|
GFT PROX TALENT 46MM*46MM*112M
|
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 46MM*46MM*112M
|
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 Z DISTAL ZTEG-2D-28-127-US
|
Facility
|
OP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem Medicaid |
$9,433.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Humana KY Medicaid |
$9,433.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,529.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,622.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-28-127-US
|
Facility
|
IP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-28-147-US
|
Facility
|
IP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-28-147-US
|
Facility
|
OP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem Medicaid |
$9,433.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Humana KY Medicaid |
$9,433.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,529.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,622.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-28-207-US
|
Facility
|
OP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem Medicaid |
$9,433.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Humana KY Medicaid |
$9,433.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,529.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,622.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-28-207-US
|
Facility
|
IP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-30-127-US
|
Facility
|
IP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-30-127-US
|
Facility
|
OP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem Medicaid |
$9,433.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Humana KY Medicaid |
$9,433.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,529.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,622.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-30-147-US
|
Facility
|
OP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem Medicaid |
$9,433.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Humana KY Medicaid |
$9,433.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,529.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,622.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-30-147-US
|
Facility
|
IP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-30-207-US
|
Facility
|
OP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem Medicaid |
$9,433.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Humana KY Medicaid |
$9,433.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,529.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,622.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-30-207-US
|
Facility
|
IP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-32-127-US
|
Facility
|
OP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem Medicaid |
$9,433.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Humana KY Medicaid |
$9,433.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,529.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,622.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-32-127-US
|
Facility
|
IP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-32-147-US
|
Facility
|
IP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-32-147-US
|
Facility
|
OP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem Medicaid |
$9,433.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Humana KY Medicaid |
$9,433.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,529.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,622.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-32-207-US
|
Facility
|
IP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-32-207-US
|
Facility
|
OP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem Medicaid |
$9,433.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Humana KY Medicaid |
$9,433.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,529.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,622.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-34-136-US
|
Facility
|
IP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-34-136-US
|
Facility
|
OP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem Medicaid |
$9,433.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Humana KY Medicaid |
$9,433.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,529.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,622.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-34-186-US
|
Facility
|
IP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-34-186-US
|
Facility
|
OP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem Medicaid |
$9,433.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Humana KY Medicaid |
$9,433.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,529.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,622.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
|
GFT Z DISTAL ZTEG-2D-36-136-US
|
Facility
|
OP
|
$27,430.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.90 |
| Max. Negotiated Rate |
$26,332.80 |
| Rate for Payer: Aetna Commercial |
$21,121.10
|
| Rate for Payer: Anthem Medicaid |
$9,433.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,395.40
|
| Rate for Payer: Cash Price |
$13,715.00
|
| Rate for Payer: Cigna Commercial |
$22,766.90
|
| Rate for Payer: First Health Commercial |
$26,058.50
|
| Rate for Payer: Humana Commercial |
$23,315.50
|
| Rate for Payer: Humana KY Medicaid |
$9,433.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,529.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,492.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,243.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,229.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,622.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,138.40
|
| Rate for Payer: Ohio Health Group HMO |
$20,572.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,503.30
|
| Rate for Payer: PHCS Commercial |
$26,332.80
|
| Rate for Payer: United Healthcare All Payer |
$24,138.40
|
|
