|
ART COMP 40M .1875 PST 8.5*8.5
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ART COMP 40M .1875 PST 8.5*8.5
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ART COMP 40M .1875 PST 9.0*9.0
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ART COMP 40M .1875 PST 9.0*9.0
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ART COMP 40M .1875 PST 9.5*9.5
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ART COMP 40M .1875 PST 9.5*9.5
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ARTEGRAFT BOVINE 5MM*15CM
|
Facility
|
OP
|
$8,434.85
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,530.45 |
| Max. Negotiated Rate |
$8,097.46 |
| Rate for Payer: Aetna Commercial |
$6,494.83
|
| Rate for Payer: Anthem Medicaid |
$2,900.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,579.18
|
| Rate for Payer: Cash Price |
$4,217.42
|
| Rate for Payer: Cigna Commercial |
$7,000.93
|
| Rate for Payer: First Health Commercial |
$8,013.11
|
| Rate for Payer: Humana Commercial |
$7,169.62
|
| Rate for Payer: Humana KY Medicaid |
$2,900.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,930.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,916.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,224.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,530.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,958.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,422.67
|
| Rate for Payer: Ohio Health Group HMO |
$6,326.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,747.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,338.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,820.05
|
| Rate for Payer: PHCS Commercial |
$8,097.46
|
| Rate for Payer: United Healthcare All Payer |
$7,422.67
|
|
|
ARTEGRAFT BOVINE 5MM*15CM
|
Facility
|
IP
|
$8,434.85
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,530.45 |
| Max. Negotiated Rate |
$8,097.46 |
| Rate for Payer: Aetna Commercial |
$6,494.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,579.18
|
| Rate for Payer: Cash Price |
$4,217.42
|
| Rate for Payer: Cigna Commercial |
$7,000.93
|
| Rate for Payer: First Health Commercial |
$8,013.11
|
| Rate for Payer: Humana Commercial |
$7,169.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,916.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,224.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,530.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,422.67
|
| Rate for Payer: Ohio Health Group HMO |
$6,326.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,747.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,338.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,820.05
|
| Rate for Payer: PHCS Commercial |
$8,097.46
|
| Rate for Payer: United Healthcare All Payer |
$7,422.67
|
|
|
ARTEGRAFT BOVINE 5MM*30CM
|
Facility
|
IP
|
$7,412.85
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,223.86 |
| Max. Negotiated Rate |
$7,116.34 |
| Rate for Payer: Aetna Commercial |
$5,707.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.02
|
| Rate for Payer: Cash Price |
$3,706.43
|
| Rate for Payer: Cigna Commercial |
$6,152.67
|
| Rate for Payer: First Health Commercial |
$7,042.21
|
| Rate for Payer: Humana Commercial |
$6,300.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,078.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,470.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,223.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,559.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,930.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,449.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,114.87
|
| Rate for Payer: PHCS Commercial |
$7,116.34
|
| Rate for Payer: United Healthcare All Payer |
$6,523.31
|
|
|
ARTEGRAFT BOVINE 5MM*30CM
|
Facility
|
OP
|
$7,412.85
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,223.86 |
| Max. Negotiated Rate |
$7,116.34 |
| Rate for Payer: Aetna Commercial |
$5,707.89
|
| Rate for Payer: Anthem Medicaid |
$2,549.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,782.02
|
| Rate for Payer: Cash Price |
$3,706.43
|
| Rate for Payer: Cigna Commercial |
$6,152.67
|
| Rate for Payer: First Health Commercial |
$7,042.21
|
| Rate for Payer: Humana Commercial |
$6,300.92
|
| Rate for Payer: Humana KY Medicaid |
$2,549.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,575.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,078.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,470.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,223.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,600.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,523.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,559.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,930.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,449.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,114.87
|
| Rate for Payer: PHCS Commercial |
$7,116.34
|
| Rate for Payer: United Healthcare All Payer |
$6,523.31
|
|
|
ARTEGRAFT BOVINE 5MM X 45CM
|
Facility
|
IP
|
$16,939.30
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.79 |
| Max. Negotiated Rate |
$16,261.73 |
| Rate for Payer: Aetna Commercial |
$13,043.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.65
|
| Rate for Payer: Cash Price |
$8,469.65
|
| Rate for Payer: Cigna Commercial |
$14,059.62
|
| Rate for Payer: First Health Commercial |
$16,092.33
|
| Rate for Payer: Humana Commercial |
$14,398.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,890.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,501.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,906.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,704.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,551.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,737.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,688.12
|
| Rate for Payer: PHCS Commercial |
$16,261.73
|
| Rate for Payer: United Healthcare All Payer |
$14,906.58
|
|
|
ARTEGRAFT BOVINE 5MM X 45CM
|
Facility
|
OP
|
$16,939.30
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.79 |
| Max. Negotiated Rate |
$16,261.73 |
| Rate for Payer: Aetna Commercial |
$13,043.26
|
| Rate for Payer: Anthem Medicaid |
$5,825.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.65
|
| Rate for Payer: Cash Price |
$8,469.65
|
| Rate for Payer: Cigna Commercial |
$14,059.62
|
| Rate for Payer: First Health Commercial |
$16,092.33
|
| Rate for Payer: Humana Commercial |
$14,398.41
|
| Rate for Payer: Humana KY Medicaid |
$5,825.43
|
| Rate for Payer: Kentucky WC Medicaid |
$5,884.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,890.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,501.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,942.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,906.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,704.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,551.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,737.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,688.12
|
| Rate for Payer: PHCS Commercial |
$16,261.73
|
| Rate for Payer: United Healthcare All Payer |
$14,906.58
|
|
|
ARTEGRAFT BOVINE 7MM*15CM
|
Facility
|
OP
|
$3,946.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.88 |
| Max. Negotiated Rate |
$3,788.40 |
| Rate for Payer: Aetna Commercial |
$3,038.61
|
| Rate for Payer: Anthem Medicaid |
$1,357.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,078.07
|
| Rate for Payer: Cash Price |
$1,973.12
|
| Rate for Payer: Cigna Commercial |
$3,275.39
|
| Rate for Payer: First Health Commercial |
$3,748.94
|
| Rate for Payer: Humana Commercial |
$3,354.31
|
| Rate for Payer: Humana KY Medicaid |
$1,357.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,370.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,235.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,912.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,183.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,384.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,472.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,959.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,157.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,433.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,722.91
|
| Rate for Payer: PHCS Commercial |
$3,788.40
|
| Rate for Payer: United Healthcare All Payer |
$3,472.70
|
|
|
ARTEGRAFT BOVINE 7MM*15CM
|
Facility
|
IP
|
$3,946.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.88 |
| Max. Negotiated Rate |
$3,788.40 |
| Rate for Payer: Aetna Commercial |
$3,038.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,078.07
|
| Rate for Payer: Cash Price |
$1,973.12
|
| Rate for Payer: Cigna Commercial |
$3,275.39
|
| Rate for Payer: First Health Commercial |
$3,748.94
|
| Rate for Payer: Humana Commercial |
$3,354.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,235.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,912.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,183.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,472.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,959.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,157.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,433.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,722.91
|
| Rate for Payer: PHCS Commercial |
$3,788.40
|
| Rate for Payer: United Healthcare All Payer |
$3,472.70
|
|
|
ARTEGRAFT BOVINE 7MM*30CM
|
Facility
|
OP
|
$7,157.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,147.20 |
| Max. Negotiated Rate |
$6,871.06 |
| Rate for Payer: Aetna Commercial |
$5,511.16
|
| Rate for Payer: Anthem Medicaid |
$2,461.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,582.73
|
| Rate for Payer: Cash Price |
$3,578.68
|
| Rate for Payer: Cigna Commercial |
$5,940.60
|
| Rate for Payer: First Health Commercial |
$6,799.48
|
| Rate for Payer: Humana Commercial |
$6,083.75
|
| Rate for Payer: Humana KY Medicaid |
$2,461.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,486.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,869.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,282.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,147.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,510.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,298.47
|
| Rate for Payer: Ohio Health Group HMO |
$5,368.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,725.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,226.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,938.57
|
| Rate for Payer: PHCS Commercial |
$6,871.06
|
| Rate for Payer: United Healthcare All Payer |
$6,298.47
|
|
|
ARTEGRAFT BOVINE 7MM*30CM
|
Facility
|
IP
|
$7,157.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,147.20 |
| Max. Negotiated Rate |
$6,871.06 |
| Rate for Payer: Aetna Commercial |
$5,511.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,582.73
|
| Rate for Payer: Cash Price |
$3,578.68
|
| Rate for Payer: Cigna Commercial |
$5,940.60
|
| Rate for Payer: First Health Commercial |
$6,799.48
|
| Rate for Payer: Humana Commercial |
$6,083.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,869.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,282.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,147.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,298.47
|
| Rate for Payer: Ohio Health Group HMO |
$5,368.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,725.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,226.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,938.57
|
| Rate for Payer: PHCS Commercial |
$6,871.06
|
| Rate for Payer: United Healthcare All Payer |
$6,298.47
|
|
|
ARTEGRAFT BOVINE 7MM*50CM
|
Facility
|
OP
|
$10,259.85
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,077.95 |
| Max. Negotiated Rate |
$9,849.46 |
| Rate for Payer: Aetna Commercial |
$7,900.08
|
| Rate for Payer: Anthem Medicaid |
$3,528.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,002.68
|
| Rate for Payer: Cash Price |
$5,129.92
|
| Rate for Payer: Cigna Commercial |
$8,515.68
|
| Rate for Payer: First Health Commercial |
$9,746.86
|
| Rate for Payer: Humana Commercial |
$8,720.87
|
| Rate for Payer: Humana KY Medicaid |
$3,528.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,564.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,413.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,571.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,077.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,599.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,028.67
|
| Rate for Payer: Ohio Health Group HMO |
$7,694.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,207.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,926.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,079.30
|
| Rate for Payer: PHCS Commercial |
$9,849.46
|
| Rate for Payer: United Healthcare All Payer |
$9,028.67
|
|
|
ARTEGRAFT BOVINE 7MM*50CM
|
Facility
|
IP
|
$10,259.85
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,077.95 |
| Max. Negotiated Rate |
$9,849.46 |
| Rate for Payer: Aetna Commercial |
$7,900.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,002.68
|
| Rate for Payer: Cash Price |
$5,129.92
|
| Rate for Payer: Cigna Commercial |
$8,515.68
|
| Rate for Payer: First Health Commercial |
$9,746.86
|
| Rate for Payer: Humana Commercial |
$8,720.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,413.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,571.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,077.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,028.67
|
| Rate for Payer: Ohio Health Group HMO |
$7,694.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,207.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,926.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,079.30
|
| Rate for Payer: PHCS Commercial |
$9,849.46
|
| Rate for Payer: United Healthcare All Payer |
$9,028.67
|
|
|
ARTEGRAFT BOVINE 8MM*33CM
|
Facility
|
OP
|
$10,946.43
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,283.93 |
| Max. Negotiated Rate |
$10,508.57 |
| Rate for Payer: Aetna Commercial |
$8,428.75
|
| Rate for Payer: Anthem Medicaid |
$3,764.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,538.22
|
| Rate for Payer: Cash Price |
$5,473.22
|
| Rate for Payer: Cigna Commercial |
$9,085.54
|
| Rate for Payer: First Health Commercial |
$10,399.11
|
| Rate for Payer: Humana Commercial |
$9,304.47
|
| Rate for Payer: Humana KY Medicaid |
$3,764.48
|
| Rate for Payer: Kentucky WC Medicaid |
$3,802.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,976.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,078.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,283.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,840.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,632.86
|
| Rate for Payer: Ohio Health Group HMO |
$8,209.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,757.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,523.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,553.04
|
| Rate for Payer: PHCS Commercial |
$10,508.57
|
| Rate for Payer: United Healthcare All Payer |
$9,632.86
|
|
|
ARTEGRAFT BOVINE 8MM*33CM
|
Facility
|
IP
|
$10,946.43
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,283.93 |
| Max. Negotiated Rate |
$10,508.57 |
| Rate for Payer: Aetna Commercial |
$8,428.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,538.22
|
| Rate for Payer: Cash Price |
$5,473.22
|
| Rate for Payer: Cigna Commercial |
$9,085.54
|
| Rate for Payer: First Health Commercial |
$10,399.11
|
| Rate for Payer: Humana Commercial |
$9,304.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,976.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,078.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,283.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,632.86
|
| Rate for Payer: Ohio Health Group HMO |
$8,209.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,757.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,523.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,553.04
|
| Rate for Payer: PHCS Commercial |
$10,508.57
|
| Rate for Payer: United Healthcare All Payer |
$9,632.86
|
|
|
ARTEGRAFT BOVINE 8MMX15CM
|
Facility
|
IP
|
$9,091.85
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,727.55 |
| Max. Negotiated Rate |
$8,728.18 |
| Rate for Payer: Aetna Commercial |
$7,000.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,091.64
|
| Rate for Payer: Cash Price |
$4,545.92
|
| Rate for Payer: Cigna Commercial |
$7,546.24
|
| Rate for Payer: First Health Commercial |
$8,637.26
|
| Rate for Payer: Humana Commercial |
$7,728.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,455.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,709.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,727.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,000.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,818.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,273.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,909.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,273.38
|
| Rate for Payer: PHCS Commercial |
$8,728.18
|
| Rate for Payer: United Healthcare All Payer |
$8,000.83
|
|
|
ARTEGRAFT BOVINE 8MMX15CM
|
Facility
|
OP
|
$9,091.85
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,727.55 |
| Max. Negotiated Rate |
$8,728.18 |
| Rate for Payer: Aetna Commercial |
$7,000.72
|
| Rate for Payer: Anthem Medicaid |
$3,126.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,091.64
|
| Rate for Payer: Cash Price |
$4,545.92
|
| Rate for Payer: Cigna Commercial |
$7,546.24
|
| Rate for Payer: First Health Commercial |
$8,637.26
|
| Rate for Payer: Humana Commercial |
$7,728.07
|
| Rate for Payer: Humana KY Medicaid |
$3,126.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,158.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,455.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,709.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,727.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,189.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,000.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,818.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,273.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,909.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,273.38
|
| Rate for Payer: PHCS Commercial |
$8,728.18
|
| Rate for Payer: United Healthcare All Payer |
$8,000.83
|
|
|
ARTERIAL BLOOD GAS STICK
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
76101499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.81 |
| Max. Negotiated Rate |
$166.74 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem Medicaid |
$58.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Humana KY Medicaid |
$58.81
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$59.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.99
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
ARTERIAL BLOOD GAS STICK
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
76101499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.38
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.99
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
ARTERIAL BLOOD GAS STICK RT
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
30000004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$174.72 |
| Rate for Payer: Aetna Commercial |
$140.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.15
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cigna Commercial |
$151.06
|
| Rate for Payer: First Health Commercial |
$172.90
|
| Rate for Payer: Humana Commercial |
$154.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$149.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$160.16
|
| Rate for Payer: Ohio Health Group HMO |
$136.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.58
|
| Rate for Payer: PHCS Commercial |
$174.72
|
| Rate for Payer: United Healthcare All Payer |
$160.16
|
|
