|
ENDRNT AAA AORTC EXT 28*28*49
|
Facility
|
IP
|
$21,031.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,309.38 |
| Max. Negotiated Rate |
$20,190.00 |
| Rate for Payer: Aetna Commercial |
$16,194.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,404.38
|
| Rate for Payer: Cash Price |
$10,515.62
|
| Rate for Payer: Cigna Commercial |
$17,455.94
|
| Rate for Payer: First Health Commercial |
$19,979.69
|
| Rate for Payer: Humana Commercial |
$17,876.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,245.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,521.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,309.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,507.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,773.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,297.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,511.56
|
| Rate for Payer: PHCS Commercial |
$20,190.00
|
| Rate for Payer: United Healthcare All Payer |
$18,507.50
|
|
|
ENDRNT AAA AORTC EXT 28*28*49
|
Facility
|
OP
|
$21,031.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,309.38 |
| Max. Negotiated Rate |
$20,190.00 |
| Rate for Payer: Aetna Commercial |
$16,194.06
|
| Rate for Payer: Anthem Medicaid |
$7,232.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,404.38
|
| Rate for Payer: Cash Price |
$10,515.62
|
| Rate for Payer: Cigna Commercial |
$17,455.94
|
| Rate for Payer: First Health Commercial |
$19,979.69
|
| Rate for Payer: Humana Commercial |
$17,876.56
|
| Rate for Payer: Humana KY Medicaid |
$7,232.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,306.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,245.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,521.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,309.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,377.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,507.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,773.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,297.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,511.56
|
| Rate for Payer: PHCS Commercial |
$20,190.00
|
| Rate for Payer: United Healthcare All Payer |
$18,507.50
|
|
|
ENDRNT AAA AORTC EXT 28*28*70
|
Facility
|
IP
|
$33,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,021.88 |
| Max. Negotiated Rate |
$32,070.00 |
| Rate for Payer: Aetna Commercial |
$25,722.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,056.88
|
| Rate for Payer: Cash Price |
$16,703.12
|
| Rate for Payer: Cigna Commercial |
$27,727.19
|
| Rate for Payer: First Health Commercial |
$31,735.94
|
| Rate for Payer: Humana Commercial |
$28,395.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,393.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,653.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,021.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,397.50
|
| Rate for Payer: Ohio Health Group HMO |
$25,054.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,725.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,063.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,050.31
|
| Rate for Payer: PHCS Commercial |
$32,070.00
|
| Rate for Payer: United Healthcare All Payer |
$29,397.50
|
|
|
ENDRNT AAA AORTC EXT 28*28*70
|
Facility
|
OP
|
$33,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,021.88 |
| Max. Negotiated Rate |
$32,070.00 |
| Rate for Payer: Aetna Commercial |
$25,722.81
|
| Rate for Payer: Anthem Medicaid |
$11,488.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,056.88
|
| Rate for Payer: Cash Price |
$16,703.12
|
| Rate for Payer: Cigna Commercial |
$27,727.19
|
| Rate for Payer: First Health Commercial |
$31,735.94
|
| Rate for Payer: Humana Commercial |
$28,395.31
|
| Rate for Payer: Humana KY Medicaid |
$11,488.41
|
| Rate for Payer: Kentucky WC Medicaid |
$11,605.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,393.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,653.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,021.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,718.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,397.50
|
| Rate for Payer: Ohio Health Group HMO |
$25,054.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,725.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,063.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,050.31
|
| Rate for Payer: PHCS Commercial |
$32,070.00
|
| Rate for Payer: United Healthcare All Payer |
$29,397.50
|
|
|
ENDRNT AAA AORTC EXT 32*32*49
|
Facility
|
IP
|
$22,156.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,646.88 |
| Max. Negotiated Rate |
$21,270.00 |
| Rate for Payer: Aetna Commercial |
$17,060.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,281.88
|
| Rate for Payer: Cash Price |
$11,078.12
|
| Rate for Payer: Cigna Commercial |
$18,389.69
|
| Rate for Payer: First Health Commercial |
$21,048.44
|
| Rate for Payer: Humana Commercial |
$18,832.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,168.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,351.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,646.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,497.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,617.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,725.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,275.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,287.81
|
| Rate for Payer: PHCS Commercial |
$21,270.00
|
| Rate for Payer: United Healthcare All Payer |
$19,497.50
|
|
|
ENDRNT AAA AORTC EXT 32*32*49
|
Facility
|
OP
|
$22,156.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,646.88 |
| Max. Negotiated Rate |
$21,270.00 |
| Rate for Payer: Aetna Commercial |
$17,060.31
|
| Rate for Payer: Anthem Medicaid |
$7,619.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,281.88
|
| Rate for Payer: Cash Price |
$11,078.12
|
| Rate for Payer: Cigna Commercial |
$18,389.69
|
| Rate for Payer: First Health Commercial |
$21,048.44
|
| Rate for Payer: Humana Commercial |
$18,832.81
|
| Rate for Payer: Humana KY Medicaid |
$7,619.53
|
| Rate for Payer: Kentucky WC Medicaid |
$7,697.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,168.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,351.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,646.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,772.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,497.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,617.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,725.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,275.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,287.81
|
| Rate for Payer: PHCS Commercial |
$21,270.00
|
| Rate for Payer: United Healthcare All Payer |
$19,497.50
|
|
|
ENDRNT AAA AORTC EXT 32*32*70
|
Facility
|
IP
|
$33,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,021.88 |
| Max. Negotiated Rate |
$32,070.00 |
| Rate for Payer: Aetna Commercial |
$25,722.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,056.88
|
| Rate for Payer: Cash Price |
$16,703.12
|
| Rate for Payer: Cigna Commercial |
$27,727.19
|
| Rate for Payer: First Health Commercial |
$31,735.94
|
| Rate for Payer: Humana Commercial |
$28,395.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,393.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,653.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,021.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,397.50
|
| Rate for Payer: Ohio Health Group HMO |
$25,054.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,725.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,063.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,050.31
|
| Rate for Payer: PHCS Commercial |
$32,070.00
|
| Rate for Payer: United Healthcare All Payer |
$29,397.50
|
|
|
ENDRNT AAA AORTC EXT 32*32*70
|
Facility
|
OP
|
$33,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,021.88 |
| Max. Negotiated Rate |
$32,070.00 |
| Rate for Payer: Aetna Commercial |
$25,722.81
|
| Rate for Payer: Anthem Medicaid |
$11,488.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,056.88
|
| Rate for Payer: Cash Price |
$16,703.12
|
| Rate for Payer: Cigna Commercial |
$27,727.19
|
| Rate for Payer: First Health Commercial |
$31,735.94
|
| Rate for Payer: Humana Commercial |
$28,395.31
|
| Rate for Payer: Humana KY Medicaid |
$11,488.41
|
| Rate for Payer: Kentucky WC Medicaid |
$11,605.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,393.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,653.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,021.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,718.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,397.50
|
| Rate for Payer: Ohio Health Group HMO |
$25,054.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,725.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,063.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,050.31
|
| Rate for Payer: PHCS Commercial |
$32,070.00
|
| Rate for Payer: United Healthcare All Payer |
$29,397.50
|
|
|
ENDRNT AAA AORTC EXT 36*36*49
|
Facility
|
OP
|
$22,531.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,759.38 |
| Max. Negotiated Rate |
$21,630.00 |
| Rate for Payer: Aetna Commercial |
$17,349.06
|
| Rate for Payer: Anthem Medicaid |
$7,748.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,574.38
|
| Rate for Payer: Cash Price |
$11,265.62
|
| Rate for Payer: Cigna Commercial |
$18,700.94
|
| Rate for Payer: First Health Commercial |
$21,404.69
|
| Rate for Payer: Humana Commercial |
$19,151.56
|
| Rate for Payer: Humana KY Medicaid |
$7,748.50
|
| Rate for Payer: Kentucky WC Medicaid |
$7,827.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,475.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,628.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,759.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,903.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,827.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,898.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,025.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,602.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,546.56
|
| Rate for Payer: PHCS Commercial |
$21,630.00
|
| Rate for Payer: United Healthcare All Payer |
$19,827.50
|
|
|
ENDRNT AAA AORTC EXT 36*36*49
|
Facility
|
IP
|
$22,531.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,759.38 |
| Max. Negotiated Rate |
$21,630.00 |
| Rate for Payer: Aetna Commercial |
$17,349.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,574.38
|
| Rate for Payer: Cash Price |
$11,265.62
|
| Rate for Payer: Cigna Commercial |
$18,700.94
|
| Rate for Payer: First Health Commercial |
$21,404.69
|
| Rate for Payer: Humana Commercial |
$19,151.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,475.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,628.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,759.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,827.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,898.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,025.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,602.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,546.56
|
| Rate for Payer: PHCS Commercial |
$21,630.00
|
| Rate for Payer: United Healthcare All Payer |
$19,827.50
|
|
|
ENDRNT AAA AORTC EXT 36*36*70
|
Facility
|
IP
|
$33,968.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,190.62 |
| Max. Negotiated Rate |
$32,610.00 |
| Rate for Payer: Aetna Commercial |
$26,155.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,495.62
|
| Rate for Payer: Cash Price |
$16,984.38
|
| Rate for Payer: Cigna Commercial |
$28,194.06
|
| Rate for Payer: First Health Commercial |
$32,270.31
|
| Rate for Payer: Humana Commercial |
$28,873.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,854.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,068.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,190.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,892.50
|
| Rate for Payer: Ohio Health Group HMO |
$25,476.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,552.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,438.44
|
| Rate for Payer: PHCS Commercial |
$32,610.00
|
| Rate for Payer: United Healthcare All Payer |
$29,892.50
|
|
|
ENDRNT AAA AORTC EXT 36*36*70
|
Facility
|
OP
|
$33,968.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,190.62 |
| Max. Negotiated Rate |
$32,610.00 |
| Rate for Payer: Aetna Commercial |
$26,155.94
|
| Rate for Payer: Anthem Medicaid |
$11,681.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,495.62
|
| Rate for Payer: Cash Price |
$16,984.38
|
| Rate for Payer: Cigna Commercial |
$28,194.06
|
| Rate for Payer: First Health Commercial |
$32,270.31
|
| Rate for Payer: Humana Commercial |
$28,873.44
|
| Rate for Payer: Humana KY Medicaid |
$11,681.85
|
| Rate for Payer: Kentucky WC Medicaid |
$11,800.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,854.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,068.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,190.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,916.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,892.50
|
| Rate for Payer: Ohio Health Group HMO |
$25,476.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,552.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,438.44
|
| Rate for Payer: PHCS Commercial |
$32,610.00
|
| Rate for Payer: United Healthcare All Payer |
$29,892.50
|
|
|
ENDRNT AAA CONT LIMB 16*10*124
|
Facility
|
OP
|
$23,656.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,096.88 |
| Max. Negotiated Rate |
$22,710.00 |
| Rate for Payer: Aetna Commercial |
$18,215.31
|
| Rate for Payer: Anthem Medicaid |
$8,135.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,451.88
|
| Rate for Payer: Cash Price |
$11,828.12
|
| Rate for Payer: Cigna Commercial |
$19,634.69
|
| Rate for Payer: First Health Commercial |
$22,473.44
|
| Rate for Payer: Humana Commercial |
$20,107.81
|
| Rate for Payer: Humana KY Medicaid |
$8,135.38
|
| Rate for Payer: Kentucky WC Medicaid |
$8,218.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,398.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,458.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,096.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,298.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,817.50
|
| Rate for Payer: Ohio Health Group HMO |
$17,742.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,580.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,322.81
|
| Rate for Payer: PHCS Commercial |
$22,710.00
|
| Rate for Payer: United Healthcare All Payer |
$20,817.50
|
|
|
ENDRNT AAA CONT LIMB 16*10*124
|
Facility
|
IP
|
$23,656.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,096.88 |
| Max. Negotiated Rate |
$22,710.00 |
| Rate for Payer: Aetna Commercial |
$18,215.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,451.88
|
| Rate for Payer: Cash Price |
$11,828.12
|
| Rate for Payer: Cigna Commercial |
$19,634.69
|
| Rate for Payer: First Health Commercial |
$22,473.44
|
| Rate for Payer: Humana Commercial |
$20,107.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,398.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,458.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,096.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,817.50
|
| Rate for Payer: Ohio Health Group HMO |
$17,742.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,580.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,322.81
|
| Rate for Payer: PHCS Commercial |
$22,710.00
|
| Rate for Payer: United Healthcare All Payer |
$20,817.50
|
|
|
ENDRNT AAA CONT LIMB 16*10*82
|
Facility
|
OP
|
$23,187.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.25 |
| Max. Negotiated Rate |
$22,260.00 |
| Rate for Payer: Aetna Commercial |
$17,854.38
|
| Rate for Payer: Anthem Medicaid |
$7,974.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,086.25
|
| Rate for Payer: Cash Price |
$11,593.75
|
| Rate for Payer: Cigna Commercial |
$19,245.62
|
| Rate for Payer: First Health Commercial |
$22,028.12
|
| Rate for Payer: Humana Commercial |
$19,709.38
|
| Rate for Payer: Humana KY Medicaid |
$7,974.18
|
| Rate for Payer: Kentucky WC Medicaid |
$8,055.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,112.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,134.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,405.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,173.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,999.38
|
| Rate for Payer: PHCS Commercial |
$22,260.00
|
| Rate for Payer: United Healthcare All Payer |
$20,405.00
|
|
|
ENDRNT AAA CONT LIMB 16*10*82
|
Facility
|
IP
|
$23,187.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.25 |
| Max. Negotiated Rate |
$22,260.00 |
| Rate for Payer: Aetna Commercial |
$17,854.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,086.25
|
| Rate for Payer: Cash Price |
$11,593.75
|
| Rate for Payer: Cigna Commercial |
$19,245.62
|
| Rate for Payer: First Health Commercial |
$22,028.12
|
| Rate for Payer: Humana Commercial |
$19,709.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,112.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,405.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,173.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,999.38
|
| Rate for Payer: PHCS Commercial |
$22,260.00
|
| Rate for Payer: United Healthcare All Payer |
$20,405.00
|
|
|
ENDRNT AAA CONT LIMB 16*10*93
|
Facility
|
IP
|
$23,187.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.25 |
| Max. Negotiated Rate |
$22,260.00 |
| Rate for Payer: Aetna Commercial |
$17,854.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,086.25
|
| Rate for Payer: Cash Price |
$11,593.75
|
| Rate for Payer: Cigna Commercial |
$19,245.62
|
| Rate for Payer: First Health Commercial |
$22,028.12
|
| Rate for Payer: Humana Commercial |
$19,709.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,112.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,405.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,173.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,999.38
|
| Rate for Payer: PHCS Commercial |
$22,260.00
|
| Rate for Payer: United Healthcare All Payer |
$20,405.00
|
|
|
ENDRNT AAA CONT LIMB 16*10*93
|
Facility
|
OP
|
$23,187.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.25 |
| Max. Negotiated Rate |
$22,260.00 |
| Rate for Payer: Aetna Commercial |
$17,854.38
|
| Rate for Payer: Anthem Medicaid |
$7,974.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,086.25
|
| Rate for Payer: Cash Price |
$11,593.75
|
| Rate for Payer: Cigna Commercial |
$19,245.62
|
| Rate for Payer: First Health Commercial |
$22,028.12
|
| Rate for Payer: Humana Commercial |
$19,709.38
|
| Rate for Payer: Humana KY Medicaid |
$7,974.18
|
| Rate for Payer: Kentucky WC Medicaid |
$8,055.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,112.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,134.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,405.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,173.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,999.38
|
| Rate for Payer: PHCS Commercial |
$22,260.00
|
| Rate for Payer: United Healthcare All Payer |
$20,405.00
|
|
|
ENDRNT AAA CONT LIMB 16*13*124
|
Facility
|
IP
|
$23,656.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,096.88 |
| Max. Negotiated Rate |
$22,710.00 |
| Rate for Payer: Aetna Commercial |
$18,215.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,451.88
|
| Rate for Payer: Cash Price |
$11,828.12
|
| Rate for Payer: Cigna Commercial |
$19,634.69
|
| Rate for Payer: First Health Commercial |
$22,473.44
|
| Rate for Payer: Humana Commercial |
$20,107.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,398.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,458.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,096.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,817.50
|
| Rate for Payer: Ohio Health Group HMO |
$17,742.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,580.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,322.81
|
| Rate for Payer: PHCS Commercial |
$22,710.00
|
| Rate for Payer: United Healthcare All Payer |
$20,817.50
|
|
|
ENDRNT AAA CONT LIMB 16*13*124
|
Facility
|
OP
|
$23,656.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,096.88 |
| Max. Negotiated Rate |
$22,710.00 |
| Rate for Payer: Aetna Commercial |
$18,215.31
|
| Rate for Payer: Anthem Medicaid |
$8,135.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,451.88
|
| Rate for Payer: Cash Price |
$11,828.12
|
| Rate for Payer: Cigna Commercial |
$19,634.69
|
| Rate for Payer: First Health Commercial |
$22,473.44
|
| Rate for Payer: Humana Commercial |
$20,107.81
|
| Rate for Payer: Humana KY Medicaid |
$8,135.38
|
| Rate for Payer: Kentucky WC Medicaid |
$8,218.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,398.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,458.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,096.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,298.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,817.50
|
| Rate for Payer: Ohio Health Group HMO |
$17,742.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,580.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,322.81
|
| Rate for Payer: PHCS Commercial |
$22,710.00
|
| Rate for Payer: United Healthcare All Payer |
$20,817.50
|
|
|
ENDRNT AAA CONT LIMB 16*13*82
|
Facility
|
OP
|
$23,187.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.25 |
| Max. Negotiated Rate |
$22,260.00 |
| Rate for Payer: Aetna Commercial |
$17,854.38
|
| Rate for Payer: Anthem Medicaid |
$7,974.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,086.25
|
| Rate for Payer: Cash Price |
$11,593.75
|
| Rate for Payer: Cigna Commercial |
$19,245.62
|
| Rate for Payer: First Health Commercial |
$22,028.12
|
| Rate for Payer: Humana Commercial |
$19,709.38
|
| Rate for Payer: Humana KY Medicaid |
$7,974.18
|
| Rate for Payer: Kentucky WC Medicaid |
$8,055.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,112.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,134.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,405.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,173.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,999.38
|
| Rate for Payer: PHCS Commercial |
$22,260.00
|
| Rate for Payer: United Healthcare All Payer |
$20,405.00
|
|
|
ENDRNT AAA CONT LIMB 16*13*82
|
Facility
|
IP
|
$23,187.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.25 |
| Max. Negotiated Rate |
$22,260.00 |
| Rate for Payer: Aetna Commercial |
$17,854.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,086.25
|
| Rate for Payer: Cash Price |
$11,593.75
|
| Rate for Payer: Cigna Commercial |
$19,245.62
|
| Rate for Payer: First Health Commercial |
$22,028.12
|
| Rate for Payer: Humana Commercial |
$19,709.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,112.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,405.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,173.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,999.38
|
| Rate for Payer: PHCS Commercial |
$22,260.00
|
| Rate for Payer: United Healthcare All Payer |
$20,405.00
|
|
|
ENDRNT AAA CONT LIMB 16*13*93
|
Facility
|
IP
|
$23,468.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,040.62 |
| Max. Negotiated Rate |
$22,530.00 |
| Rate for Payer: Aetna Commercial |
$18,070.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,305.62
|
| Rate for Payer: Cash Price |
$11,734.38
|
| Rate for Payer: Cigna Commercial |
$19,479.06
|
| Rate for Payer: First Health Commercial |
$22,295.31
|
| Rate for Payer: Humana Commercial |
$19,948.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,244.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,319.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,040.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,652.50
|
| Rate for Payer: Ohio Health Group HMO |
$17,601.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,775.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,417.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,193.44
|
| Rate for Payer: PHCS Commercial |
$22,530.00
|
| Rate for Payer: United Healthcare All Payer |
$20,652.50
|
|
|
ENDRNT AAA CONT LIMB 16*13*93
|
Facility
|
OP
|
$23,468.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,040.62 |
| Max. Negotiated Rate |
$22,530.00 |
| Rate for Payer: Aetna Commercial |
$18,070.94
|
| Rate for Payer: Anthem Medicaid |
$8,070.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,305.62
|
| Rate for Payer: Cash Price |
$11,734.38
|
| Rate for Payer: Cigna Commercial |
$19,479.06
|
| Rate for Payer: First Health Commercial |
$22,295.31
|
| Rate for Payer: Humana Commercial |
$19,948.44
|
| Rate for Payer: Humana KY Medicaid |
$8,070.90
|
| Rate for Payer: Kentucky WC Medicaid |
$8,153.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,244.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,319.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,040.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,232.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,652.50
|
| Rate for Payer: Ohio Health Group HMO |
$17,601.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,775.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,417.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,193.44
|
| Rate for Payer: PHCS Commercial |
$22,530.00
|
| Rate for Payer: United Healthcare All Payer |
$20,652.50
|
|
|
ENDRNT AAA CONT LIMB 16*16*124
|
Facility
|
OP
|
$23,656.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,096.88 |
| Max. Negotiated Rate |
$22,710.00 |
| Rate for Payer: Aetna Commercial |
$18,215.31
|
| Rate for Payer: Anthem Medicaid |
$8,135.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,451.88
|
| Rate for Payer: Cash Price |
$11,828.12
|
| Rate for Payer: Cigna Commercial |
$19,634.69
|
| Rate for Payer: First Health Commercial |
$22,473.44
|
| Rate for Payer: Humana Commercial |
$20,107.81
|
| Rate for Payer: Humana KY Medicaid |
$8,135.38
|
| Rate for Payer: Kentucky WC Medicaid |
$8,218.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,398.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,458.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,096.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,298.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,817.50
|
| Rate for Payer: Ohio Health Group HMO |
$17,742.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,580.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,322.81
|
| Rate for Payer: PHCS Commercial |
$22,710.00
|
| Rate for Payer: United Healthcare All Payer |
$20,817.50
|
|
