|
AORTC EXT INFRARENAL 25-25-95L
|
Facility
|
IP
|
$14,491.65
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,347.49 |
| Max. Negotiated Rate |
$13,911.98 |
| Rate for Payer: Aetna Commercial |
$11,158.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,303.49
|
| Rate for Payer: Cash Price |
$7,245.82
|
| Rate for Payer: Cigna Commercial |
$12,028.07
|
| Rate for Payer: First Health Commercial |
$13,767.07
|
| Rate for Payer: Humana Commercial |
$12,317.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,883.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,694.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,347.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,752.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,868.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,593.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,607.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,999.24
|
| Rate for Payer: PHCS Commercial |
$13,911.98
|
| Rate for Payer: United Healthcare All Payer |
$12,752.65
|
|
|
AORTC EXT INFRARENAL 25-25-95L
|
Facility
|
OP
|
$14,491.65
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,347.49 |
| Max. Negotiated Rate |
$13,911.98 |
| Rate for Payer: Aetna Commercial |
$11,158.57
|
| Rate for Payer: Anthem Medicaid |
$4,983.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,303.49
|
| Rate for Payer: Cash Price |
$7,245.82
|
| Rate for Payer: Cigna Commercial |
$12,028.07
|
| Rate for Payer: First Health Commercial |
$13,767.07
|
| Rate for Payer: Humana Commercial |
$12,317.90
|
| Rate for Payer: Humana KY Medicaid |
$4,983.68
|
| Rate for Payer: Kentucky WC Medicaid |
$5,034.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,883.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,694.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,347.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,083.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,752.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,868.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,593.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,607.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,999.24
|
| Rate for Payer: PHCS Commercial |
$13,911.98
|
| Rate for Payer: United Healthcare All Payer |
$12,752.65
|
|
|
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 |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
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 |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
AORTC EXT INFRARENAL 28-28-95L
|
Facility
|
IP
|
$14,491.65
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,347.49 |
| Max. Negotiated Rate |
$13,911.98 |
| Rate for Payer: Aetna Commercial |
$11,158.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,303.49
|
| Rate for Payer: Cash Price |
$7,245.82
|
| Rate for Payer: Cigna Commercial |
$12,028.07
|
| Rate for Payer: First Health Commercial |
$13,767.07
|
| Rate for Payer: Humana Commercial |
$12,317.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,883.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,694.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,347.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,752.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,868.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,593.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,607.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,999.24
|
| Rate for Payer: PHCS Commercial |
$13,911.98
|
| Rate for Payer: United Healthcare All Payer |
$12,752.65
|
|
|
AORTC EXT INFRARENAL 28-28-95L
|
Facility
|
OP
|
$14,491.65
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,347.49 |
| Max. Negotiated Rate |
$13,911.98 |
| Rate for Payer: Aetna Commercial |
$11,158.57
|
| Rate for Payer: Anthem Medicaid |
$4,983.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,303.49
|
| Rate for Payer: Cash Price |
$7,245.82
|
| Rate for Payer: Cigna Commercial |
$12,028.07
|
| Rate for Payer: First Health Commercial |
$13,767.07
|
| Rate for Payer: Humana Commercial |
$12,317.90
|
| Rate for Payer: Humana KY Medicaid |
$4,983.68
|
| Rate for Payer: Kentucky WC Medicaid |
$5,034.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,883.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,694.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,347.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,083.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,752.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,868.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,593.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,607.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,999.24
|
| Rate for Payer: PHCS Commercial |
$13,911.98
|
| Rate for Payer: United Healthcare All Payer |
$12,752.65
|
|
|
AORTC EXT INFRARENAL 34-34-80L
|
Facility
|
IP
|
$18,441.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,532.45 |
| Max. Negotiated Rate |
$17,703.84 |
| Rate for Payer: Aetna Commercial |
$14,199.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,384.37
|
| Rate for Payer: Cash Price |
$9,220.75
|
| Rate for Payer: Cigna Commercial |
$15,306.44
|
| Rate for Payer: First Health Commercial |
$17,519.42
|
| Rate for Payer: Humana Commercial |
$15,675.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,122.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,609.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,532.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,228.52
|
| Rate for Payer: Ohio Health Group HMO |
$13,831.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,753.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,044.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,724.64
|
| Rate for Payer: PHCS Commercial |
$17,703.84
|
| Rate for Payer: United Healthcare All Payer |
$16,228.52
|
|
|
AORTC EXT INFRARENAL 34-34-80L
|
Facility
|
OP
|
$18,441.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,532.45 |
| Max. Negotiated Rate |
$17,703.84 |
| Rate for Payer: Aetna Commercial |
$14,199.95
|
| Rate for Payer: Anthem Medicaid |
$6,342.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,384.37
|
| Rate for Payer: Cash Price |
$9,220.75
|
| Rate for Payer: Cigna Commercial |
$15,306.44
|
| Rate for Payer: First Health Commercial |
$17,519.42
|
| Rate for Payer: Humana Commercial |
$15,675.27
|
| Rate for Payer: Humana KY Medicaid |
$6,342.03
|
| Rate for Payer: Kentucky WC Medicaid |
$6,406.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,122.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,609.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,532.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,469.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,228.52
|
| Rate for Payer: Ohio Health Group HMO |
$13,831.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,753.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,044.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,724.64
|
| Rate for Payer: PHCS Commercial |
$17,703.84
|
| Rate for Payer: United Healthcare All Payer |
$16,228.52
|
|
|
AORTC EXT INFRARNAL 34-34-100L
|
Facility
|
OP
|
$20,356.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,106.88 |
| Max. Negotiated Rate |
$19,542.00 |
| Rate for Payer: Aetna Commercial |
$15,674.31
|
| Rate for Payer: Anthem Medicaid |
$7,000.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,877.88
|
| Rate for Payer: Cash Price |
$10,178.12
|
| Rate for Payer: Cigna Commercial |
$16,895.69
|
| Rate for Payer: First Health Commercial |
$19,338.44
|
| Rate for Payer: Humana Commercial |
$17,302.81
|
| Rate for Payer: Humana KY Medicaid |
$7,000.51
|
| Rate for Payer: Kentucky WC Medicaid |
$7,071.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,692.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,022.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,106.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,140.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,913.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,267.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,709.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,045.81
|
| Rate for Payer: PHCS Commercial |
$19,542.00
|
| Rate for Payer: United Healthcare All Payer |
$17,913.50
|
|
|
AORTC EXT INFRARNAL 34-34-100L
|
Facility
|
IP
|
$20,356.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,106.88 |
| Max. Negotiated Rate |
$19,542.00 |
| Rate for Payer: Aetna Commercial |
$15,674.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,877.88
|
| Rate for Payer: Cash Price |
$10,178.12
|
| Rate for Payer: Cigna Commercial |
$16,895.69
|
| Rate for Payer: First Health Commercial |
$19,338.44
|
| Rate for Payer: Humana Commercial |
$17,302.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,692.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,022.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,106.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,913.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,267.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,709.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,045.81
|
| Rate for Payer: PHCS Commercial |
$19,542.00
|
| Rate for Payer: United Healthcare All Payer |
$17,913.50
|
|
|
AORTC EXT INFRARNAL 34-34-80LE
|
Facility
|
OP
|
$18,441.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,532.45 |
| Max. Negotiated Rate |
$17,703.84 |
| Rate for Payer: Aetna Commercial |
$14,199.95
|
| Rate for Payer: Anthem Medicaid |
$6,342.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,384.37
|
| Rate for Payer: Cash Price |
$9,220.75
|
| Rate for Payer: Cigna Commercial |
$15,306.44
|
| Rate for Payer: First Health Commercial |
$17,519.42
|
| Rate for Payer: Humana Commercial |
$15,675.27
|
| Rate for Payer: Humana KY Medicaid |
$6,342.03
|
| Rate for Payer: Kentucky WC Medicaid |
$6,406.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,122.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,609.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,532.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,469.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,228.52
|
| Rate for Payer: Ohio Health Group HMO |
$13,831.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,753.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,044.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,724.64
|
| Rate for Payer: PHCS Commercial |
$17,703.84
|
| Rate for Payer: United Healthcare All Payer |
$16,228.52
|
|
|
AORTC EXT INFRARNAL 34-34-80LE
|
Facility
|
IP
|
$18,441.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,532.45 |
| Max. Negotiated Rate |
$17,703.84 |
| Rate for Payer: Aetna Commercial |
$14,199.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,384.37
|
| Rate for Payer: Cash Price |
$9,220.75
|
| Rate for Payer: Cigna Commercial |
$15,306.44
|
| Rate for Payer: First Health Commercial |
$17,519.42
|
| Rate for Payer: Humana Commercial |
$15,675.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,122.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,609.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,532.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,228.52
|
| Rate for Payer: Ohio Health Group HMO |
$13,831.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,753.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,044.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,724.64
|
| Rate for Payer: PHCS Commercial |
$17,703.84
|
| Rate for Payer: United Healthcare All Payer |
$16,228.52
|
|
|
AORTC EXT INFRARNL 34-34-100LE
|
Facility
|
OP
|
$20,356.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,106.88 |
| Max. Negotiated Rate |
$19,542.00 |
| Rate for Payer: Aetna Commercial |
$15,674.31
|
| Rate for Payer: Anthem Medicaid |
$7,000.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,877.88
|
| Rate for Payer: Cash Price |
$10,178.12
|
| Rate for Payer: Cigna Commercial |
$16,895.69
|
| Rate for Payer: First Health Commercial |
$19,338.44
|
| Rate for Payer: Humana Commercial |
$17,302.81
|
| Rate for Payer: Humana KY Medicaid |
$7,000.51
|
| Rate for Payer: Kentucky WC Medicaid |
$7,071.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,692.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,022.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,106.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,140.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,913.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,267.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,709.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,045.81
|
| Rate for Payer: PHCS Commercial |
$19,542.00
|
| Rate for Payer: United Healthcare All Payer |
$17,913.50
|
|
|
AORTC EXT INFRARNL 34-34-100LE
|
Facility
|
IP
|
$20,356.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,106.88 |
| Max. Negotiated Rate |
$19,542.00 |
| Rate for Payer: Aetna Commercial |
$15,674.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,877.88
|
| Rate for Payer: Cash Price |
$10,178.12
|
| Rate for Payer: Cigna Commercial |
$16,895.69
|
| Rate for Payer: First Health Commercial |
$19,338.44
|
| Rate for Payer: Humana Commercial |
$17,302.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,692.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,022.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,106.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,913.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,267.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,709.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,045.81
|
| Rate for Payer: PHCS Commercial |
$19,542.00
|
| Rate for Payer: United Healthcare All Payer |
$17,913.50
|
|
|
AORTC EXT POWERFIT 25-25-115RL
|
Facility
|
OP
|
$16,961.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,088.45 |
| Max. Negotiated Rate |
$16,283.04 |
| Rate for Payer: Aetna Commercial |
$13,060.35
|
| Rate for Payer: Anthem Medicaid |
$5,833.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,229.97
|
| Rate for Payer: Cash Price |
$8,480.75
|
| Rate for Payer: Cigna Commercial |
$14,078.05
|
| Rate for Payer: First Health Commercial |
$16,113.42
|
| Rate for Payer: Humana Commercial |
$14,417.27
|
| Rate for Payer: Humana KY Medicaid |
$5,833.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,892.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,908.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,517.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,088.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,950.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,926.12
|
| Rate for Payer: Ohio Health Group HMO |
$12,721.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,569.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,756.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,703.43
|
| Rate for Payer: PHCS Commercial |
$16,283.04
|
| Rate for Payer: United Healthcare All Payer |
$14,926.12
|
|
|
AORTC EXT POWERFIT 25-25-115RL
|
Facility
|
IP
|
$16,961.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,088.45 |
| Max. Negotiated Rate |
$16,283.04 |
| Rate for Payer: Aetna Commercial |
$13,060.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,229.97
|
| Rate for Payer: Cash Price |
$8,480.75
|
| Rate for Payer: Cigna Commercial |
$14,078.05
|
| Rate for Payer: First Health Commercial |
$16,113.42
|
| Rate for Payer: Humana Commercial |
$14,417.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,908.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,517.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,088.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,926.12
|
| Rate for Payer: Ohio Health Group HMO |
$12,721.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,569.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,756.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,703.43
|
| Rate for Payer: PHCS Commercial |
$16,283.04
|
| Rate for Payer: United Healthcare All Payer |
$14,926.12
|
|
|
AORTC EXT POWERFIT 28-28-115RL
|
Facility
|
IP
|
$19,181.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.45 |
| Max. Negotiated Rate |
$18,414.24 |
| Rate for Payer: Aetna Commercial |
$14,769.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,961.57
|
| Rate for Payer: Cash Price |
$9,590.75
|
| Rate for Payer: Cigna Commercial |
$15,920.65
|
| Rate for Payer: First Health Commercial |
$18,222.42
|
| Rate for Payer: Humana Commercial |
$16,304.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,728.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,155.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,879.72
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,687.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.24
|
| Rate for Payer: PHCS Commercial |
$18,414.24
|
| Rate for Payer: United Healthcare All Payer |
$16,879.72
|
|
|
AORTC EXT POWERFIT 28-28-115RL
|
Facility
|
OP
|
$19,181.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.45 |
| Max. Negotiated Rate |
$18,414.24 |
| Rate for Payer: Aetna Commercial |
$14,769.75
|
| Rate for Payer: Anthem Medicaid |
$6,596.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,961.57
|
| Rate for Payer: Cash Price |
$9,590.75
|
| Rate for Payer: Cigna Commercial |
$15,920.65
|
| Rate for Payer: First Health Commercial |
$18,222.42
|
| Rate for Payer: Humana Commercial |
$16,304.27
|
| Rate for Payer: Humana KY Medicaid |
$6,596.52
|
| Rate for Payer: Kentucky WC Medicaid |
$6,663.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,728.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,155.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,728.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,879.72
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,687.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.24
|
| Rate for Payer: PHCS Commercial |
$18,414.24
|
| Rate for Payer: United Healthcare All Payer |
$16,879.72
|
|
|
AORTC EXT POWERFIT 34-34-100RL
|
Facility
|
IP
|
$20,731.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,219.38 |
| Max. Negotiated Rate |
$19,902.00 |
| Rate for Payer: Aetna Commercial |
$15,963.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,170.38
|
| Rate for Payer: Cash Price |
$10,365.62
|
| Rate for Payer: Cigna Commercial |
$17,206.94
|
| Rate for Payer: First Health Commercial |
$19,694.69
|
| Rate for Payer: Humana Commercial |
$17,621.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,999.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,299.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,219.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,243.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,548.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,585.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,036.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,304.56
|
| Rate for Payer: PHCS Commercial |
$19,902.00
|
| Rate for Payer: United Healthcare All Payer |
$18,243.50
|
|
|
AORTC EXT POWERFIT 34-34-100RL
|
Facility
|
OP
|
$20,731.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,219.38 |
| Max. Negotiated Rate |
$19,902.00 |
| Rate for Payer: Aetna Commercial |
$15,963.06
|
| Rate for Payer: Anthem Medicaid |
$7,129.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,170.38
|
| Rate for Payer: Cash Price |
$10,365.62
|
| Rate for Payer: Cigna Commercial |
$17,206.94
|
| Rate for Payer: First Health Commercial |
$19,694.69
|
| Rate for Payer: Humana Commercial |
$17,621.56
|
| Rate for Payer: Humana KY Medicaid |
$7,129.48
|
| Rate for Payer: Kentucky WC Medicaid |
$7,202.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,999.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,299.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,219.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,272.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,243.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,548.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,585.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,036.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,304.56
|
| Rate for Payer: PHCS Commercial |
$19,902.00
|
| Rate for Payer: United Healthcare All Payer |
$18,243.50
|
|
|
AORTC EXT POWERFIT 34-34-120RL
|
Facility
|
IP
|
$21,856.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,556.88 |
| Max. Negotiated Rate |
$20,982.00 |
| Rate for Payer: Aetna Commercial |
$16,829.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,047.88
|
| Rate for Payer: Cash Price |
$10,928.12
|
| Rate for Payer: Cigna Commercial |
$18,140.69
|
| Rate for Payer: First Health Commercial |
$20,763.44
|
| Rate for Payer: Humana Commercial |
$18,577.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,922.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,129.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,556.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,233.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,392.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,014.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,080.81
|
| Rate for Payer: PHCS Commercial |
$20,982.00
|
| Rate for Payer: United Healthcare All Payer |
$19,233.50
|
|
|
AORTC EXT POWERFIT 34-34-120RL
|
Facility
|
OP
|
$21,856.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,556.88 |
| Max. Negotiated Rate |
$20,982.00 |
| Rate for Payer: Aetna Commercial |
$16,829.31
|
| Rate for Payer: Anthem Medicaid |
$7,516.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,047.88
|
| Rate for Payer: Cash Price |
$10,928.12
|
| Rate for Payer: Cigna Commercial |
$18,140.69
|
| Rate for Payer: First Health Commercial |
$20,763.44
|
| Rate for Payer: Humana Commercial |
$18,577.81
|
| Rate for Payer: Humana KY Medicaid |
$7,516.36
|
| Rate for Payer: Kentucky WC Medicaid |
$7,592.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,922.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,129.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,556.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,667.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,233.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,392.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,014.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,080.81
|
| Rate for Payer: PHCS Commercial |
$20,982.00
|
| Rate for Payer: United Healthcare All Payer |
$19,233.50
|
|
|
AORTC EXT POWRFIT 34-34-100RLE
|
Facility
|
OP
|
$20,731.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,219.38 |
| Max. Negotiated Rate |
$19,902.00 |
| Rate for Payer: Aetna Commercial |
$15,963.06
|
| Rate for Payer: Anthem Medicaid |
$7,129.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,170.38
|
| Rate for Payer: Cash Price |
$10,365.62
|
| Rate for Payer: Cigna Commercial |
$17,206.94
|
| Rate for Payer: First Health Commercial |
$19,694.69
|
| Rate for Payer: Humana Commercial |
$17,621.56
|
| Rate for Payer: Humana KY Medicaid |
$7,129.48
|
| Rate for Payer: Kentucky WC Medicaid |
$7,202.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,999.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,299.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,219.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,272.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,243.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,548.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,585.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,036.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,304.56
|
| Rate for Payer: PHCS Commercial |
$19,902.00
|
| Rate for Payer: United Healthcare All Payer |
$18,243.50
|
|
|
AORTC EXT POWRFIT 34-34-100RLE
|
Facility
|
IP
|
$20,731.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,219.38 |
| Max. Negotiated Rate |
$19,902.00 |
| Rate for Payer: Aetna Commercial |
$15,963.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,170.38
|
| Rate for Payer: Cash Price |
$10,365.62
|
| Rate for Payer: Cigna Commercial |
$17,206.94
|
| Rate for Payer: First Health Commercial |
$19,694.69
|
| Rate for Payer: Humana Commercial |
$17,621.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,999.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,299.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,219.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,243.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,548.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,585.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,036.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,304.56
|
| Rate for Payer: PHCS Commercial |
$19,902.00
|
| Rate for Payer: United Healthcare All Payer |
$18,243.50
|
|
|
AORTC EXT POWRFIT 34-34-120RLE
|
Facility
|
IP
|
$21,856.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,556.88 |
| Max. Negotiated Rate |
$20,982.00 |
| Rate for Payer: Aetna Commercial |
$16,829.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,047.88
|
| Rate for Payer: Cash Price |
$10,928.12
|
| Rate for Payer: Cigna Commercial |
$18,140.69
|
| Rate for Payer: First Health Commercial |
$20,763.44
|
| Rate for Payer: Humana Commercial |
$18,577.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,922.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,129.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,556.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,233.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,392.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,014.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,080.81
|
| Rate for Payer: PHCS Commercial |
$20,982.00
|
| Rate for Payer: United Healthcare All Payer |
$19,233.50
|
|
