|
GFT Z ILIAC LEG TFLE-22-39-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-22-39-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-22-56-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-22-56-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-22-73-ZT
|
Facility
|
OP
|
$15,306.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,989.78 |
| Max. Negotiated Rate |
$14,693.76 |
| Rate for Payer: Aetna Commercial |
$11,785.62
|
| Rate for Payer: Anthem Medicaid |
$5,263.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,938.68
|
| Rate for Payer: Cash Price |
$7,653.00
|
| Rate for Payer: Cigna Commercial |
$12,703.98
|
| Rate for Payer: First Health Commercial |
$14,540.70
|
| Rate for Payer: Humana Commercial |
$13,010.10
|
| Rate for Payer: Humana KY Medicaid |
$5,263.73
|
| Rate for Payer: Kentucky WC Medicaid |
$5,317.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,550.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,295.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,591.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,369.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,469.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,479.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,989.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,744.86
|
| Rate for Payer: PHCS Commercial |
$14,693.76
|
| Rate for Payer: United Healthcare All Payer |
$13,469.28
|
|
|
GFT Z ILIAC LEG TFLE-22-73-ZT
|
Facility
|
IP
|
$15,306.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,989.78 |
| Max. Negotiated Rate |
$14,693.76 |
| Rate for Payer: Aetna Commercial |
$11,785.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,938.68
|
| Rate for Payer: Cash Price |
$7,653.00
|
| Rate for Payer: Cigna Commercial |
$12,703.98
|
| Rate for Payer: First Health Commercial |
$14,540.70
|
| Rate for Payer: Humana Commercial |
$13,010.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,550.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,295.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,591.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,469.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,479.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,989.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,744.86
|
| Rate for Payer: PHCS Commercial |
$14,693.76
|
| Rate for Payer: United Healthcare All Payer |
$13,469.28
|
|
|
GFT Z ILIAC LEG TFLE-22-90-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-22-90-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-24-39-ZT
|
Facility
|
IP
|
$15,306.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,989.78 |
| Max. Negotiated Rate |
$14,693.76 |
| Rate for Payer: Aetna Commercial |
$11,785.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,938.68
|
| Rate for Payer: Cash Price |
$7,653.00
|
| Rate for Payer: Cigna Commercial |
$12,703.98
|
| Rate for Payer: First Health Commercial |
$14,540.70
|
| Rate for Payer: Humana Commercial |
$13,010.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,550.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,295.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,591.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,469.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,479.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,989.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,744.86
|
| Rate for Payer: PHCS Commercial |
$14,693.76
|
| Rate for Payer: United Healthcare All Payer |
$13,469.28
|
|
|
GFT Z ILIAC LEG TFLE-24-39-ZT
|
Facility
|
OP
|
$15,306.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,989.78 |
| Max. Negotiated Rate |
$14,693.76 |
| Rate for Payer: Aetna Commercial |
$11,785.62
|
| Rate for Payer: Anthem Medicaid |
$5,263.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,938.68
|
| Rate for Payer: Cash Price |
$7,653.00
|
| Rate for Payer: Cigna Commercial |
$12,703.98
|
| Rate for Payer: First Health Commercial |
$14,540.70
|
| Rate for Payer: Humana Commercial |
$13,010.10
|
| Rate for Payer: Humana KY Medicaid |
$5,263.73
|
| Rate for Payer: Kentucky WC Medicaid |
$5,317.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,550.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,295.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,591.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,369.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,469.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,479.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,989.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,744.86
|
| Rate for Payer: PHCS Commercial |
$14,693.76
|
| Rate for Payer: United Healthcare All Payer |
$13,469.28
|
|
|
GFT Z ILIAC LEG TFLE-24-56-ZT
|
Facility
|
IP
|
$15,306.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,989.78 |
| Max. Negotiated Rate |
$14,693.76 |
| Rate for Payer: Aetna Commercial |
$11,785.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,938.68
|
| Rate for Payer: Cash Price |
$7,653.00
|
| Rate for Payer: Cigna Commercial |
$12,703.98
|
| Rate for Payer: First Health Commercial |
$14,540.70
|
| Rate for Payer: Humana Commercial |
$13,010.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,550.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,295.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,591.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,469.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,479.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,989.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,744.86
|
| Rate for Payer: PHCS Commercial |
$14,693.76
|
| Rate for Payer: United Healthcare All Payer |
$13,469.28
|
|
|
GFT Z ILIAC LEG TFLE-24-56-ZT
|
Facility
|
OP
|
$15,306.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,989.78 |
| Max. Negotiated Rate |
$14,693.76 |
| Rate for Payer: Aetna Commercial |
$11,785.62
|
| Rate for Payer: Anthem Medicaid |
$5,263.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,938.68
|
| Rate for Payer: Cash Price |
$7,653.00
|
| Rate for Payer: Cigna Commercial |
$12,703.98
|
| Rate for Payer: First Health Commercial |
$14,540.70
|
| Rate for Payer: Humana Commercial |
$13,010.10
|
| Rate for Payer: Humana KY Medicaid |
$5,263.73
|
| Rate for Payer: Kentucky WC Medicaid |
$5,317.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,550.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,295.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,591.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,369.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,469.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,479.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,989.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,744.86
|
| Rate for Payer: PHCS Commercial |
$14,693.76
|
| Rate for Payer: United Healthcare All Payer |
$13,469.28
|
|
|
GFT Z ILIAC LEG TFLE-24-73-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-24-73-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-24-90-ZT
|
Facility
|
IP
|
$15,306.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,989.78 |
| Max. Negotiated Rate |
$14,693.76 |
| Rate for Payer: Aetna Commercial |
$11,785.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,938.68
|
| Rate for Payer: Cash Price |
$7,653.00
|
| Rate for Payer: Cigna Commercial |
$12,703.98
|
| Rate for Payer: First Health Commercial |
$14,540.70
|
| Rate for Payer: Humana Commercial |
$13,010.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,550.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,295.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,591.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,469.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,479.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,989.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,744.86
|
| Rate for Payer: PHCS Commercial |
$14,693.76
|
| Rate for Payer: United Healthcare All Payer |
$13,469.28
|
|
|
GFT Z ILIAC LEG TFLE-24-90-ZT
|
Facility
|
OP
|
$15,306.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,989.78 |
| Max. Negotiated Rate |
$14,693.76 |
| Rate for Payer: Aetna Commercial |
$11,785.62
|
| Rate for Payer: Anthem Medicaid |
$5,263.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,938.68
|
| Rate for Payer: Cash Price |
$7,653.00
|
| Rate for Payer: Cigna Commercial |
$12,703.98
|
| Rate for Payer: First Health Commercial |
$14,540.70
|
| Rate for Payer: Humana Commercial |
$13,010.10
|
| Rate for Payer: Humana KY Medicaid |
$5,263.73
|
| Rate for Payer: Kentucky WC Medicaid |
$5,317.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,550.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,295.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,591.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,369.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,469.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,479.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,989.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,744.86
|
| Rate for Payer: PHCS Commercial |
$14,693.76
|
| Rate for Payer: United Healthcare All Payer |
$13,469.28
|
|
|
GFT Z ILIAC LEG TFLE-8-105-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-8-105-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-8-122-ZT
|
Facility
|
OP
|
$15,306.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,989.78 |
| Max. Negotiated Rate |
$14,693.76 |
| Rate for Payer: Aetna Commercial |
$11,785.62
|
| Rate for Payer: Anthem Medicaid |
$5,263.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,938.68
|
| Rate for Payer: Cash Price |
$7,653.00
|
| Rate for Payer: Cigna Commercial |
$12,703.98
|
| Rate for Payer: First Health Commercial |
$14,540.70
|
| Rate for Payer: Humana Commercial |
$13,010.10
|
| Rate for Payer: Humana KY Medicaid |
$5,263.73
|
| Rate for Payer: Kentucky WC Medicaid |
$5,317.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,550.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,295.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,591.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,369.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,469.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,479.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,989.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,744.86
|
| Rate for Payer: PHCS Commercial |
$14,693.76
|
| Rate for Payer: United Healthcare All Payer |
$13,469.28
|
|
|
GFT Z ILIAC LEG TFLE-8-122-ZT
|
Facility
|
IP
|
$15,306.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,989.78 |
| Max. Negotiated Rate |
$14,693.76 |
| Rate for Payer: Aetna Commercial |
$11,785.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,938.68
|
| Rate for Payer: Cash Price |
$7,653.00
|
| Rate for Payer: Cigna Commercial |
$12,703.98
|
| Rate for Payer: First Health Commercial |
$14,540.70
|
| Rate for Payer: Humana Commercial |
$13,010.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,550.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,295.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,591.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,469.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,479.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,989.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,744.86
|
| Rate for Payer: PHCS Commercial |
$14,693.76
|
| Rate for Payer: United Healthcare All Payer |
$13,469.28
|
|
|
GFT Z ILIAC LEG ZSLE-11-107-ZT
|
Facility
|
IP
|
$15,306.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,989.78 |
| Max. Negotiated Rate |
$14,693.76 |
| Rate for Payer: Aetna Commercial |
$11,785.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,938.68
|
| Rate for Payer: Cash Price |
$7,653.00
|
| Rate for Payer: Cigna Commercial |
$12,703.98
|
| Rate for Payer: First Health Commercial |
$14,540.70
|
| Rate for Payer: Humana Commercial |
$13,010.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,550.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,295.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,591.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,469.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,479.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,989.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,744.86
|
| Rate for Payer: PHCS Commercial |
$14,693.76
|
| Rate for Payer: United Healthcare All Payer |
$13,469.28
|
|
|
GFT Z ILIAC LEG ZSLE-11-107-ZT
|
Facility
|
OP
|
$15,306.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,989.78 |
| Max. Negotiated Rate |
$14,693.76 |
| Rate for Payer: Aetna Commercial |
$11,785.62
|
| Rate for Payer: Anthem Medicaid |
$5,263.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,938.68
|
| Rate for Payer: Cash Price |
$7,653.00
|
| Rate for Payer: Cigna Commercial |
$12,703.98
|
| Rate for Payer: First Health Commercial |
$14,540.70
|
| Rate for Payer: Humana Commercial |
$13,010.10
|
| Rate for Payer: Humana KY Medicaid |
$5,263.73
|
| Rate for Payer: Kentucky WC Medicaid |
$5,317.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,550.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,295.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,591.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,369.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,469.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,479.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,989.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,744.86
|
| Rate for Payer: PHCS Commercial |
$14,693.76
|
| Rate for Payer: United Healthcare All Payer |
$13,469.28
|
|
|
GFT Z ILIAC LEG ZSLE-11-56-ZT
|
Facility
|
IP
|
$20,491.35
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,663.88 |
| Max. Negotiated Rate |
$19,671.70 |
| Rate for Payer: Aetna Commercial |
$15,778.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,983.25
|
| Rate for Payer: Cash Price |
$10,245.67
|
| Rate for Payer: Cigna Commercial |
$17,007.82
|
| Rate for Payer: First Health Commercial |
$19,466.78
|
| Rate for Payer: Humana Commercial |
$17,417.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,802.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,122.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,147.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,032.39
|
| Rate for Payer: Ohio Health Group HMO |
$15,368.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,098.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,663.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,352.32
|
| Rate for Payer: PHCS Commercial |
$19,671.70
|
| Rate for Payer: United Healthcare All Payer |
$18,032.39
|
|
|
GFT Z ILIAC LEG ZSLE-11-56-ZT
|
Facility
|
OP
|
$20,491.35
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,663.88 |
| Max. Negotiated Rate |
$19,671.70 |
| Rate for Payer: Aetna Commercial |
$15,778.34
|
| Rate for Payer: Anthem Medicaid |
$7,046.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,983.25
|
| Rate for Payer: Cash Price |
$10,245.67
|
| Rate for Payer: Cigna Commercial |
$17,007.82
|
| Rate for Payer: First Health Commercial |
$19,466.78
|
| Rate for Payer: Humana Commercial |
$17,417.65
|
| Rate for Payer: Humana KY Medicaid |
$7,046.98
|
| Rate for Payer: Kentucky WC Medicaid |
$7,118.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,802.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,122.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,147.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,188.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,032.39
|
| Rate for Payer: Ohio Health Group HMO |
$15,368.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,098.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,663.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,352.32
|
| Rate for Payer: PHCS Commercial |
$19,671.70
|
| Rate for Payer: United Healthcare All Payer |
$18,032.39
|
|
|
GFT Z ILIAC LEG ZSLE-13-122-ZT
|
Facility
|
IP
|
$15,306.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,989.78 |
| Max. Negotiated Rate |
$14,693.76 |
| Rate for Payer: Aetna Commercial |
$11,785.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,938.68
|
| Rate for Payer: Cash Price |
$7,653.00
|
| Rate for Payer: Cigna Commercial |
$12,703.98
|
| Rate for Payer: First Health Commercial |
$14,540.70
|
| Rate for Payer: Humana Commercial |
$13,010.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,550.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,295.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,591.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,469.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,479.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,989.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,744.86
|
| Rate for Payer: PHCS Commercial |
$14,693.76
|
| Rate for Payer: United Healthcare All Payer |
$13,469.28
|
|
