|
GFT DIST TALENT 30MM*26MM*113M
|
Facility
|
OP
|
$72,700.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,451.00 |
| Max. Negotiated Rate |
$69,792.00 |
| Rate for Payer: Aetna Commercial |
$55,979.00
|
| Rate for Payer: Anthem Medicaid |
$25,001.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,706.00
|
| Rate for Payer: Cash Price |
$36,350.00
|
| Rate for Payer: Cigna Commercial |
$60,341.00
|
| Rate for Payer: First Health Commercial |
$69,065.00
|
| Rate for Payer: Humana Commercial |
$61,795.00
|
| Rate for Payer: Humana KY Medicaid |
$25,001.53
|
| Rate for Payer: Kentucky WC Medicaid |
$25,255.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,652.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,503.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$54,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,537.00
|
| Rate for Payer: PHCS Commercial |
$69,792.00
|
| Rate for Payer: United Healthcare All Payer |
$63,976.00
|
|
|
GFT DIST TALENT 30MM*26MM*113M
|
Facility
|
IP
|
$72,700.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,451.00 |
| Max. Negotiated Rate |
$69,792.00 |
| Rate for Payer: Aetna Commercial |
$55,979.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,706.00
|
| Rate for Payer: Cash Price |
$36,350.00
|
| Rate for Payer: Cigna Commercial |
$60,341.00
|
| Rate for Payer: First Health Commercial |
$69,065.00
|
| Rate for Payer: Humana Commercial |
$61,795.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,652.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$54,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,537.00
|
| Rate for Payer: PHCS Commercial |
$69,792.00
|
| Rate for Payer: United Healthcare All Payer |
$63,976.00
|
|
|
GFT DIST TALENT 32MM*28MM*113M
|
Facility
|
IP
|
$72,700.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,451.00 |
| Max. Negotiated Rate |
$69,792.00 |
| Rate for Payer: Aetna Commercial |
$55,979.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,706.00
|
| Rate for Payer: Cash Price |
$36,350.00
|
| Rate for Payer: Cigna Commercial |
$60,341.00
|
| Rate for Payer: First Health Commercial |
$69,065.00
|
| Rate for Payer: Humana Commercial |
$61,795.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,652.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$54,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,537.00
|
| Rate for Payer: PHCS Commercial |
$69,792.00
|
| Rate for Payer: United Healthcare All Payer |
$63,976.00
|
|
|
GFT DIST TALENT 32MM*28MM*113M
|
Facility
|
OP
|
$72,700.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,451.00 |
| Max. Negotiated Rate |
$69,792.00 |
| Rate for Payer: Aetna Commercial |
$55,979.00
|
| Rate for Payer: Anthem Medicaid |
$25,001.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,706.00
|
| Rate for Payer: Cash Price |
$36,350.00
|
| Rate for Payer: Cigna Commercial |
$60,341.00
|
| Rate for Payer: First Health Commercial |
$69,065.00
|
| Rate for Payer: Humana Commercial |
$61,795.00
|
| Rate for Payer: Humana KY Medicaid |
$25,001.53
|
| Rate for Payer: Kentucky WC Medicaid |
$25,255.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,652.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,503.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$54,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,537.00
|
| Rate for Payer: PHCS Commercial |
$69,792.00
|
| Rate for Payer: United Healthcare All Payer |
$63,976.00
|
|
|
GFT DIST TALENT 34MM*30MM*113M
|
Facility
|
OP
|
$72,700.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,451.00 |
| Max. Negotiated Rate |
$69,792.00 |
| Rate for Payer: Aetna Commercial |
$55,979.00
|
| Rate for Payer: Anthem Medicaid |
$25,001.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,706.00
|
| Rate for Payer: Cash Price |
$36,350.00
|
| Rate for Payer: Cigna Commercial |
$60,341.00
|
| Rate for Payer: First Health Commercial |
$69,065.00
|
| Rate for Payer: Humana Commercial |
$61,795.00
|
| Rate for Payer: Humana KY Medicaid |
$25,001.53
|
| Rate for Payer: Kentucky WC Medicaid |
$25,255.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,652.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,503.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$54,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,537.00
|
| Rate for Payer: PHCS Commercial |
$69,792.00
|
| Rate for Payer: United Healthcare All Payer |
$63,976.00
|
|
|
GFT DIST TALENT 34MM*30MM*113M
|
Facility
|
IP
|
$72,700.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,451.00 |
| Max. Negotiated Rate |
$69,792.00 |
| Rate for Payer: Aetna Commercial |
$55,979.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,706.00
|
| Rate for Payer: Cash Price |
$36,350.00
|
| Rate for Payer: Cigna Commercial |
$60,341.00
|
| Rate for Payer: First Health Commercial |
$69,065.00
|
| Rate for Payer: Humana Commercial |
$61,795.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,652.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$54,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,537.00
|
| Rate for Payer: PHCS Commercial |
$69,792.00
|
| Rate for Payer: United Healthcare All Payer |
$63,976.00
|
|
|
GFT DIST TALENT 36MM*32MM*112M
|
Facility
|
IP
|
$72,700.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,451.00 |
| Max. Negotiated Rate |
$69,792.00 |
| Rate for Payer: Aetna Commercial |
$55,979.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,706.00
|
| Rate for Payer: Cash Price |
$36,350.00
|
| Rate for Payer: Cigna Commercial |
$60,341.00
|
| Rate for Payer: First Health Commercial |
$69,065.00
|
| Rate for Payer: Humana Commercial |
$61,795.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,652.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$54,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,537.00
|
| Rate for Payer: PHCS Commercial |
$69,792.00
|
| Rate for Payer: United Healthcare All Payer |
$63,976.00
|
|
|
GFT DIST TALENT 36MM*32MM*112M
|
Facility
|
OP
|
$72,700.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,451.00 |
| Max. Negotiated Rate |
$69,792.00 |
| Rate for Payer: Aetna Commercial |
$55,979.00
|
| Rate for Payer: Anthem Medicaid |
$25,001.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,706.00
|
| Rate for Payer: Cash Price |
$36,350.00
|
| Rate for Payer: Cigna Commercial |
$60,341.00
|
| Rate for Payer: First Health Commercial |
$69,065.00
|
| Rate for Payer: Humana Commercial |
$61,795.00
|
| Rate for Payer: Humana KY Medicaid |
$25,001.53
|
| Rate for Payer: Kentucky WC Medicaid |
$25,255.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,652.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,503.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$54,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,537.00
|
| Rate for Payer: PHCS Commercial |
$69,792.00
|
| Rate for Payer: United Healthcare All Payer |
$63,976.00
|
|
|
GFT DIST TALENT 38MM*34MM*112M
|
Facility
|
IP
|
$72,700.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,451.00 |
| Max. Negotiated Rate |
$69,792.00 |
| Rate for Payer: Aetna Commercial |
$55,979.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,706.00
|
| Rate for Payer: Cash Price |
$36,350.00
|
| Rate for Payer: Cigna Commercial |
$60,341.00
|
| Rate for Payer: First Health Commercial |
$69,065.00
|
| Rate for Payer: Humana Commercial |
$61,795.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,652.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$54,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,537.00
|
| Rate for Payer: PHCS Commercial |
$69,792.00
|
| Rate for Payer: United Healthcare All Payer |
$63,976.00
|
|
|
GFT DIST TALENT 38MM*34MM*112M
|
Facility
|
OP
|
$72,700.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,451.00 |
| Max. Negotiated Rate |
$69,792.00 |
| Rate for Payer: Aetna Commercial |
$55,979.00
|
| Rate for Payer: Anthem Medicaid |
$25,001.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,706.00
|
| Rate for Payer: Cash Price |
$36,350.00
|
| Rate for Payer: Cigna Commercial |
$60,341.00
|
| Rate for Payer: First Health Commercial |
$69,065.00
|
| Rate for Payer: Humana Commercial |
$61,795.00
|
| Rate for Payer: Humana KY Medicaid |
$25,001.53
|
| Rate for Payer: Kentucky WC Medicaid |
$25,255.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,652.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,503.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$54,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,537.00
|
| Rate for Payer: PHCS Commercial |
$69,792.00
|
| Rate for Payer: United Healthcare All Payer |
$63,976.00
|
|
|
GFT DIST TALENT 40MM*36MM*112M
|
Facility
|
OP
|
$72,700.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,451.00 |
| Max. Negotiated Rate |
$69,792.00 |
| Rate for Payer: Aetna Commercial |
$55,979.00
|
| Rate for Payer: Anthem Medicaid |
$25,001.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,706.00
|
| Rate for Payer: Cash Price |
$36,350.00
|
| Rate for Payer: Cigna Commercial |
$60,341.00
|
| Rate for Payer: First Health Commercial |
$69,065.00
|
| Rate for Payer: Humana Commercial |
$61,795.00
|
| Rate for Payer: Humana KY Medicaid |
$25,001.53
|
| Rate for Payer: Kentucky WC Medicaid |
$25,255.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,652.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,503.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$54,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,537.00
|
| Rate for Payer: PHCS Commercial |
$69,792.00
|
| Rate for Payer: United Healthcare All Payer |
$63,976.00
|
|
|
GFT DIST TALENT 40MM*36MM*112M
|
Facility
|
IP
|
$72,700.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,451.00 |
| Max. Negotiated Rate |
$69,792.00 |
| Rate for Payer: Aetna Commercial |
$55,979.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,706.00
|
| Rate for Payer: Cash Price |
$36,350.00
|
| Rate for Payer: Cigna Commercial |
$60,341.00
|
| Rate for Payer: First Health Commercial |
$69,065.00
|
| Rate for Payer: Humana Commercial |
$61,795.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,652.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$54,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,537.00
|
| Rate for Payer: PHCS Commercial |
$69,792.00
|
| Rate for Payer: United Healthcare All Payer |
$63,976.00
|
|
|
GFT DIST TALENT 42MM*38MM*111M
|
Facility
|
IP
|
$74,140.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,638.20 |
| Max. Negotiated Rate |
$71,174.40 |
| Rate for Payer: Aetna Commercial |
$57,087.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,829.20
|
| Rate for Payer: Cash Price |
$37,070.00
|
| Rate for Payer: Cigna Commercial |
$61,536.20
|
| Rate for Payer: First Health Commercial |
$70,433.00
|
| Rate for Payer: Humana Commercial |
$63,019.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,794.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,715.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,242.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,243.20
|
| Rate for Payer: Ohio Health Group HMO |
$55,605.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,828.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,638.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,983.40
|
| Rate for Payer: PHCS Commercial |
$71,174.40
|
| Rate for Payer: United Healthcare All Payer |
$65,243.20
|
|
|
GFT DIST TALENT 42MM*38MM*111M
|
Facility
|
OP
|
$74,140.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,638.20 |
| Max. Negotiated Rate |
$71,174.40 |
| Rate for Payer: Aetna Commercial |
$57,087.80
|
| Rate for Payer: Anthem Medicaid |
$25,496.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,829.20
|
| Rate for Payer: Cash Price |
$37,070.00
|
| Rate for Payer: Cigna Commercial |
$61,536.20
|
| Rate for Payer: First Health Commercial |
$70,433.00
|
| Rate for Payer: Humana Commercial |
$63,019.00
|
| Rate for Payer: Humana KY Medicaid |
$25,496.75
|
| Rate for Payer: Kentucky WC Medicaid |
$25,756.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,794.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,715.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,242.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,008.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,243.20
|
| Rate for Payer: Ohio Health Group HMO |
$55,605.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,828.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,638.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,983.40
|
| Rate for Payer: PHCS Commercial |
$71,174.40
|
| Rate for Payer: United Healthcare All Payer |
$65,243.20
|
|
|
GFT DIST TALENT 44MM*40MM*111M
|
Facility
|
IP
|
$74,140.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,638.20 |
| Max. Negotiated Rate |
$71,174.40 |
| Rate for Payer: Aetna Commercial |
$57,087.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,829.20
|
| Rate for Payer: Cash Price |
$37,070.00
|
| Rate for Payer: Cigna Commercial |
$61,536.20
|
| Rate for Payer: First Health Commercial |
$70,433.00
|
| Rate for Payer: Humana Commercial |
$63,019.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,794.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,715.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,242.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,243.20
|
| Rate for Payer: Ohio Health Group HMO |
$55,605.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,828.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,638.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,983.40
|
| Rate for Payer: PHCS Commercial |
$71,174.40
|
| Rate for Payer: United Healthcare All Payer |
$65,243.20
|
|
|
GFT DIST TALENT 44MM*40MM*111M
|
Facility
|
OP
|
$74,140.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,638.20 |
| Max. Negotiated Rate |
$71,174.40 |
| Rate for Payer: Aetna Commercial |
$57,087.80
|
| Rate for Payer: Anthem Medicaid |
$25,496.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,829.20
|
| Rate for Payer: Cash Price |
$37,070.00
|
| Rate for Payer: Cigna Commercial |
$61,536.20
|
| Rate for Payer: First Health Commercial |
$70,433.00
|
| Rate for Payer: Humana Commercial |
$63,019.00
|
| Rate for Payer: Humana KY Medicaid |
$25,496.75
|
| Rate for Payer: Kentucky WC Medicaid |
$25,756.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,794.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,715.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,242.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,008.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,243.20
|
| Rate for Payer: Ohio Health Group HMO |
$55,605.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,828.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,638.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,983.40
|
| Rate for Payer: PHCS Commercial |
$71,174.40
|
| Rate for Payer: United Healthcare All Payer |
$65,243.20
|
|
|
GFT DIST TALENT 46MM*42MM*110M
|
Facility
|
OP
|
$74,140.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,638.20 |
| Max. Negotiated Rate |
$71,174.40 |
| Rate for Payer: Aetna Commercial |
$57,087.80
|
| Rate for Payer: Anthem Medicaid |
$25,496.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,829.20
|
| Rate for Payer: Cash Price |
$37,070.00
|
| Rate for Payer: Cigna Commercial |
$61,536.20
|
| Rate for Payer: First Health Commercial |
$70,433.00
|
| Rate for Payer: Humana Commercial |
$63,019.00
|
| Rate for Payer: Humana KY Medicaid |
$25,496.75
|
| Rate for Payer: Kentucky WC Medicaid |
$25,756.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,794.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,715.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,242.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,008.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,243.20
|
| Rate for Payer: Ohio Health Group HMO |
$55,605.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,828.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,638.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,983.40
|
| Rate for Payer: PHCS Commercial |
$71,174.40
|
| Rate for Payer: United Healthcare All Payer |
$65,243.20
|
|
|
GFT DIST TALENT 46MM*42MM*110M
|
Facility
|
IP
|
$74,140.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,638.20 |
| Max. Negotiated Rate |
$71,174.40 |
| Rate for Payer: Aetna Commercial |
$57,087.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,829.20
|
| Rate for Payer: Cash Price |
$37,070.00
|
| Rate for Payer: Cigna Commercial |
$61,536.20
|
| Rate for Payer: First Health Commercial |
$70,433.00
|
| Rate for Payer: Humana Commercial |
$63,019.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,794.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,715.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,242.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,243.20
|
| Rate for Payer: Ohio Health Group HMO |
$55,605.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,828.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,638.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,983.40
|
| Rate for Payer: PHCS Commercial |
$71,174.40
|
| Rate for Payer: United Healthcare All Payer |
$65,243.20
|
|
|
GFT DIST TALENT 46MM*44MM*110M
|
Facility
|
OP
|
$74,140.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,638.20 |
| Max. Negotiated Rate |
$71,174.40 |
| Rate for Payer: Aetna Commercial |
$57,087.80
|
| Rate for Payer: Anthem Medicaid |
$25,496.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,829.20
|
| Rate for Payer: Cash Price |
$37,070.00
|
| Rate for Payer: Cigna Commercial |
$61,536.20
|
| Rate for Payer: First Health Commercial |
$70,433.00
|
| Rate for Payer: Humana Commercial |
$63,019.00
|
| Rate for Payer: Humana KY Medicaid |
$25,496.75
|
| Rate for Payer: Kentucky WC Medicaid |
$25,756.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,794.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,715.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,242.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,008.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,243.20
|
| Rate for Payer: Ohio Health Group HMO |
$55,605.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,828.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,638.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,983.40
|
| Rate for Payer: PHCS Commercial |
$71,174.40
|
| Rate for Payer: United Healthcare All Payer |
$65,243.20
|
|
|
GFT DIST TALENT 46MM*44MM*110M
|
Facility
|
IP
|
$74,140.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,638.20 |
| Max. Negotiated Rate |
$71,174.40 |
| Rate for Payer: Aetna Commercial |
$57,087.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,829.20
|
| Rate for Payer: Cash Price |
$37,070.00
|
| Rate for Payer: Cigna Commercial |
$61,536.20
|
| Rate for Payer: First Health Commercial |
$70,433.00
|
| Rate for Payer: Humana Commercial |
$63,019.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,794.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,715.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,242.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,243.20
|
| Rate for Payer: Ohio Health Group HMO |
$55,605.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,828.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,638.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,983.40
|
| Rate for Payer: PHCS Commercial |
$71,174.40
|
| Rate for Payer: United Healthcare All Payer |
$65,243.20
|
|
|
GFT ENDRNT II BIFU 25*16*145MM
|
Facility
|
IP
|
$41,208.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,357.14 |
| Max. Negotiated Rate |
$39,560.40 |
| Rate for Payer: Aetna Commercial |
$31,730.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,142.82
|
| Rate for Payer: Cash Price |
$20,604.38
|
| Rate for Payer: Cigna Commercial |
$34,203.26
|
| Rate for Payer: First Health Commercial |
$39,148.31
|
| Rate for Payer: Humana Commercial |
$35,027.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,791.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,412.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,362.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,263.70
|
| Rate for Payer: Ohio Health Group HMO |
$30,906.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,241.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,357.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,774.71
|
| Rate for Payer: PHCS Commercial |
$39,560.40
|
| Rate for Payer: United Healthcare All Payer |
$36,263.70
|
|
|
GFT ENDRNT II BIFU 25*16*145MM
|
Facility
|
OP
|
$41,208.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,357.14 |
| Max. Negotiated Rate |
$39,560.40 |
| Rate for Payer: Aetna Commercial |
$31,730.74
|
| Rate for Payer: Anthem Medicaid |
$14,171.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,142.82
|
| Rate for Payer: Cash Price |
$20,604.38
|
| Rate for Payer: Cigna Commercial |
$34,203.26
|
| Rate for Payer: First Health Commercial |
$39,148.31
|
| Rate for Payer: Humana Commercial |
$35,027.44
|
| Rate for Payer: Humana KY Medicaid |
$14,171.69
|
| Rate for Payer: Kentucky WC Medicaid |
$14,315.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,791.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,412.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,362.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,456.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,263.70
|
| Rate for Payer: Ohio Health Group HMO |
$30,906.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,241.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,357.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,774.71
|
| Rate for Payer: PHCS Commercial |
$39,560.40
|
| Rate for Payer: United Healthcare All Payer |
$36,263.70
|
|
|
GFT EXCLDR TRK 31*14.5*15 18FR
|
Facility
|
OP
|
$72,145.60
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,378.93 |
| Max. Negotiated Rate |
$69,259.78 |
| Rate for Payer: Aetna Commercial |
$55,552.11
|
| Rate for Payer: Anthem Medicaid |
$24,810.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,273.57
|
| Rate for Payer: Cash Price |
$36,072.80
|
| Rate for Payer: Cigna Commercial |
$59,880.85
|
| Rate for Payer: First Health Commercial |
$68,538.32
|
| Rate for Payer: Humana Commercial |
$61,323.76
|
| Rate for Payer: Humana KY Medicaid |
$24,810.87
|
| Rate for Payer: Kentucky WC Medicaid |
$25,063.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,159.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,243.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,643.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,308.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,488.13
|
| Rate for Payer: Ohio Health Group HMO |
$54,109.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,429.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,378.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,365.14
|
| Rate for Payer: PHCS Commercial |
$69,259.78
|
| Rate for Payer: United Healthcare All Payer |
$63,488.13
|
|
|
GFT EXCLDR TRK 31*14.5*15 18FR
|
Facility
|
IP
|
$72,145.60
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,378.93 |
| Max. Negotiated Rate |
$69,259.78 |
| Rate for Payer: Aetna Commercial |
$55,552.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,273.57
|
| Rate for Payer: Cash Price |
$36,072.80
|
| Rate for Payer: Cigna Commercial |
$59,880.85
|
| Rate for Payer: First Health Commercial |
$68,538.32
|
| Rate for Payer: Humana Commercial |
$61,323.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,159.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,243.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,643.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,488.13
|
| Rate for Payer: Ohio Health Group HMO |
$54,109.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,429.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,378.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,365.14
|
| Rate for Payer: PHCS Commercial |
$69,259.78
|
| Rate for Payer: United Healthcare All Payer |
$63,488.13
|
|
|
GFT HEMASHIELD STRAIGHT 16*30
|
Facility
|
IP
|
$3,451.81
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.74 |
| Max. Negotiated Rate |
$3,313.74 |
| Rate for Payer: Aetna Commercial |
$2,657.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,692.41
|
| Rate for Payer: Cash Price |
$1,725.90
|
| Rate for Payer: Cigna Commercial |
$2,865.00
|
| Rate for Payer: First Health Commercial |
$3,279.22
|
| Rate for Payer: Humana Commercial |
$2,934.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,830.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,547.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,035.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,037.59
|
| Rate for Payer: Ohio Health Group HMO |
$2,588.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,070.06
|
| Rate for Payer: PHCS Commercial |
$3,313.74
|
| Rate for Payer: United Healthcare All Payer |
$3,037.59
|
|
