|
ENDRNT AAA CONT LIMB 16*16*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*16*82
|
Facility
|
IP
|
$21,781.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,534.38 |
| Max. Negotiated Rate |
$20,910.00 |
| Rate for Payer: Aetna Commercial |
$16,771.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,989.38
|
| Rate for Payer: Cash Price |
$10,890.62
|
| Rate for Payer: Cigna Commercial |
$18,078.44
|
| Rate for Payer: First Health Commercial |
$20,692.19
|
| Rate for Payer: Humana Commercial |
$18,514.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,860.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,074.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,534.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,167.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,335.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,425.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,949.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,029.06
|
| Rate for Payer: PHCS Commercial |
$20,910.00
|
| Rate for Payer: United Healthcare All Payer |
$19,167.50
|
|
|
ENDRNT AAA CONT LIMB 16*16*82
|
Facility
|
OP
|
$21,781.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,534.38 |
| Max. Negotiated Rate |
$20,910.00 |
| Rate for Payer: Aetna Commercial |
$16,771.56
|
| Rate for Payer: Anthem Medicaid |
$7,490.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,989.38
|
| Rate for Payer: Cash Price |
$10,890.62
|
| Rate for Payer: Cigna Commercial |
$18,078.44
|
| Rate for Payer: First Health Commercial |
$20,692.19
|
| Rate for Payer: Humana Commercial |
$18,514.06
|
| Rate for Payer: Humana KY Medicaid |
$7,490.57
|
| Rate for Payer: Kentucky WC Medicaid |
$7,566.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,860.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,074.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,534.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,167.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,335.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,425.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,949.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,029.06
|
| Rate for Payer: PHCS Commercial |
$20,910.00
|
| Rate for Payer: United Healthcare All Payer |
$19,167.50
|
|
|
ENDRNT AAA CONT LIMB 16*16*93
|
Facility
|
IP
|
$22,437.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,731.25 |
| Max. Negotiated Rate |
$21,540.00 |
| Rate for Payer: Aetna Commercial |
$17,276.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,501.25
|
| Rate for Payer: Cash Price |
$11,218.75
|
| Rate for Payer: Cigna Commercial |
$18,623.12
|
| Rate for Payer: First Health Commercial |
$21,315.62
|
| Rate for Payer: Humana Commercial |
$19,071.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,398.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,558.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,731.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,745.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,828.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,520.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,481.88
|
| Rate for Payer: PHCS Commercial |
$21,540.00
|
| Rate for Payer: United Healthcare All Payer |
$19,745.00
|
|
|
ENDRNT AAA CONT LIMB 16*16*93
|
Facility
|
OP
|
$22,437.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,731.25 |
| Max. Negotiated Rate |
$21,540.00 |
| Rate for Payer: Aetna Commercial |
$17,276.88
|
| Rate for Payer: Anthem Medicaid |
$7,716.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,501.25
|
| Rate for Payer: Cash Price |
$11,218.75
|
| Rate for Payer: Cigna Commercial |
$18,623.12
|
| Rate for Payer: First Health Commercial |
$21,315.62
|
| Rate for Payer: Humana Commercial |
$19,071.88
|
| Rate for Payer: Humana KY Medicaid |
$7,716.26
|
| Rate for Payer: Kentucky WC Medicaid |
$7,794.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,398.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,558.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,731.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,871.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,745.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,828.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,520.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,481.88
|
| Rate for Payer: PHCS Commercial |
$21,540.00
|
| Rate for Payer: United Healthcare All Payer |
$19,745.00
|
|
|
ENDRNT AAA CONT LIMB 16*20*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*20*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*20*82
|
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*20*82
|
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*20*93
|
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*20*93
|
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*24*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*24*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*24*93
|
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*24*93
|
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*28*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*28*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*28*82
|
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*28*82
|
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*28*93
|
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*28*93
|
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 CONTR LIMB 16*24*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 CONTR LIMB 16*24*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 ILIAC EXT 10*10*82
|
Facility
|
IP
|
$22,437.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,731.25 |
| Max. Negotiated Rate |
$21,540.00 |
| Rate for Payer: Aetna Commercial |
$17,276.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,501.25
|
| Rate for Payer: Cash Price |
$11,218.75
|
| Rate for Payer: Cigna Commercial |
$18,623.12
|
| Rate for Payer: First Health Commercial |
$21,315.62
|
| Rate for Payer: Humana Commercial |
$19,071.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,398.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,558.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,731.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,745.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,828.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,520.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,481.88
|
| Rate for Payer: PHCS Commercial |
$21,540.00
|
| Rate for Payer: United Healthcare All Payer |
$19,745.00
|
|
|
ENDRNT AAA ILIAC EXT 10*10*82
|
Facility
|
OP
|
$22,437.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,731.25 |
| Max. Negotiated Rate |
$21,540.00 |
| Rate for Payer: Aetna Commercial |
$17,276.88
|
| Rate for Payer: Anthem Medicaid |
$7,716.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,501.25
|
| Rate for Payer: Cash Price |
$11,218.75
|
| Rate for Payer: Cigna Commercial |
$18,623.12
|
| Rate for Payer: First Health Commercial |
$21,315.62
|
| Rate for Payer: Humana Commercial |
$19,071.88
|
| Rate for Payer: Humana KY Medicaid |
$7,716.26
|
| Rate for Payer: Kentucky WC Medicaid |
$7,794.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,398.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,558.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,731.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,871.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,745.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,828.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,520.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,481.88
|
| Rate for Payer: PHCS Commercial |
$21,540.00
|
| Rate for Payer: United Healthcare All Payer |
$19,745.00
|
|
