|
ENDRNT AAA CONT LIMB 16*16*93
|
Facility
|
IP
|
$21,772.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,830.42 |
| Max. Negotiated Rate |
$20,901.60 |
| Rate for Payer: Aetna Commercial |
$16,764.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,982.55
|
| Rate for Payer: Cash Price |
$10,886.25
|
| Rate for Payer: Cigna Commercial |
$18,071.18
|
| Rate for Payer: First Health Commercial |
$20,683.88
|
| Rate for Payer: Humana Commercial |
$18,506.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,853.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,068.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,531.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,159.80
|
| Rate for Payer: Ohio Health Group HMO |
$16,329.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,354.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,830.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,749.48
|
| Rate for Payer: PHCS Commercial |
$20,901.60
|
| Rate for Payer: United Healthcare All Payer |
$19,159.80
|
|
|
ENDRNT AAA CONT LIMB 16*16*93
|
Facility
|
OP
|
$21,772.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,830.42 |
| Max. Negotiated Rate |
$20,901.60 |
| Rate for Payer: Aetna Commercial |
$16,764.82
|
| Rate for Payer: Anthem Medicaid |
$7,487.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,982.55
|
| Rate for Payer: Cash Price |
$10,886.25
|
| Rate for Payer: Cigna Commercial |
$18,071.18
|
| Rate for Payer: First Health Commercial |
$20,683.88
|
| Rate for Payer: Humana Commercial |
$18,506.62
|
| Rate for Payer: Humana KY Medicaid |
$7,487.56
|
| Rate for Payer: Kentucky WC Medicaid |
$7,563.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,853.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,068.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,531.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,637.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,159.80
|
| Rate for Payer: Ohio Health Group HMO |
$16,329.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,354.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,830.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,749.48
|
| Rate for Payer: PHCS Commercial |
$20,901.60
|
| Rate for Payer: United Healthcare All Payer |
$19,159.80
|
|
|
ENDRNT AAA CONT LIMB 16*20*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*20*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*20*82
|
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*20*82
|
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*20*93
|
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*20*93
|
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*24*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*24*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*24*93
|
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*24*93
|
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*28*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*28*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*28*82
|
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*28*82
|
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*28*93
|
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*28*93
|
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 CONTR LIMB 16*24*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 CONTR LIMB 16*24*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 ILIAC EXT 10*10*82
|
Facility
|
IP
|
$21,772.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,830.42 |
| Max. Negotiated Rate |
$20,901.60 |
| Rate for Payer: Aetna Commercial |
$16,764.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,982.55
|
| Rate for Payer: Cash Price |
$10,886.25
|
| Rate for Payer: Cigna Commercial |
$18,071.18
|
| Rate for Payer: First Health Commercial |
$20,683.88
|
| Rate for Payer: Humana Commercial |
$18,506.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,853.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,068.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,531.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,159.80
|
| Rate for Payer: Ohio Health Group HMO |
$16,329.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,354.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,830.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,749.48
|
| Rate for Payer: PHCS Commercial |
$20,901.60
|
| Rate for Payer: United Healthcare All Payer |
$19,159.80
|
|
|
ENDRNT AAA ILIAC EXT 10*10*82
|
Facility
|
OP
|
$21,772.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,830.42 |
| Max. Negotiated Rate |
$20,901.60 |
| Rate for Payer: Aetna Commercial |
$16,764.82
|
| Rate for Payer: Anthem Medicaid |
$7,487.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,982.55
|
| Rate for Payer: Cash Price |
$10,886.25
|
| Rate for Payer: Cigna Commercial |
$18,071.18
|
| Rate for Payer: First Health Commercial |
$20,683.88
|
| Rate for Payer: Humana Commercial |
$18,506.62
|
| Rate for Payer: Humana KY Medicaid |
$7,487.56
|
| Rate for Payer: Kentucky WC Medicaid |
$7,563.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,853.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,068.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,531.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,637.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,159.80
|
| Rate for Payer: Ohio Health Group HMO |
$16,329.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,354.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,830.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,749.48
|
| Rate for Payer: PHCS Commercial |
$20,901.60
|
| Rate for Payer: United Healthcare All Payer |
$19,159.80
|
|
|
ENDRNT AAA ILIAC EXT 13*13*82
|
Facility
|
IP
|
$21,772.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,830.42 |
| Max. Negotiated Rate |
$20,901.60 |
| Rate for Payer: Aetna Commercial |
$16,764.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,982.55
|
| Rate for Payer: Cash Price |
$10,886.25
|
| Rate for Payer: Cigna Commercial |
$18,071.18
|
| Rate for Payer: First Health Commercial |
$20,683.88
|
| Rate for Payer: Humana Commercial |
$18,506.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,853.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,068.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,531.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,159.80
|
| Rate for Payer: Ohio Health Group HMO |
$16,329.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,354.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,830.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,749.48
|
| Rate for Payer: PHCS Commercial |
$20,901.60
|
| Rate for Payer: United Healthcare All Payer |
$19,159.80
|
|
|
ENDRNT AAA ILIAC EXT 13*13*82
|
Facility
|
OP
|
$21,772.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,830.42 |
| Max. Negotiated Rate |
$20,901.60 |
| Rate for Payer: Aetna Commercial |
$16,764.82
|
| Rate for Payer: Anthem Medicaid |
$7,487.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,982.55
|
| Rate for Payer: Cash Price |
$10,886.25
|
| Rate for Payer: Cigna Commercial |
$18,071.18
|
| Rate for Payer: First Health Commercial |
$20,683.88
|
| Rate for Payer: Humana Commercial |
$18,506.62
|
| Rate for Payer: Humana KY Medicaid |
$7,487.56
|
| Rate for Payer: Kentucky WC Medicaid |
$7,563.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,853.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,068.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,531.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,637.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,159.80
|
| Rate for Payer: Ohio Health Group HMO |
$16,329.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,354.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,830.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,749.48
|
| Rate for Payer: PHCS Commercial |
$20,901.60
|
| Rate for Payer: United Healthcare All Payer |
$19,159.80
|
|
|
ENDRNT AAA ILIAC EXT 20*20*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
|
|
