|
GRAFT Z MAIN BODY TFFB-24-140
|
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-24-140
|
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-24-82
|
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-24-82
|
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-24-96
|
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-24-96
|
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-26-111
|
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-26-111
|
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-26-125
|
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-26-125
|
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-26-140
|
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-26-140
|
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-26-82
|
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-26-82
|
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-26-82-Z
|
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 TFFB-26-82-Z
|
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 BODY TFFB-26-96
|
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-26-96
|
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-26-96-Z
|
Facility
|
OP
|
$67,876.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,362.86 |
| Max. Negotiated Rate |
$65,161.15 |
| Rate for Payer: Aetna Commercial |
$52,264.67
|
| Rate for Payer: Anthem Medicaid |
$23,342.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52,943.44
|
| Rate for Payer: Cash Price |
$33,938.10
|
| Rate for Payer: Cigna Commercial |
$56,337.25
|
| Rate for Payer: First Health Commercial |
$64,482.39
|
| Rate for Payer: Humana Commercial |
$57,694.77
|
| Rate for Payer: Humana KY Medicaid |
$23,342.63
|
| Rate for Payer: Kentucky WC Medicaid |
$23,580.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55,658.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,092.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,362.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,810.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$59,731.06
|
| Rate for Payer: Ohio Health Group HMO |
$50,907.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,300.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,052.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46,834.58
|
| Rate for Payer: PHCS Commercial |
$65,161.15
|
| Rate for Payer: United Healthcare All Payer |
$59,731.06
|
|
|
GRAFT Z MAIN BODY TFFB-26-96-Z
|
Facility
|
IP
|
$67,876.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,362.86 |
| Max. Negotiated Rate |
$65,161.15 |
| Rate for Payer: Aetna Commercial |
$52,264.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52,943.44
|
| Rate for Payer: Cash Price |
$33,938.10
|
| Rate for Payer: Cigna Commercial |
$56,337.25
|
| Rate for Payer: First Health Commercial |
$64,482.39
|
| Rate for Payer: Humana Commercial |
$57,694.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55,658.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,092.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,362.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$59,731.06
|
| Rate for Payer: Ohio Health Group HMO |
$50,907.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,300.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,052.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46,834.58
|
| Rate for Payer: PHCS Commercial |
$65,161.15
|
| Rate for Payer: United Healthcare All Payer |
$59,731.06
|
|
|
GRAFT Z MAIN BODY TFFB-28-111
|
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-28-111
|
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-28-125
|
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-28-125
|
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-28-140
|
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
|
|
