|
AORTA BI FEMORAL BYPASS GRAFT
|
Facility
|
IP
|
$4,100.00
|
|
|
Service Code
|
HCPCS 35646
|
| Hospital Charge Code |
76101410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$533.00 |
| Max. Negotiated Rate |
$3,936.00 |
| Rate for Payer: Aetna Commercial |
$3,157.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,198.00
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cigna Commercial |
$3,403.00
|
| Rate for Payer: First Health Commercial |
$3,895.00
|
| Rate for Payer: Humana Commercial |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,362.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,025.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,608.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,075.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.00
|
| Rate for Payer: PHCS Commercial |
$3,936.00
|
| Rate for Payer: United Healthcare All Payer |
$3,608.00
|
|
|
AORTA BI FEMORAL BYPASS GRAFT
|
Facility
|
OP
|
$4,100.00
|
|
|
Service Code
|
HCPCS 35646
|
| Hospital Charge Code |
76101410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$533.00 |
| Max. Negotiated Rate |
$3,936.00 |
| Rate for Payer: Aetna Commercial |
$3,157.00
|
| Rate for Payer: Anthem Medicaid |
$1,409.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,198.00
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cigna Commercial |
$3,403.00
|
| Rate for Payer: First Health Commercial |
$3,895.00
|
| Rate for Payer: Humana Commercial |
$3,485.00
|
| Rate for Payer: Humana KY Medicaid |
$1,409.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,362.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,025.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,438.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,608.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,075.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.00
|
| Rate for Payer: PHCS Commercial |
$3,936.00
|
| Rate for Payer: United Healthcare All Payer |
$3,608.00
|
|
|
AORTA BI FEMORAL BYPASS GRAFT
|
Professional
|
Both
|
$4,100.00
|
|
|
Service Code
|
HCPCS 35646
|
| Hospital Charge Code |
76101410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,435.00 |
| Max. Negotiated Rate |
$4,100.00 |
| Rate for Payer: Aetna Commercial |
$3,054.45
|
| Rate for Payer: Anthem Medicaid |
$1,457.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,100.00
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cigna Commercial |
$2,919.02
|
| Rate for Payer: Healthspan PPO |
$3,003.12
|
| Rate for Payer: Humana Medicaid |
$1,457.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,363.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,486.14
|
| Rate for Payer: Molina Healthcare Passport |
$1,457.00
|
| Rate for Payer: Multiplan PHCS |
$2,460.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,870.00
|
| Rate for Payer: UHCCP Medicaid |
$1,435.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,471.57
|
|
|
AORTC EXT INFRARENAL 25-25-95L
|
Facility
|
OP
|
$14,231.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.13 |
| Max. Negotiated Rate |
$13,662.48 |
| Rate for Payer: Aetna Commercial |
$10,958.45
|
| Rate for Payer: Anthem Medicaid |
$4,894.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,100.76
|
| Rate for Payer: Cash Price |
$7,115.88
|
| Rate for Payer: Cigna Commercial |
$11,812.35
|
| Rate for Payer: First Health Commercial |
$13,520.16
|
| Rate for Payer: Humana Commercial |
$12,096.99
|
| Rate for Payer: Humana KY Medicaid |
$4,894.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,944.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,670.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,503.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,269.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,992.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,523.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,673.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,846.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,411.84
|
| Rate for Payer: PHCS Commercial |
$13,662.48
|
| Rate for Payer: United Healthcare All Payer |
$12,523.94
|
|
|
AORTC EXT INFRARENAL 25-25-95L
|
Facility
|
IP
|
$14,231.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.13 |
| Max. Negotiated Rate |
$13,662.48 |
| Rate for Payer: Aetna Commercial |
$10,958.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,100.76
|
| Rate for Payer: Cash Price |
$7,115.88
|
| Rate for Payer: Cigna Commercial |
$11,812.35
|
| Rate for Payer: First Health Commercial |
$13,520.16
|
| Rate for Payer: Humana Commercial |
$12,096.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,670.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,503.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,269.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,523.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,673.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,846.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,411.84
|
| Rate for Payer: PHCS Commercial |
$13,662.48
|
| Rate for Payer: United Healthcare All Payer |
$12,523.94
|
|
|
AORTC EXT INFRARENAL 28-28-55L
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
AORTC EXT INFRARENAL 28-28-55L
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
AORTC EXT INFRARENAL 28-28-95L
|
Facility
|
IP
|
$14,231.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.13 |
| Max. Negotiated Rate |
$13,662.48 |
| Rate for Payer: Aetna Commercial |
$10,958.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,100.76
|
| Rate for Payer: Cash Price |
$7,115.88
|
| Rate for Payer: Cigna Commercial |
$11,812.35
|
| Rate for Payer: First Health Commercial |
$13,520.16
|
| Rate for Payer: Humana Commercial |
$12,096.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,670.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,503.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,269.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,523.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,673.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,846.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,411.84
|
| Rate for Payer: PHCS Commercial |
$13,662.48
|
| Rate for Payer: United Healthcare All Payer |
$12,523.94
|
|
|
AORTC EXT INFRARENAL 28-28-95L
|
Facility
|
OP
|
$14,231.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.13 |
| Max. Negotiated Rate |
$13,662.48 |
| Rate for Payer: Aetna Commercial |
$10,958.45
|
| Rate for Payer: Anthem Medicaid |
$4,894.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,100.76
|
| Rate for Payer: Cash Price |
$7,115.88
|
| Rate for Payer: Cigna Commercial |
$11,812.35
|
| Rate for Payer: First Health Commercial |
$13,520.16
|
| Rate for Payer: Humana Commercial |
$12,096.99
|
| Rate for Payer: Humana KY Medicaid |
$4,894.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,944.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,670.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,503.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,269.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,992.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,523.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,673.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,846.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,411.84
|
| Rate for Payer: PHCS Commercial |
$13,662.48
|
| Rate for Payer: United Healthcare All Payer |
$12,523.94
|
|
|
AORTC EXT INFRARENAL 34-34-80L
|
Facility
|
OP
|
$17,862.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,322.06 |
| Max. Negotiated Rate |
$17,147.52 |
| Rate for Payer: Aetna Commercial |
$13,753.74
|
| Rate for Payer: Anthem Medicaid |
$6,142.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,932.36
|
| Rate for Payer: Cash Price |
$8,931.00
|
| Rate for Payer: Cigna Commercial |
$14,825.46
|
| Rate for Payer: First Health Commercial |
$16,968.90
|
| Rate for Payer: Humana Commercial |
$15,182.70
|
| Rate for Payer: Humana KY Medicaid |
$6,142.74
|
| Rate for Payer: Kentucky WC Medicaid |
$6,205.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,646.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,182.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,358.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,265.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,718.56
|
| Rate for Payer: Ohio Health Group HMO |
$13,396.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,572.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,322.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,537.22
|
| Rate for Payer: PHCS Commercial |
$17,147.52
|
| Rate for Payer: United Healthcare All Payer |
$15,718.56
|
|
|
AORTC EXT INFRARENAL 34-34-80L
|
Facility
|
IP
|
$17,862.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,322.06 |
| Max. Negotiated Rate |
$17,147.52 |
| Rate for Payer: Aetna Commercial |
$13,753.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,932.36
|
| Rate for Payer: Cash Price |
$8,931.00
|
| Rate for Payer: Cigna Commercial |
$14,825.46
|
| Rate for Payer: First Health Commercial |
$16,968.90
|
| Rate for Payer: Humana Commercial |
$15,182.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,646.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,182.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,358.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,718.56
|
| Rate for Payer: Ohio Health Group HMO |
$13,396.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,572.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,322.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,537.22
|
| Rate for Payer: PHCS Commercial |
$17,147.52
|
| Rate for Payer: United Healthcare All Payer |
$15,718.56
|
|
|
AORTC EXT INFRARNAL 34-34-100L
|
Facility
|
OP
|
$19,746.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,567.08 |
| Max. Negotiated Rate |
$18,956.88 |
| Rate for Payer: Aetna Commercial |
$15,205.00
|
| Rate for Payer: Anthem Medicaid |
$6,790.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,402.46
|
| Rate for Payer: Cash Price |
$9,873.38
|
| Rate for Payer: Cigna Commercial |
$16,389.80
|
| Rate for Payer: First Health Commercial |
$18,759.41
|
| Rate for Payer: Humana Commercial |
$16,784.74
|
| Rate for Payer: Humana KY Medicaid |
$6,790.91
|
| Rate for Payer: Kentucky WC Medicaid |
$6,860.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,192.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,573.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,924.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,927.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,377.14
|
| Rate for Payer: Ohio Health Group HMO |
$14,810.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,567.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,121.49
|
| Rate for Payer: PHCS Commercial |
$18,956.88
|
| Rate for Payer: United Healthcare All Payer |
$17,377.14
|
|
|
AORTC EXT INFRARNAL 34-34-100L
|
Facility
|
IP
|
$19,746.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,567.08 |
| Max. Negotiated Rate |
$18,956.88 |
| Rate for Payer: Aetna Commercial |
$15,205.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,402.46
|
| Rate for Payer: Cash Price |
$9,873.38
|
| Rate for Payer: Cigna Commercial |
$16,389.80
|
| Rate for Payer: First Health Commercial |
$18,759.41
|
| Rate for Payer: Humana Commercial |
$16,784.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,192.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,573.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,924.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,377.14
|
| Rate for Payer: Ohio Health Group HMO |
$14,810.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,567.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,121.49
|
| Rate for Payer: PHCS Commercial |
$18,956.88
|
| Rate for Payer: United Healthcare All Payer |
$17,377.14
|
|
|
AORTC EXT INFRARNAL 34-34-80LE
|
Facility
|
OP
|
$17,862.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,322.06 |
| Max. Negotiated Rate |
$17,147.52 |
| Rate for Payer: Aetna Commercial |
$13,753.74
|
| Rate for Payer: Anthem Medicaid |
$6,142.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,932.36
|
| Rate for Payer: Cash Price |
$8,931.00
|
| Rate for Payer: Cigna Commercial |
$14,825.46
|
| Rate for Payer: First Health Commercial |
$16,968.90
|
| Rate for Payer: Humana Commercial |
$15,182.70
|
| Rate for Payer: Humana KY Medicaid |
$6,142.74
|
| Rate for Payer: Kentucky WC Medicaid |
$6,205.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,646.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,182.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,358.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,265.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,718.56
|
| Rate for Payer: Ohio Health Group HMO |
$13,396.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,572.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,322.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,537.22
|
| Rate for Payer: PHCS Commercial |
$17,147.52
|
| Rate for Payer: United Healthcare All Payer |
$15,718.56
|
|
|
AORTC EXT INFRARNAL 34-34-80LE
|
Facility
|
IP
|
$17,862.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,322.06 |
| Max. Negotiated Rate |
$17,147.52 |
| Rate for Payer: Aetna Commercial |
$13,753.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,932.36
|
| Rate for Payer: Cash Price |
$8,931.00
|
| Rate for Payer: Cigna Commercial |
$14,825.46
|
| Rate for Payer: First Health Commercial |
$16,968.90
|
| Rate for Payer: Humana Commercial |
$15,182.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,646.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,182.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,358.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,718.56
|
| Rate for Payer: Ohio Health Group HMO |
$13,396.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,572.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,322.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,537.22
|
| Rate for Payer: PHCS Commercial |
$17,147.52
|
| Rate for Payer: United Healthcare All Payer |
$15,718.56
|
|
|
AORTC EXT INFRARNL 34-34-100LE
|
Facility
|
IP
|
$19,746.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,567.08 |
| Max. Negotiated Rate |
$18,956.88 |
| Rate for Payer: Aetna Commercial |
$15,205.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,402.46
|
| Rate for Payer: Cash Price |
$9,873.38
|
| Rate for Payer: Cigna Commercial |
$16,389.80
|
| Rate for Payer: First Health Commercial |
$18,759.41
|
| Rate for Payer: Humana Commercial |
$16,784.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,192.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,573.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,924.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,377.14
|
| Rate for Payer: Ohio Health Group HMO |
$14,810.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,567.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,121.49
|
| Rate for Payer: PHCS Commercial |
$18,956.88
|
| Rate for Payer: United Healthcare All Payer |
$17,377.14
|
|
|
AORTC EXT INFRARNL 34-34-100LE
|
Facility
|
OP
|
$19,746.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,567.08 |
| Max. Negotiated Rate |
$18,956.88 |
| Rate for Payer: Aetna Commercial |
$15,205.00
|
| Rate for Payer: Anthem Medicaid |
$6,790.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,402.46
|
| Rate for Payer: Cash Price |
$9,873.38
|
| Rate for Payer: Cigna Commercial |
$16,389.80
|
| Rate for Payer: First Health Commercial |
$18,759.41
|
| Rate for Payer: Humana Commercial |
$16,784.74
|
| Rate for Payer: Humana KY Medicaid |
$6,790.91
|
| Rate for Payer: Kentucky WC Medicaid |
$6,860.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,192.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,573.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,924.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,927.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,377.14
|
| Rate for Payer: Ohio Health Group HMO |
$14,810.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,567.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,121.49
|
| Rate for Payer: PHCS Commercial |
$18,956.88
|
| Rate for Payer: United Healthcare All Payer |
$17,377.14
|
|
|
AORTC EXT POWERFIT 25-25-115RL
|
Facility
|
IP
|
$16,422.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,134.86 |
| Max. Negotiated Rate |
$15,765.12 |
| Rate for Payer: Aetna Commercial |
$12,644.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,809.16
|
| Rate for Payer: Cash Price |
$8,211.00
|
| Rate for Payer: Cigna Commercial |
$13,630.26
|
| Rate for Payer: First Health Commercial |
$15,600.90
|
| Rate for Payer: Humana Commercial |
$13,958.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,466.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,119.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,926.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,451.36
|
| Rate for Payer: Ohio Health Group HMO |
$12,316.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,284.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,134.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,090.82
|
| Rate for Payer: PHCS Commercial |
$15,765.12
|
| Rate for Payer: United Healthcare All Payer |
$14,451.36
|
|
|
AORTC EXT POWERFIT 25-25-115RL
|
Facility
|
OP
|
$16,422.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,134.86 |
| Max. Negotiated Rate |
$15,765.12 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,466.04
|
| Rate for Payer: Aetna Commercial |
$12,644.94
|
| Rate for Payer: Anthem Medicaid |
$5,647.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,809.16
|
| Rate for Payer: Cash Price |
$8,211.00
|
| Rate for Payer: Cigna Commercial |
$13,630.26
|
| Rate for Payer: First Health Commercial |
$15,600.90
|
| Rate for Payer: Humana Commercial |
$13,958.70
|
| Rate for Payer: Humana KY Medicaid |
$5,647.53
|
| Rate for Payer: Kentucky WC Medicaid |
$5,705.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,119.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,926.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,760.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,451.36
|
| Rate for Payer: Ohio Health Group HMO |
$12,316.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,284.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,134.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,090.82
|
| Rate for Payer: PHCS Commercial |
$15,765.12
|
| Rate for Payer: United Healthcare All Payer |
$14,451.36
|
|
|
AORTC EXT POWERFIT 28-28-115RL
|
Facility
|
OP
|
$18,582.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.66 |
| Max. Negotiated Rate |
$17,838.72 |
| Rate for Payer: Aetna Commercial |
$14,308.14
|
| Rate for Payer: Anthem Medicaid |
$6,390.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,493.96
|
| Rate for Payer: Cash Price |
$9,291.00
|
| Rate for Payer: Cigna Commercial |
$15,423.06
|
| Rate for Payer: First Health Commercial |
$17,652.90
|
| Rate for Payer: Humana Commercial |
$15,794.70
|
| Rate for Payer: Humana KY Medicaid |
$6,390.35
|
| Rate for Payer: Kentucky WC Medicaid |
$6,455.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,713.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,518.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.16
|
| Rate for Payer: Ohio Health Group HMO |
$13,936.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.42
|
| Rate for Payer: PHCS Commercial |
$17,838.72
|
| Rate for Payer: United Healthcare All Payer |
$16,352.16
|
|
|
AORTC EXT POWERFIT 28-28-115RL
|
Facility
|
IP
|
$18,582.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.66 |
| Max. Negotiated Rate |
$17,838.72 |
| Rate for Payer: Aetna Commercial |
$14,308.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,493.96
|
| Rate for Payer: Cash Price |
$9,291.00
|
| Rate for Payer: Cigna Commercial |
$15,423.06
|
| Rate for Payer: First Health Commercial |
$17,652.90
|
| Rate for Payer: Humana Commercial |
$15,794.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,713.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.16
|
| Rate for Payer: Ohio Health Group HMO |
$13,936.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.42
|
| Rate for Payer: PHCS Commercial |
$17,838.72
|
| Rate for Payer: United Healthcare All Payer |
$16,352.16
|
|
|
AORTC EXT POWERFIT 34-34-100RL
|
Facility
|
OP
|
$20,111.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,614.53 |
| Max. Negotiated Rate |
$19,307.28 |
| Rate for Payer: Aetna Commercial |
$15,486.05
|
| Rate for Payer: Anthem Medicaid |
$6,916.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,687.16
|
| Rate for Payer: Cash Price |
$10,055.88
|
| Rate for Payer: Cigna Commercial |
$16,692.75
|
| Rate for Payer: First Health Commercial |
$19,106.16
|
| Rate for Payer: Humana Commercial |
$17,094.99
|
| Rate for Payer: Humana KY Medicaid |
$6,916.43
|
| Rate for Payer: Kentucky WC Medicaid |
$6,986.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,491.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,842.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,033.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,055.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,698.34
|
| Rate for Payer: Ohio Health Group HMO |
$15,083.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,022.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,614.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,234.64
|
| Rate for Payer: PHCS Commercial |
$19,307.28
|
| Rate for Payer: United Healthcare All Payer |
$17,698.34
|
|
|
AORTC EXT POWERFIT 34-34-100RL
|
Facility
|
IP
|
$20,111.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,614.53 |
| Max. Negotiated Rate |
$19,307.28 |
| Rate for Payer: Aetna Commercial |
$15,486.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,687.16
|
| Rate for Payer: Cash Price |
$10,055.88
|
| Rate for Payer: Cigna Commercial |
$16,692.75
|
| Rate for Payer: First Health Commercial |
$19,106.16
|
| Rate for Payer: Humana Commercial |
$17,094.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,491.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,842.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,033.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,698.34
|
| Rate for Payer: Ohio Health Group HMO |
$15,083.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,022.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,614.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,234.64
|
| Rate for Payer: PHCS Commercial |
$19,307.28
|
| Rate for Payer: United Healthcare All Payer |
$17,698.34
|
|
|
AORTC EXT POWERFIT 34-34-120RL
|
Facility
|
IP
|
$21,206.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,756.88 |
| Max. Negotiated Rate |
$20,358.48 |
| Rate for Payer: Aetna Commercial |
$16,329.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,541.26
|
| Rate for Payer: Cash Price |
$10,603.38
|
| Rate for Payer: Cigna Commercial |
$17,601.60
|
| Rate for Payer: First Health Commercial |
$20,146.41
|
| Rate for Payer: Humana Commercial |
$18,025.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,389.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,650.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,362.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,661.94
|
| Rate for Payer: Ohio Health Group HMO |
$15,905.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,241.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,756.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,574.09
|
| Rate for Payer: PHCS Commercial |
$20,358.48
|
| Rate for Payer: United Healthcare All Payer |
$18,661.94
|
|
|
AORTC EXT POWERFIT 34-34-120RL
|
Facility
|
OP
|
$21,206.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,756.88 |
| Max. Negotiated Rate |
$20,358.48 |
| Rate for Payer: Aetna Commercial |
$16,329.20
|
| Rate for Payer: Anthem Medicaid |
$7,293.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,541.26
|
| Rate for Payer: Cash Price |
$10,603.38
|
| Rate for Payer: Cigna Commercial |
$17,601.60
|
| Rate for Payer: First Health Commercial |
$20,146.41
|
| Rate for Payer: Humana Commercial |
$18,025.74
|
| Rate for Payer: Humana KY Medicaid |
$7,293.00
|
| Rate for Payer: Kentucky WC Medicaid |
$7,367.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,389.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,650.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,362.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,439.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,661.94
|
| Rate for Payer: Ohio Health Group HMO |
$15,905.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,241.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,756.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,574.09
|
| Rate for Payer: PHCS Commercial |
$20,358.48
|
| Rate for Payer: United Healthcare All Payer |
$18,661.94
|
|
