|
GERMAN COCKROACH IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000689
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
GERMAN COCKROACH IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000689
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
G-ESOPH REFLX TST W/ELECTROD
|
Facility
|
OP
|
$2,258.00
|
|
|
Service Code
|
HCPCS 91035
|
| Hospital Charge Code |
75000003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$293.54 |
| Max. Negotiated Rate |
$2,167.68 |
| Rate for Payer: Aetna Commercial |
$1,738.66
|
| Rate for Payer: Anthem Medicaid |
$776.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,761.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$1,129.00
|
| Rate for Payer: Cash Price |
$1,129.00
|
| Rate for Payer: Cigna Commercial |
$1,874.14
|
| Rate for Payer: First Health Commercial |
$2,145.10
|
| Rate for Payer: Humana Commercial |
$1,919.30
|
| Rate for Payer: Humana KY Medicaid |
$776.53
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$784.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,851.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,666.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$792.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,987.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,693.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$451.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$699.98
|
| Rate for Payer: PHCS Commercial |
$2,167.68
|
| Rate for Payer: United Healthcare All Payer |
$1,987.04
|
|
|
G-ESOPH REFLX TST W/ELECTROD
|
Facility
|
IP
|
$2,258.00
|
|
|
Service Code
|
HCPCS 91035
|
| Hospital Charge Code |
75000003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$293.54 |
| Max. Negotiated Rate |
$2,167.68 |
| Rate for Payer: Aetna Commercial |
$1,738.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,761.24
|
| Rate for Payer: Cash Price |
$1,129.00
|
| Rate for Payer: Cigna Commercial |
$1,874.14
|
| Rate for Payer: First Health Commercial |
$2,145.10
|
| Rate for Payer: Humana Commercial |
$1,919.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,851.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,666.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$677.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,987.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,693.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$451.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$699.98
|
| Rate for Payer: PHCS Commercial |
$2,167.68
|
| Rate for Payer: United Healthcare All Payer |
$1,987.04
|
|
|
G-ESOPH REFLX TST W/ELECTROD
|
Professional
|
Both
|
$2,258.00
|
|
|
Service Code
|
HCPCS 91035
|
| Hospital Charge Code |
75000003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$108.10 |
| Max. Negotiated Rate |
$2,258.00 |
| Rate for Payer: Aetna Commercial |
$684.78
|
| Rate for Payer: Anthem Medicaid |
$325.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,258.00
|
| Rate for Payer: Cash Price |
$1,129.00
|
| Rate for Payer: Cash Price |
$1,129.00
|
| Rate for Payer: Cigna Commercial |
$602.95
|
| Rate for Payer: Healthspan PPO |
$560.38
|
| Rate for Payer: Humana Medicaid |
$325.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$332.38
|
| Rate for Payer: Molina Healthcare Passport |
$325.86
|
| Rate for Payer: Multiplan PHCS |
$1,354.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,580.60
|
| Rate for Payer: UHCCP Medicaid |
$790.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$329.12
|
|
|
G-ESOPH REFLX TST W/ELECTRO(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 91035
|
| Hospital Charge Code |
750P0003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$684.78 |
| Rate for Payer: Aetna Commercial |
$684.78
|
| Rate for Payer: Anthem Medicaid |
$325.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$602.95
|
| Rate for Payer: Healthspan PPO |
$560.38
|
| Rate for Payer: Humana Medicaid |
$325.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$332.38
|
| Rate for Payer: Molina Healthcare Passport |
$325.86
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$329.12
|
|
|
G-ESOPH REFLX TST W/ELECTRO(T
|
Facility
|
OP
|
$2,058.00
|
|
|
Service Code
|
HCPCS 91035
|
| Hospital Charge Code |
750T0003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$267.54 |
| Max. Negotiated Rate |
$1,975.68 |
| Rate for Payer: Aetna Commercial |
$1,584.66
|
| Rate for Payer: Anthem Medicaid |
$707.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,605.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: Cigna Commercial |
$1,708.14
|
| Rate for Payer: First Health Commercial |
$1,955.10
|
| Rate for Payer: Humana Commercial |
$1,749.30
|
| Rate for Payer: Humana KY Medicaid |
$707.75
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$714.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,687.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,518.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$721.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,811.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,543.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.98
|
| Rate for Payer: PHCS Commercial |
$1,975.68
|
| Rate for Payer: United Healthcare All Payer |
$1,811.04
|
|
|
G-ESOPH REFLX TST W/ELECTRO(T
|
Facility
|
IP
|
$2,058.00
|
|
|
Service Code
|
HCPCS 91035
|
| Hospital Charge Code |
750T0003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$267.54 |
| Max. Negotiated Rate |
$1,975.68 |
| Rate for Payer: Aetna Commercial |
$1,584.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,605.24
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: Cigna Commercial |
$1,708.14
|
| Rate for Payer: First Health Commercial |
$1,955.10
|
| Rate for Payer: Humana Commercial |
$1,749.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,687.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,518.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,811.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,543.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.98
|
| Rate for Payer: PHCS Commercial |
$1,975.68
|
| Rate for Payer: United Healthcare All Payer |
$1,811.04
|
|
|
GFT AORTC BDY OVATION P 23*80
|
Facility
|
IP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
GFT AORTC BDY OVATION P 23*80
|
Facility
|
OP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem Medicaid |
$11,064.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Humana KY Medicaid |
$11,064.98
|
| Rate for Payer: Kentucky WC Medicaid |
$11,177.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,286.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
GFT AORTC BDY OVATION P 26*80
|
Facility
|
IP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
GFT AORTC BDY OVATION P 26*80
|
Facility
|
OP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem Medicaid |
$11,064.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Humana KY Medicaid |
$11,064.98
|
| Rate for Payer: Kentucky WC Medicaid |
$11,177.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,286.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
GFT AORTC BDY OVATION P 29*80
|
Facility
|
IP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
GFT AORTC BDY OVATION P 29*80
|
Facility
|
OP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem Medicaid |
$11,064.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Humana KY Medicaid |
$11,064.98
|
| Rate for Payer: Kentucky WC Medicaid |
$11,177.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,286.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
GFT AORTC BDY OVATION P 34*80
|
Facility
|
OP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem Medicaid |
$11,064.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Humana KY Medicaid |
$11,064.98
|
| Rate for Payer: Kentucky WC Medicaid |
$11,177.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,286.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
GFT AORTC BDY OVATION P 34*80
|
Facility
|
IP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
GFT AORTC EXT A25-25/C75-O20 V
|
Facility
|
OP
|
$25,601.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,328.18 |
| Max. Negotiated Rate |
$24,577.30 |
| Rate for Payer: Aetna Commercial |
$19,713.04
|
| Rate for Payer: Anthem Medicaid |
$8,804.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,969.05
|
| Rate for Payer: Cash Price |
$12,800.67
|
| Rate for Payer: Cigna Commercial |
$21,249.12
|
| Rate for Payer: First Health Commercial |
$24,321.28
|
| Rate for Payer: Humana Commercial |
$21,761.15
|
| Rate for Payer: Humana KY Medicaid |
$8,804.30
|
| Rate for Payer: Kentucky WC Medicaid |
$8,893.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,993.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,893.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,680.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,980.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,529.19
|
| Rate for Payer: Ohio Health Group HMO |
$19,201.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,120.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,328.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,936.42
|
| Rate for Payer: PHCS Commercial |
$24,577.30
|
| Rate for Payer: United Healthcare All Payer |
$22,529.19
|
|
|
GFT AORTC EXT A25-25/C75-O20 V
|
Facility
|
IP
|
$25,601.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,328.18 |
| Max. Negotiated Rate |
$24,577.30 |
| Rate for Payer: Aetna Commercial |
$19,713.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,969.05
|
| Rate for Payer: Cash Price |
$12,800.67
|
| Rate for Payer: Cigna Commercial |
$21,249.12
|
| Rate for Payer: First Health Commercial |
$24,321.28
|
| Rate for Payer: Humana Commercial |
$21,761.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,993.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,893.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,680.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,529.19
|
| Rate for Payer: Ohio Health Group HMO |
$19,201.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,120.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,328.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,936.42
|
| Rate for Payer: PHCS Commercial |
$24,577.30
|
| Rate for Payer: United Healthcare All Payer |
$22,529.19
|
|
|
GFT AORTC EXT A25-25/C95-O20 V
|
Facility
|
IP
|
$23,177.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,013.11 |
| Max. Negotiated Rate |
$22,250.64 |
| Rate for Payer: Aetna Commercial |
$17,846.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,078.64
|
| Rate for Payer: Cash Price |
$11,588.88
|
| Rate for Payer: Cigna Commercial |
$19,237.53
|
| Rate for Payer: First Health Commercial |
$22,018.86
|
| Rate for Payer: Humana Commercial |
$19,701.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,005.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,105.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,953.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,396.42
|
| Rate for Payer: Ohio Health Group HMO |
$17,383.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,635.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,013.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,185.10
|
| Rate for Payer: PHCS Commercial |
$22,250.64
|
| Rate for Payer: United Healthcare All Payer |
$20,396.42
|
|
|
GFT AORTC EXT A25-25/C95-O20 V
|
Facility
|
OP
|
$23,177.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,013.11 |
| Max. Negotiated Rate |
$22,250.64 |
| Rate for Payer: Aetna Commercial |
$17,846.87
|
| Rate for Payer: Anthem Medicaid |
$7,970.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,078.64
|
| Rate for Payer: Cash Price |
$11,588.88
|
| Rate for Payer: Cigna Commercial |
$19,237.53
|
| Rate for Payer: First Health Commercial |
$22,018.86
|
| Rate for Payer: Humana Commercial |
$19,701.09
|
| Rate for Payer: Humana KY Medicaid |
$7,970.83
|
| Rate for Payer: Kentucky WC Medicaid |
$8,051.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,005.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,105.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,953.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,130.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,396.42
|
| Rate for Payer: Ohio Health Group HMO |
$17,383.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,635.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,013.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,185.10
|
| Rate for Payer: PHCS Commercial |
$22,250.64
|
| Rate for Payer: United Healthcare All Payer |
$20,396.42
|
|
|
GFT AORTC EXT A28-28/C95-O20 V
|
Facility
|
OP
|
$25,601.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,328.18 |
| Max. Negotiated Rate |
$24,577.30 |
| Rate for Payer: Aetna Commercial |
$19,713.04
|
| Rate for Payer: Anthem Medicaid |
$8,804.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,969.05
|
| Rate for Payer: Cash Price |
$12,800.67
|
| Rate for Payer: Cigna Commercial |
$21,249.12
|
| Rate for Payer: First Health Commercial |
$24,321.28
|
| Rate for Payer: Humana Commercial |
$21,761.15
|
| Rate for Payer: Humana KY Medicaid |
$8,804.30
|
| Rate for Payer: Kentucky WC Medicaid |
$8,893.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,993.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,893.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,680.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,980.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,529.19
|
| Rate for Payer: Ohio Health Group HMO |
$19,201.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,120.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,328.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,936.42
|
| Rate for Payer: PHCS Commercial |
$24,577.30
|
| Rate for Payer: United Healthcare All Payer |
$22,529.19
|
|
|
GFT AORTC EXT A28-28/C95-O20 V
|
Facility
|
IP
|
$25,601.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,328.18 |
| Max. Negotiated Rate |
$24,577.30 |
| Rate for Payer: Aetna Commercial |
$19,713.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,969.05
|
| Rate for Payer: Cash Price |
$12,800.67
|
| Rate for Payer: Cigna Commercial |
$21,249.12
|
| Rate for Payer: First Health Commercial |
$24,321.28
|
| Rate for Payer: Humana Commercial |
$21,761.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,993.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,893.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,680.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,529.19
|
| Rate for Payer: Ohio Health Group HMO |
$19,201.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,120.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,328.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,936.42
|
| Rate for Payer: PHCS Commercial |
$24,577.30
|
| Rate for Payer: United Healthcare All Payer |
$22,529.19
|
|
|
GFT AORTC EXT A34-34/C100-O20
|
Facility
|
IP
|
$24,017.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.24 |
| Max. Negotiated Rate |
$23,056.56 |
| Rate for Payer: Aetna Commercial |
$18,493.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,733.46
|
| Rate for Payer: Cash Price |
$12,008.62
|
| Rate for Payer: Cigna Commercial |
$19,934.32
|
| Rate for Payer: First Health Commercial |
$22,816.39
|
| Rate for Payer: Humana Commercial |
$20,414.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,694.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,724.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,205.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,135.18
|
| Rate for Payer: Ohio Health Group HMO |
$18,012.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,803.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,445.35
|
| Rate for Payer: PHCS Commercial |
$23,056.56
|
| Rate for Payer: United Healthcare All Payer |
$21,135.18
|
|
|
GFT AORTC EXT A34-34/C100-O20
|
Facility
|
OP
|
$24,017.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.24 |
| Max. Negotiated Rate |
$23,056.56 |
| Rate for Payer: Aetna Commercial |
$18,493.28
|
| Rate for Payer: Anthem Medicaid |
$8,259.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,733.46
|
| Rate for Payer: Cash Price |
$12,008.62
|
| Rate for Payer: Cigna Commercial |
$19,934.32
|
| Rate for Payer: First Health Commercial |
$22,816.39
|
| Rate for Payer: Humana Commercial |
$20,414.66
|
| Rate for Payer: Humana KY Medicaid |
$8,259.53
|
| Rate for Payer: Kentucky WC Medicaid |
$8,343.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,694.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,724.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,205.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,425.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,135.18
|
| Rate for Payer: Ohio Health Group HMO |
$18,012.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,803.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,445.35
|
| Rate for Payer: PHCS Commercial |
$23,056.56
|
| Rate for Payer: United Healthcare All Payer |
$21,135.18
|
|
|
GFT DIST EXT TALENT 26*26*50MM
|
Facility
|
OP
|
$24,875.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,233.75 |
| Max. Negotiated Rate |
$23,880.00 |
| Rate for Payer: Aetna Commercial |
$19,153.75
|
| Rate for Payer: Anthem Medicaid |
$8,554.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,402.50
|
| Rate for Payer: Cash Price |
$12,437.50
|
| Rate for Payer: Cigna Commercial |
$20,646.25
|
| Rate for Payer: First Health Commercial |
$23,631.25
|
| Rate for Payer: Humana Commercial |
$21,143.75
|
| Rate for Payer: Humana KY Medicaid |
$8,554.51
|
| Rate for Payer: Kentucky WC Medicaid |
$8,641.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,397.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,357.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,462.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,726.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,890.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,975.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,233.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,711.25
|
| Rate for Payer: PHCS Commercial |
$23,880.00
|
| Rate for Payer: United Healthcare All Payer |
$21,890.00
|
|
