|
GFT MAIN BDY BIFR 28*100*16*40
|
Facility
|
IP
|
$70,162.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,121.06 |
| Max. Negotiated Rate |
$67,355.52 |
| Rate for Payer: Aetna Commercial |
$54,024.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,726.36
|
| Rate for Payer: Cash Price |
$35,081.00
|
| Rate for Payer: Cigna Commercial |
$58,234.46
|
| Rate for Payer: First Health Commercial |
$66,653.90
|
| Rate for Payer: Humana Commercial |
$59,637.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,532.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,779.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,048.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,742.56
|
| Rate for Payer: Ohio Health Group HMO |
$52,621.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,032.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,121.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,750.22
|
| Rate for Payer: PHCS Commercial |
$67,355.52
|
| Rate for Payer: United Healthcare All Payer |
$61,742.56
|
|
|
GFT MAIN BDY BIFR 28*100*16*55
|
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 28*100*16*55
|
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 28*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
|
|
|
GFT MAIN BDY BIFR 28*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 28*110*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 28*110*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 28*110*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 28*110*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 28*120*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 28*120*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 28*120*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 28*120*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 28*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 28*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 28*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 28*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 28*80*I16*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: Humana Commercial |
$60,509.80
|
| 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 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 28*80*I16*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 28*90/116*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 28*90/116*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 28*90*120*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 28*90*120*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 BIFUR 28*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 BIFUR 28*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
|
|
