|
GFT Z DISTAL ZTEG-2D-36-136-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-36-186-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-36-186-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-38-136-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-38-136-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-38-186-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-38-186-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-40-144-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-40-144-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-40-198-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-40-198-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-42-144-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-42-144-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-42-198-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-42-198-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 ILIAC LEG TFLE-10-105-ZT
|
Facility
|
OP
|
$14,235.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.60 |
| Max. Negotiated Rate |
$13,665.98 |
| Rate for Payer: Aetna Commercial |
$10,961.26
|
| Rate for Payer: Anthem Medicaid |
$4,895.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.61
|
| Rate for Payer: Cash Price |
$7,117.70
|
| Rate for Payer: Cigna Commercial |
$11,815.38
|
| Rate for Payer: First Health Commercial |
$13,523.63
|
| Rate for Payer: Humana Commercial |
$12,100.09
|
| Rate for Payer: Humana KY Medicaid |
$4,895.55
|
| Rate for Payer: Kentucky WC Medicaid |
$4,945.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,673.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,993.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,527.15
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,847.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,412.97
|
| Rate for Payer: PHCS Commercial |
$13,665.98
|
| Rate for Payer: United Healthcare All Payer |
$12,527.15
|
|
|
GFT Z ILIAC LEG TFLE-10-105-ZT
|
Facility
|
IP
|
$14,235.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.60 |
| Max. Negotiated Rate |
$13,665.98 |
| Rate for Payer: Aetna Commercial |
$10,961.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.61
|
| Rate for Payer: Cash Price |
$7,117.70
|
| Rate for Payer: Cigna Commercial |
$11,815.38
|
| Rate for Payer: First Health Commercial |
$13,523.63
|
| Rate for Payer: Humana Commercial |
$12,100.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,673.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,527.15
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,847.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,412.97
|
| Rate for Payer: PHCS Commercial |
$13,665.98
|
| Rate for Payer: United Healthcare All Payer |
$12,527.15
|
|
|
GFT Z ILIAC LEG TFLE-10-122-ZT
|
Facility
|
OP
|
$14,235.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.60 |
| Max. Negotiated Rate |
$13,665.98 |
| Rate for Payer: Aetna Commercial |
$10,961.26
|
| Rate for Payer: Anthem Medicaid |
$4,895.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.61
|
| Rate for Payer: Cash Price |
$7,117.70
|
| Rate for Payer: Cigna Commercial |
$11,815.38
|
| Rate for Payer: First Health Commercial |
$13,523.63
|
| Rate for Payer: Humana Commercial |
$12,100.09
|
| Rate for Payer: Humana KY Medicaid |
$4,895.55
|
| Rate for Payer: Kentucky WC Medicaid |
$4,945.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,673.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,993.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,527.15
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,847.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,412.97
|
| Rate for Payer: PHCS Commercial |
$13,665.98
|
| Rate for Payer: United Healthcare All Payer |
$12,527.15
|
|
|
GFT Z ILIAC LEG TFLE-10-122-ZT
|
Facility
|
IP
|
$14,235.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.60 |
| Max. Negotiated Rate |
$13,665.98 |
| Rate for Payer: Aetna Commercial |
$10,961.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.61
|
| Rate for Payer: Cash Price |
$7,117.70
|
| Rate for Payer: Cigna Commercial |
$11,815.38
|
| Rate for Payer: First Health Commercial |
$13,523.63
|
| Rate for Payer: Humana Commercial |
$12,100.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,673.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,527.15
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,847.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,412.97
|
| Rate for Payer: PHCS Commercial |
$13,665.98
|
| Rate for Payer: United Healthcare All Payer |
$12,527.15
|
|
|
GFT Z ILIAC LEG TFLE-10-37-ZT
|
Facility
|
OP
|
$14,235.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.60 |
| Max. Negotiated Rate |
$13,665.98 |
| Rate for Payer: Aetna Commercial |
$10,961.26
|
| Rate for Payer: Anthem Medicaid |
$4,895.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.61
|
| Rate for Payer: Cash Price |
$7,117.70
|
| Rate for Payer: Cigna Commercial |
$11,815.38
|
| Rate for Payer: First Health Commercial |
$13,523.63
|
| Rate for Payer: Humana Commercial |
$12,100.09
|
| Rate for Payer: Humana KY Medicaid |
$4,895.55
|
| Rate for Payer: Kentucky WC Medicaid |
$4,945.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,673.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,993.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,527.15
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,847.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,412.97
|
| Rate for Payer: PHCS Commercial |
$13,665.98
|
| Rate for Payer: United Healthcare All Payer |
$12,527.15
|
|
|
GFT Z ILIAC LEG TFLE-10-37-ZT
|
Facility
|
IP
|
$14,235.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.60 |
| Max. Negotiated Rate |
$13,665.98 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,673.03
|
| Rate for Payer: Aetna Commercial |
$10,961.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.61
|
| Rate for Payer: Cash Price |
$7,117.70
|
| Rate for Payer: Cigna Commercial |
$11,815.38
|
| Rate for Payer: First Health Commercial |
$13,523.63
|
| Rate for Payer: Humana Commercial |
$12,100.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,527.15
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,847.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,412.97
|
| Rate for Payer: PHCS Commercial |
$13,665.98
|
| Rate for Payer: United Healthcare All Payer |
$12,527.15
|
|
|
GFT Z ILIAC LEG TFLE-10-54-ZT
|
Facility
|
IP
|
$14,235.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.60 |
| Max. Negotiated Rate |
$13,665.98 |
| Rate for Payer: Aetna Commercial |
$10,961.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.61
|
| Rate for Payer: Cash Price |
$7,117.70
|
| Rate for Payer: Cigna Commercial |
$11,815.38
|
| Rate for Payer: First Health Commercial |
$13,523.63
|
| Rate for Payer: Humana Commercial |
$12,100.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,673.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,527.15
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,847.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,412.97
|
| Rate for Payer: PHCS Commercial |
$13,665.98
|
| Rate for Payer: United Healthcare All Payer |
$12,527.15
|
|
|
GFT Z ILIAC LEG TFLE-10-54-ZT
|
Facility
|
OP
|
$14,235.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.60 |
| Max. Negotiated Rate |
$13,665.98 |
| Rate for Payer: Aetna Commercial |
$10,961.26
|
| Rate for Payer: Anthem Medicaid |
$4,895.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.61
|
| Rate for Payer: Cash Price |
$7,117.70
|
| Rate for Payer: Cigna Commercial |
$11,815.38
|
| Rate for Payer: First Health Commercial |
$13,523.63
|
| Rate for Payer: Humana Commercial |
$12,100.09
|
| Rate for Payer: Humana KY Medicaid |
$4,895.55
|
| Rate for Payer: Kentucky WC Medicaid |
$4,945.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,673.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,993.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,527.15
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,847.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,412.97
|
| Rate for Payer: PHCS Commercial |
$13,665.98
|
| Rate for Payer: United Healthcare All Payer |
$12,527.15
|
|
|
GFT Z ILIAC LEG TFLE-10-71-ZT
|
Facility
|
OP
|
$14,235.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.60 |
| Max. Negotiated Rate |
$13,665.98 |
| Rate for Payer: Aetna Commercial |
$10,961.26
|
| Rate for Payer: Anthem Medicaid |
$4,895.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.61
|
| Rate for Payer: Cash Price |
$7,117.70
|
| Rate for Payer: Cigna Commercial |
$11,815.38
|
| Rate for Payer: First Health Commercial |
$13,523.63
|
| Rate for Payer: Humana Commercial |
$12,100.09
|
| Rate for Payer: Humana KY Medicaid |
$4,895.55
|
| Rate for Payer: Kentucky WC Medicaid |
$4,945.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,673.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,993.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,527.15
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,847.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,412.97
|
| Rate for Payer: PHCS Commercial |
$13,665.98
|
| Rate for Payer: United Healthcare All Payer |
$12,527.15
|
|
|
GFT Z ILIAC LEG TFLE-10-71-ZT
|
Facility
|
IP
|
$14,235.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.60 |
| Max. Negotiated Rate |
$13,665.98 |
| Rate for Payer: Aetna Commercial |
$10,961.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.61
|
| Rate for Payer: Cash Price |
$7,117.70
|
| Rate for Payer: Cigna Commercial |
$11,815.38
|
| Rate for Payer: First Health Commercial |
$13,523.63
|
| Rate for Payer: Humana Commercial |
$12,100.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,673.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,527.15
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,847.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,412.97
|
| Rate for Payer: PHCS Commercial |
$13,665.98
|
| Rate for Payer: United Healthcare All Payer |
$12,527.15
|
|
