|
GFT PROX EXT TALENT 46*46*52MM
|
Facility
|
OP
|
$24,875.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,233.75 |
| Max. Negotiated Rate |
$23,880.00 |
| Rate for Payer: Aetna Commercial |
$19,153.75
|
| Rate for Payer: Anthem Medicaid |
$8,554.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,402.50
|
| Rate for Payer: Cash Price |
$12,437.50
|
| Rate for Payer: Cigna Commercial |
$20,646.25
|
| Rate for Payer: First Health Commercial |
$23,631.25
|
| Rate for Payer: Humana Commercial |
$21,143.75
|
| Rate for Payer: Humana KY Medicaid |
$8,554.51
|
| Rate for Payer: Kentucky WC Medicaid |
$8,641.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,397.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,357.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,462.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,726.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,890.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,975.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,233.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,711.25
|
| Rate for Payer: PHCS Commercial |
$23,880.00
|
| Rate for Payer: United Healthcare All Payer |
$21,890.00
|
|
|
GFT PROX TALENT 22MM*22MM*116M
|
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 PROX TALENT 22MM*22MM*116M
|
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 PROX TALENT 24MM*24MM*116M
|
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 PROX TALENT 24MM*24MM*116M
|
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 PROX TALENT 26MM*26MM*116M
|
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 PROX TALENT 26MM*26MM*116M
|
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 PROX TALENT 28MM*28MM*116M
|
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 PROX TALENT 28MM*28MM*116M
|
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 PROX TALENT 30MM*30MM*115M
|
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 PROX TALENT 30MM*30MM*115M
|
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 PROX TALENT 32MM*32MM*115M
|
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 PROX TALENT 32MM*32MM*115M
|
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 PROX TALENT 34MM*34MM*115M
|
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 PROX TALENT 34MM*34MM*115M
|
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 PROX TALENT 36MM*36MM*114M
|
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 PROX TALENT 36MM*36MM*114M
|
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 PROX TALENT 38MM*38MM*114M
|
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 PROX TALENT 38MM*38MM*114M
|
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 PROX TALENT 40MM*40MM*114M
|
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 PROX TALENT 40MM*40MM*114M
|
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 PROX TALENT 42MM*42MM*113M
|
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 PROX TALENT 42MM*42MM*113M
|
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 PROX TALENT 44MM*44MM*113M
|
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 PROX TALENT 44MM*44MM*113M
|
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
|
|
