|
GFT INTUITRAK BI 25-16-100BLS
|
Facility
|
OP
|
$66,562.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,653.06 |
| Max. Negotiated Rate |
$63,899.52 |
| Rate for Payer: PHCS Commercial |
$63,899.52
|
| Rate for Payer: Aetna Commercial |
$51,252.74
|
| Rate for Payer: Anthem Medicaid |
$22,890.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51,918.36
|
| Rate for Payer: Cash Price |
$33,281.00
|
| Rate for Payer: Cigna Commercial |
$55,246.46
|
| Rate for Payer: First Health Commercial |
$63,233.90
|
| Rate for Payer: Humana Commercial |
$56,577.70
|
| Rate for Payer: Humana KY Medicaid |
$22,890.67
|
| Rate for Payer: Kentucky WC Medicaid |
$23,123.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54,580.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49,122.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,968.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,349.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$58,574.56
|
| Rate for Payer: Ohio Health Group HMO |
$49,921.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,312.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,653.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,634.22
|
| Rate for Payer: United Healthcare All Payer |
$58,574.56
|
|
|
GFT INTUITRAK BI 28-16-100BLS
|
Facility
|
IP
|
$68,362.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,887.06 |
| Max. Negotiated Rate |
$65,627.52 |
| Rate for Payer: Aetna Commercial |
$52,638.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,322.36
|
| Rate for Payer: Cash Price |
$34,181.00
|
| Rate for Payer: Cigna Commercial |
$56,740.46
|
| Rate for Payer: First Health Commercial |
$64,943.90
|
| Rate for Payer: Humana Commercial |
$58,107.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,056.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,451.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,508.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,158.56
|
| Rate for Payer: Ohio Health Group HMO |
$51,271.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,672.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,887.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,192.22
|
| Rate for Payer: PHCS Commercial |
$65,627.52
|
| Rate for Payer: United Healthcare All Payer |
$60,158.56
|
|
|
GFT INTUITRAK BI 28-16-100BLS
|
Facility
|
OP
|
$68,362.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,887.06 |
| Max. Negotiated Rate |
$65,627.52 |
| Rate for Payer: Aetna Commercial |
$52,638.74
|
| Rate for Payer: Anthem Medicaid |
$23,509.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,322.36
|
| Rate for Payer: Cash Price |
$34,181.00
|
| Rate for Payer: Cigna Commercial |
$56,740.46
|
| Rate for Payer: First Health Commercial |
$64,943.90
|
| Rate for Payer: Humana Commercial |
$58,107.70
|
| Rate for Payer: Humana KY Medicaid |
$23,509.69
|
| Rate for Payer: Kentucky WC Medicaid |
$23,748.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,056.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,451.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,508.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,981.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,158.56
|
| Rate for Payer: Ohio Health Group HMO |
$51,271.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,672.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,887.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,192.22
|
| Rate for Payer: PHCS Commercial |
$65,627.52
|
| Rate for Payer: United Healthcare All Payer |
$60,158.56
|
|
|
GFT MAIN BDY BIFR 22*40*13*40
|
Facility
|
IP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GFT MAIN BDY BIFR 22*40*13*40
|
Facility
|
OP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem Medicaid |
$24,481.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Humana KY Medicaid |
$24,481.55
|
| Rate for Payer: Kentucky WC Medicaid |
$24,730.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,972.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GFT MAIN BDY BIFR 22*60*13*40
|
Facility
|
OP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem Medicaid |
$24,481.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Humana KY Medicaid |
$24,481.55
|
| Rate for Payer: Kentucky WC Medicaid |
$24,730.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,972.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GFT MAIN BDY BIFR 22*60*13*40
|
Facility
|
IP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GFT MAIN BDY BIFR 22*60*16*40
|
Facility
|
IP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GFT MAIN BDY BIFR 22*60*16*40
|
Facility
|
OP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem Medicaid |
$24,481.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Humana KY Medicaid |
$24,481.55
|
| Rate for Payer: Kentucky WC Medicaid |
$24,730.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,972.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GFT MAIN BDY BIFR 22*70*16*30
|
Facility
|
OP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem Medicaid |
$24,481.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Humana KY Medicaid |
$24,481.55
|
| Rate for Payer: Kentucky WC Medicaid |
$24,730.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,972.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GFT MAIN BDY BIFR 22*70*16*30
|
Facility
|
IP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GFT MAIN BDY BIFR 22*70*20*30
|
Facility
|
OP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem Medicaid |
$24,481.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Humana KY Medicaid |
$24,481.55
|
| Rate for Payer: Kentucky WC Medicaid |
$24,730.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,972.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GFT MAIN BDY BIFR 22*70*20*30
|
Facility
|
IP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GFT MAIN BDY BIFR 22*80*16*40
|
Facility
|
IP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GFT MAIN BDY BIFR 22*80*16*40
|
Facility
|
OP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem Medicaid |
$24,481.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Humana KY Medicaid |
$24,481.55
|
| Rate for Payer: Kentucky WC Medicaid |
$24,730.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,972.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GFT MAIN BDY BIFR 22*80*20*40
|
Facility
|
IP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GFT MAIN BDY BIFR 22*80*20*40
|
Facility
|
OP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem Medicaid |
$24,481.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Humana KY Medicaid |
$24,481.55
|
| Rate for Payer: Kentucky WC Medicaid |
$24,730.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,972.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GFT MAIN BDY BIFR 22*90*16*30
|
Facility
|
OP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem Medicaid |
$24,481.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Humana KY Medicaid |
$24,481.55
|
| Rate for Payer: Kentucky WC Medicaid |
$24,730.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,972.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GFT MAIN BDY BIFR 22*90*16*30
|
Facility
|
IP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GFT MAIN BDY BIFR 22*90*20*30
|
Facility
|
OP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem Medicaid |
$24,481.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Humana KY Medicaid |
$24,481.55
|
| Rate for Payer: Kentucky WC Medicaid |
$24,730.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,972.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GFT MAIN BDY BIFR 22*90*20*30
|
Facility
|
IP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GFT MAIN BDY BIFR 25*100*16*40
|
Facility
|
OP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem Medicaid |
$24,481.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Humana KY Medicaid |
$24,481.55
|
| Rate for Payer: Kentucky WC Medicaid |
$24,730.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,972.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GFT MAIN BDY BIFR 25*100*16*40
|
Facility
|
IP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GFT MAIN BDY BIFR 25*100*20*40
|
Facility
|
OP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem Medicaid |
$24,481.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Humana KY Medicaid |
$24,481.55
|
| Rate for Payer: Kentucky WC Medicaid |
$24,730.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,972.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
|
GFT MAIN BDY BIFR 25*100*20*40
|
Facility
|
IP
|
$71,188.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,254.44 |
| Max. Negotiated Rate |
$68,340.48 |
| Rate for Payer: Aetna Commercial |
$54,814.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,526.64
|
| Rate for Payer: Cash Price |
$35,594.00
|
| Rate for Payer: Cigna Commercial |
$59,086.04
|
| Rate for Payer: First Health Commercial |
$67,628.60
|
| Rate for Payer: Humana Commercial |
$60,509.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,374.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,536.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,356.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,645.44
|
| Rate for Payer: Ohio Health Group HMO |
$53,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,254.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,068.28
|
| Rate for Payer: PHCS Commercial |
$68,340.48
|
| Rate for Payer: United Healthcare All Payer |
$62,645.44
|
|
