|
ENDRNT AAA AORTC EXT 28*28*70
|
Facility
|
IP
|
$32,448.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,218.34 |
| Max. Negotiated Rate |
$31,150.80 |
| Rate for Payer: Aetna Commercial |
$24,985.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,310.02
|
| Rate for Payer: Cash Price |
$16,224.38
|
| Rate for Payer: Cigna Commercial |
$26,932.46
|
| Rate for Payer: First Health Commercial |
$30,826.31
|
| Rate for Payer: Humana Commercial |
$27,581.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,607.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,947.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,734.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,554.90
|
| Rate for Payer: Ohio Health Group HMO |
$24,336.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,489.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,218.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,059.11
|
| Rate for Payer: PHCS Commercial |
$31,150.80
|
| Rate for Payer: United Healthcare All Payer |
$28,554.90
|
|
|
ENDRNT AAA AORTC EXT 32*32*49
|
Facility
|
IP
|
$21,498.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,794.84 |
| Max. Negotiated Rate |
$20,638.80 |
| Rate for Payer: Aetna Commercial |
$16,554.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,769.02
|
| Rate for Payer: Cash Price |
$10,749.38
|
| Rate for Payer: Cigna Commercial |
$17,843.96
|
| Rate for Payer: First Health Commercial |
$20,423.81
|
| Rate for Payer: Humana Commercial |
$18,273.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,628.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,866.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,449.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,918.90
|
| Rate for Payer: Ohio Health Group HMO |
$16,124.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,299.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,794.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,664.61
|
| Rate for Payer: PHCS Commercial |
$20,638.80
|
| Rate for Payer: United Healthcare All Payer |
$18,918.90
|
|
|
ENDRNT AAA AORTC EXT 32*32*49
|
Facility
|
OP
|
$21,498.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,794.84 |
| Max. Negotiated Rate |
$20,638.80 |
| Rate for Payer: Aetna Commercial |
$16,554.04
|
| Rate for Payer: Anthem Medicaid |
$7,393.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,769.02
|
| Rate for Payer: Cash Price |
$10,749.38
|
| Rate for Payer: Cigna Commercial |
$17,843.96
|
| Rate for Payer: First Health Commercial |
$20,423.81
|
| Rate for Payer: Humana Commercial |
$18,273.94
|
| Rate for Payer: Humana KY Medicaid |
$7,393.42
|
| Rate for Payer: Kentucky WC Medicaid |
$7,468.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,628.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,866.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,449.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,541.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,918.90
|
| Rate for Payer: Ohio Health Group HMO |
$16,124.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,299.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,794.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,664.61
|
| Rate for Payer: PHCS Commercial |
$20,638.80
|
| Rate for Payer: United Healthcare All Payer |
$18,918.90
|
|
|
ENDRNT AAA AORTC EXT 32*32*70
|
Facility
|
OP
|
$32,448.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,218.34 |
| Max. Negotiated Rate |
$31,150.80 |
| Rate for Payer: Aetna Commercial |
$24,985.54
|
| Rate for Payer: Anthem Medicaid |
$11,159.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,310.02
|
| Rate for Payer: Cash Price |
$16,224.38
|
| Rate for Payer: Cigna Commercial |
$26,932.46
|
| Rate for Payer: First Health Commercial |
$30,826.31
|
| Rate for Payer: Humana Commercial |
$27,581.44
|
| Rate for Payer: Humana KY Medicaid |
$11,159.13
|
| Rate for Payer: Kentucky WC Medicaid |
$11,272.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,607.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,947.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,734.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,383.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,554.90
|
| Rate for Payer: Ohio Health Group HMO |
$24,336.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,489.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,218.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,059.11
|
| Rate for Payer: PHCS Commercial |
$31,150.80
|
| Rate for Payer: United Healthcare All Payer |
$28,554.90
|
|
|
ENDRNT AAA AORTC EXT 32*32*70
|
Facility
|
IP
|
$32,448.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,218.34 |
| Max. Negotiated Rate |
$31,150.80 |
| Rate for Payer: Aetna Commercial |
$24,985.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,310.02
|
| Rate for Payer: Cash Price |
$16,224.38
|
| Rate for Payer: Cigna Commercial |
$26,932.46
|
| Rate for Payer: First Health Commercial |
$30,826.31
|
| Rate for Payer: Humana Commercial |
$27,581.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,607.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,947.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,734.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,554.90
|
| Rate for Payer: Ohio Health Group HMO |
$24,336.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,489.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,218.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,059.11
|
| Rate for Payer: PHCS Commercial |
$31,150.80
|
| Rate for Payer: United Healthcare All Payer |
$28,554.90
|
|
|
ENDRNT AAA AORTC EXT 36*36*49
|
Facility
|
OP
|
$21,863.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,842.29 |
| Max. Negotiated Rate |
$20,989.20 |
| Rate for Payer: Aetna Commercial |
$16,835.09
|
| Rate for Payer: Anthem Medicaid |
$7,518.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,053.72
|
| Rate for Payer: Cash Price |
$10,931.88
|
| Rate for Payer: Cigna Commercial |
$18,146.91
|
| Rate for Payer: First Health Commercial |
$20,770.56
|
| Rate for Payer: Humana Commercial |
$18,584.19
|
| Rate for Payer: Humana KY Medicaid |
$7,518.94
|
| Rate for Payer: Kentucky WC Medicaid |
$7,595.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,928.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,135.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,669.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,240.10
|
| Rate for Payer: Ohio Health Group HMO |
$16,397.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,372.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,842.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,777.76
|
| Rate for Payer: PHCS Commercial |
$20,989.20
|
| Rate for Payer: United Healthcare All Payer |
$19,240.10
|
|
|
ENDRNT AAA AORTC EXT 36*36*49
|
Facility
|
IP
|
$21,863.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,842.29 |
| Max. Negotiated Rate |
$20,989.20 |
| Rate for Payer: Aetna Commercial |
$16,835.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,053.72
|
| Rate for Payer: Cash Price |
$10,931.88
|
| Rate for Payer: Cigna Commercial |
$18,146.91
|
| Rate for Payer: First Health Commercial |
$20,770.56
|
| Rate for Payer: Humana Commercial |
$18,584.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,928.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,135.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,240.10
|
| Rate for Payer: Ohio Health Group HMO |
$16,397.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,372.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,842.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,777.76
|
| Rate for Payer: PHCS Commercial |
$20,989.20
|
| Rate for Payer: United Healthcare All Payer |
$19,240.10
|
|
|
ENDRNT AAA AORTC EXT 36*36*70
|
Facility
|
IP
|
$32,996.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,289.51 |
| Max. Negotiated Rate |
$31,676.40 |
| Rate for Payer: Aetna Commercial |
$25,407.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,737.08
|
| Rate for Payer: Cash Price |
$16,498.12
|
| Rate for Payer: Cigna Commercial |
$27,386.89
|
| Rate for Payer: First Health Commercial |
$31,346.44
|
| Rate for Payer: Humana Commercial |
$28,046.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,056.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,351.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,898.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,036.70
|
| Rate for Payer: Ohio Health Group HMO |
$24,747.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,599.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,289.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,228.84
|
| Rate for Payer: PHCS Commercial |
$31,676.40
|
| Rate for Payer: United Healthcare All Payer |
$29,036.70
|
|
|
ENDRNT AAA AORTC EXT 36*36*70
|
Facility
|
OP
|
$32,996.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,289.51 |
| Max. Negotiated Rate |
$31,676.40 |
| Rate for Payer: Aetna Commercial |
$25,407.11
|
| Rate for Payer: Anthem Medicaid |
$11,347.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,737.08
|
| Rate for Payer: Cash Price |
$16,498.12
|
| Rate for Payer: Cigna Commercial |
$27,386.89
|
| Rate for Payer: First Health Commercial |
$31,346.44
|
| Rate for Payer: Humana Commercial |
$28,046.81
|
| Rate for Payer: Humana KY Medicaid |
$11,347.41
|
| Rate for Payer: Kentucky WC Medicaid |
$11,462.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,056.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,351.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,898.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,575.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,036.70
|
| Rate for Payer: Ohio Health Group HMO |
$24,747.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,599.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,289.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,228.84
|
| Rate for Payer: PHCS Commercial |
$31,676.40
|
| Rate for Payer: United Healthcare All Payer |
$29,036.70
|
|
|
ENDRNT AAA CONT LIMB 16*10*124
|
Facility
|
OP
|
$22,958.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.64 |
| Max. Negotiated Rate |
$22,040.40 |
| Rate for Payer: Aetna Commercial |
$17,678.24
|
| Rate for Payer: Anthem Medicaid |
$7,895.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,907.82
|
| Rate for Payer: Cash Price |
$11,479.38
|
| Rate for Payer: Cigna Commercial |
$19,055.76
|
| Rate for Payer: First Health Commercial |
$21,810.81
|
| Rate for Payer: Humana Commercial |
$19,514.94
|
| Rate for Payer: Humana KY Medicaid |
$7,895.51
|
| Rate for Payer: Kentucky WC Medicaid |
$7,975.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,826.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,943.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,887.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,053.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,203.70
|
| Rate for Payer: Ohio Health Group HMO |
$17,219.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,591.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,984.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,117.21
|
| Rate for Payer: PHCS Commercial |
$22,040.40
|
| Rate for Payer: United Healthcare All Payer |
$20,203.70
|
|
|
ENDRNT AAA CONT LIMB 16*10*124
|
Facility
|
IP
|
$22,958.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.64 |
| Max. Negotiated Rate |
$22,040.40 |
| Rate for Payer: Aetna Commercial |
$17,678.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,907.82
|
| Rate for Payer: Cash Price |
$11,479.38
|
| Rate for Payer: Cigna Commercial |
$19,055.76
|
| Rate for Payer: First Health Commercial |
$21,810.81
|
| Rate for Payer: Humana Commercial |
$19,514.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,826.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,943.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,887.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,203.70
|
| Rate for Payer: Ohio Health Group HMO |
$17,219.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,591.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,984.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,117.21
|
| Rate for Payer: PHCS Commercial |
$22,040.40
|
| Rate for Payer: United Healthcare All Payer |
$20,203.70
|
|
|
ENDRNT AAA CONT LIMB 16*10*82
|
Facility
|
OP
|
$22,502.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.32 |
| Max. Negotiated Rate |
$21,602.40 |
| Rate for Payer: Aetna Commercial |
$17,326.92
|
| Rate for Payer: Anthem Medicaid |
$7,738.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.95
|
| Rate for Payer: Cash Price |
$11,251.25
|
| Rate for Payer: Cigna Commercial |
$18,677.08
|
| Rate for Payer: First Health Commercial |
$21,377.38
|
| Rate for Payer: Humana Commercial |
$19,127.12
|
| Rate for Payer: Humana KY Medicaid |
$7,738.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,817.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,452.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,893.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,802.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.78
|
| Rate for Payer: PHCS Commercial |
$21,602.40
|
| Rate for Payer: United Healthcare All Payer |
$19,802.20
|
|
|
ENDRNT AAA CONT LIMB 16*10*82
|
Facility
|
IP
|
$22,502.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.32 |
| Max. Negotiated Rate |
$21,602.40 |
| Rate for Payer: Aetna Commercial |
$17,326.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.95
|
| Rate for Payer: Cash Price |
$11,251.25
|
| Rate for Payer: Cigna Commercial |
$18,677.08
|
| Rate for Payer: First Health Commercial |
$21,377.38
|
| Rate for Payer: Humana Commercial |
$19,127.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,452.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,802.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.78
|
| Rate for Payer: PHCS Commercial |
$21,602.40
|
| Rate for Payer: United Healthcare All Payer |
$19,802.20
|
|
|
ENDRNT AAA CONT LIMB 16*10*93
|
Facility
|
OP
|
$22,502.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.32 |
| Max. Negotiated Rate |
$21,602.40 |
| Rate for Payer: Aetna Commercial |
$17,326.92
|
| Rate for Payer: Anthem Medicaid |
$7,738.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.95
|
| Rate for Payer: Cash Price |
$11,251.25
|
| Rate for Payer: Cigna Commercial |
$18,677.08
|
| Rate for Payer: First Health Commercial |
$21,377.38
|
| Rate for Payer: Humana Commercial |
$19,127.12
|
| Rate for Payer: Humana KY Medicaid |
$7,738.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,817.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,452.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,893.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,802.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.78
|
| Rate for Payer: PHCS Commercial |
$21,602.40
|
| Rate for Payer: United Healthcare All Payer |
$19,802.20
|
|
|
ENDRNT AAA CONT LIMB 16*10*93
|
Facility
|
IP
|
$22,502.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.32 |
| Max. Negotiated Rate |
$21,602.40 |
| Rate for Payer: Aetna Commercial |
$17,326.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.95
|
| Rate for Payer: Cash Price |
$11,251.25
|
| Rate for Payer: Cigna Commercial |
$18,677.08
|
| Rate for Payer: First Health Commercial |
$21,377.38
|
| Rate for Payer: Humana Commercial |
$19,127.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,452.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,802.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.78
|
| Rate for Payer: PHCS Commercial |
$21,602.40
|
| Rate for Payer: United Healthcare All Payer |
$19,802.20
|
|
|
ENDRNT AAA CONT LIMB 16*13*124
|
Facility
|
OP
|
$22,958.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.64 |
| Max. Negotiated Rate |
$22,040.40 |
| Rate for Payer: Aetna Commercial |
$17,678.24
|
| Rate for Payer: Anthem Medicaid |
$7,895.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,907.82
|
| Rate for Payer: Cash Price |
$11,479.38
|
| Rate for Payer: Cigna Commercial |
$19,055.76
|
| Rate for Payer: First Health Commercial |
$21,810.81
|
| Rate for Payer: Humana Commercial |
$19,514.94
|
| Rate for Payer: Humana KY Medicaid |
$7,895.51
|
| Rate for Payer: Kentucky WC Medicaid |
$7,975.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,826.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,943.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,887.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,053.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,203.70
|
| Rate for Payer: Ohio Health Group HMO |
$17,219.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,591.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,984.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,117.21
|
| Rate for Payer: PHCS Commercial |
$22,040.40
|
| Rate for Payer: United Healthcare All Payer |
$20,203.70
|
|
|
ENDRNT AAA CONT LIMB 16*13*124
|
Facility
|
IP
|
$22,958.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.64 |
| Max. Negotiated Rate |
$22,040.40 |
| Rate for Payer: Aetna Commercial |
$17,678.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,907.82
|
| Rate for Payer: Cash Price |
$11,479.38
|
| Rate for Payer: Cigna Commercial |
$19,055.76
|
| Rate for Payer: First Health Commercial |
$21,810.81
|
| Rate for Payer: Humana Commercial |
$19,514.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,826.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,943.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,887.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,203.70
|
| Rate for Payer: Ohio Health Group HMO |
$17,219.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,591.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,984.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,117.21
|
| Rate for Payer: PHCS Commercial |
$22,040.40
|
| Rate for Payer: United Healthcare All Payer |
$20,203.70
|
|
|
ENDRNT AAA CONT LIMB 16*13*82
|
Facility
|
IP
|
$22,502.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.32 |
| Max. Negotiated Rate |
$21,602.40 |
| Rate for Payer: Aetna Commercial |
$17,326.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.95
|
| Rate for Payer: Cash Price |
$11,251.25
|
| Rate for Payer: Cigna Commercial |
$18,677.08
|
| Rate for Payer: First Health Commercial |
$21,377.38
|
| Rate for Payer: Humana Commercial |
$19,127.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,452.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,802.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.78
|
| Rate for Payer: PHCS Commercial |
$21,602.40
|
| Rate for Payer: United Healthcare All Payer |
$19,802.20
|
|
|
ENDRNT AAA CONT LIMB 16*13*82
|
Facility
|
OP
|
$22,502.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.32 |
| Max. Negotiated Rate |
$21,602.40 |
| Rate for Payer: Aetna Commercial |
$17,326.92
|
| Rate for Payer: Anthem Medicaid |
$7,738.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.95
|
| Rate for Payer: Cash Price |
$11,251.25
|
| Rate for Payer: Cigna Commercial |
$18,677.08
|
| Rate for Payer: First Health Commercial |
$21,377.38
|
| Rate for Payer: Humana Commercial |
$19,127.12
|
| Rate for Payer: Humana KY Medicaid |
$7,738.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,817.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,452.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,893.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,802.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.78
|
| Rate for Payer: PHCS Commercial |
$21,602.40
|
| Rate for Payer: United Healthcare All Payer |
$19,802.20
|
|
|
ENDRNT AAA CONT LIMB 16*13*93
|
Facility
|
OP
|
$22,776.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,960.91 |
| Max. Negotiated Rate |
$21,865.20 |
| Rate for Payer: Aetna Commercial |
$17,537.71
|
| Rate for Payer: Anthem Medicaid |
$7,832.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,765.48
|
| Rate for Payer: Cash Price |
$11,388.12
|
| Rate for Payer: Cigna Commercial |
$18,904.29
|
| Rate for Payer: First Health Commercial |
$21,637.44
|
| Rate for Payer: Humana Commercial |
$19,359.81
|
| Rate for Payer: Humana KY Medicaid |
$7,832.75
|
| Rate for Payer: Kentucky WC Medicaid |
$7,912.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,676.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,808.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,832.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,989.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,043.10
|
| Rate for Payer: Ohio Health Group HMO |
$17,082.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,960.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,060.64
|
| Rate for Payer: PHCS Commercial |
$21,865.20
|
| Rate for Payer: United Healthcare All Payer |
$20,043.10
|
|
|
ENDRNT AAA CONT LIMB 16*13*93
|
Facility
|
IP
|
$22,776.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,960.91 |
| Max. Negotiated Rate |
$21,865.20 |
| Rate for Payer: Aetna Commercial |
$17,537.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,765.48
|
| Rate for Payer: Cash Price |
$11,388.12
|
| Rate for Payer: Cigna Commercial |
$18,904.29
|
| Rate for Payer: First Health Commercial |
$21,637.44
|
| Rate for Payer: Humana Commercial |
$19,359.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,676.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,808.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,832.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,043.10
|
| Rate for Payer: Ohio Health Group HMO |
$17,082.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,960.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,060.64
|
| Rate for Payer: PHCS Commercial |
$21,865.20
|
| Rate for Payer: United Healthcare All Payer |
$20,043.10
|
|
|
ENDRNT AAA CONT LIMB 16*16*124
|
Facility
|
IP
|
$22,958.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.64 |
| Max. Negotiated Rate |
$22,040.40 |
| Rate for Payer: First Health Commercial |
$21,810.81
|
| Rate for Payer: Aetna Commercial |
$17,678.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,907.82
|
| Rate for Payer: Cash Price |
$11,479.38
|
| Rate for Payer: Cigna Commercial |
$19,055.76
|
| Rate for Payer: Humana Commercial |
$19,514.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,826.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,943.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,887.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,203.70
|
| Rate for Payer: Ohio Health Group HMO |
$17,219.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,591.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,984.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,117.21
|
| Rate for Payer: PHCS Commercial |
$22,040.40
|
| Rate for Payer: United Healthcare All Payer |
$20,203.70
|
|
|
ENDRNT AAA CONT LIMB 16*16*124
|
Facility
|
OP
|
$22,958.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.64 |
| Max. Negotiated Rate |
$22,040.40 |
| Rate for Payer: Aetna Commercial |
$17,678.24
|
| Rate for Payer: Anthem Medicaid |
$7,895.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,907.82
|
| Rate for Payer: Cash Price |
$11,479.38
|
| Rate for Payer: Cigna Commercial |
$19,055.76
|
| Rate for Payer: First Health Commercial |
$21,810.81
|
| Rate for Payer: Humana Commercial |
$19,514.94
|
| Rate for Payer: Humana KY Medicaid |
$7,895.51
|
| Rate for Payer: Kentucky WC Medicaid |
$7,975.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,826.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,943.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,887.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,053.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,203.70
|
| Rate for Payer: Ohio Health Group HMO |
$17,219.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,591.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,984.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,117.21
|
| Rate for Payer: PHCS Commercial |
$22,040.40
|
| Rate for Payer: United Healthcare All Payer |
$20,203.70
|
|
|
ENDRNT AAA CONT LIMB 16*16*82
|
Facility
|
OP
|
$21,133.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.39 |
| Max. Negotiated Rate |
$20,288.40 |
| Rate for Payer: Aetna Commercial |
$16,272.99
|
| Rate for Payer: Anthem Medicaid |
$7,267.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,484.32
|
| Rate for Payer: Cash Price |
$10,566.88
|
| Rate for Payer: Cigna Commercial |
$17,541.01
|
| Rate for Payer: First Health Commercial |
$20,077.06
|
| Rate for Payer: Humana Commercial |
$17,963.69
|
| Rate for Payer: Humana KY Medicaid |
$7,267.90
|
| Rate for Payer: Kentucky WC Medicaid |
$7,341.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,329.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,596.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,340.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,413.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,597.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,850.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,226.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,747.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,551.46
|
| Rate for Payer: PHCS Commercial |
$20,288.40
|
| Rate for Payer: United Healthcare All Payer |
$18,597.70
|
|
|
ENDRNT AAA CONT LIMB 16*16*82
|
Facility
|
IP
|
$21,133.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.39 |
| Max. Negotiated Rate |
$20,288.40 |
| Rate for Payer: Aetna Commercial |
$16,272.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,484.32
|
| Rate for Payer: Cash Price |
$10,566.88
|
| Rate for Payer: Cigna Commercial |
$17,541.01
|
| Rate for Payer: First Health Commercial |
$20,077.06
|
| Rate for Payer: Humana Commercial |
$17,963.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,329.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,596.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,340.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,597.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,850.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,226.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,747.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,551.46
|
| Rate for Payer: PHCS Commercial |
$20,288.40
|
| Rate for Payer: United Healthcare All Payer |
$18,597.70
|
|
