFT Z MAIN BODY TFFB-24-111
|
Facility
|
OP
|
$35,795.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,738.50 |
| Max. Negotiated Rate |
$34,363.20 |
| Rate for Payer: Aetna Commercial |
$27,562.15
|
| Rate for Payer: Anthem Medicaid |
$12,309.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,920.10
|
| Rate for Payer: Cash Price |
$17,897.50
|
| Rate for Payer: Cigna Commercial |
$29,709.85
|
| Rate for Payer: First Health Commercial |
$34,005.25
|
| Rate for Payer: Humana Commercial |
$30,425.75
|
| Rate for Payer: Humana KY Medicaid |
$12,309.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,435.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,351.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,416.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,738.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,556.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,499.60
|
| Rate for Payer: Ohio Health Group HMO |
$26,846.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,141.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,698.55
|
| Rate for Payer: PHCS Commercial |
$34,363.20
|
| Rate for Payer: United Healthcare All Payer |
$31,499.60
|
|
|
GRAFT Z MAIN BODY TFFB-24-125
|
Facility
|
OP
|
$35,795.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,738.50 |
| Max. Negotiated Rate |
$34,363.20 |
| Rate for Payer: Aetna Commercial |
$27,562.15
|
| Rate for Payer: Anthem Medicaid |
$12,309.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,920.10
|
| Rate for Payer: Cash Price |
$17,897.50
|
| Rate for Payer: Cigna Commercial |
$29,709.85
|
| Rate for Payer: First Health Commercial |
$34,005.25
|
| Rate for Payer: Humana Commercial |
$30,425.75
|
| Rate for Payer: Humana KY Medicaid |
$12,309.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,435.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,351.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,416.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,738.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,556.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,499.60
|
| Rate for Payer: Ohio Health Group HMO |
$26,846.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,141.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,698.55
|
| Rate for Payer: PHCS Commercial |
$34,363.20
|
| Rate for Payer: United Healthcare All Payer |
$31,499.60
|
|
|
GRAFT Z MAIN BODY TFFB-24-125
|
Facility
|
IP
|
$35,795.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,738.50 |
| Max. Negotiated Rate |
$34,363.20 |
| Rate for Payer: Aetna Commercial |
$27,562.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,920.10
|
| Rate for Payer: Cash Price |
$17,897.50
|
| Rate for Payer: Cigna Commercial |
$29,709.85
|
| Rate for Payer: First Health Commercial |
$34,005.25
|
| Rate for Payer: Humana Commercial |
$30,425.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,351.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,416.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,738.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,499.60
|
| Rate for Payer: Ohio Health Group HMO |
$26,846.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,141.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,698.55
|
| Rate for Payer: PHCS Commercial |
$34,363.20
|
| Rate for Payer: United Healthcare All Payer |
$31,499.60
|
|
