|
GFT Z ILIAC LEG ZSLE-13-122-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 ZSLE-24-90-ZT
|
Facility
|
IP
|
$18,579.62
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.35 |
| Max. Negotiated Rate |
$17,836.44 |
| Rate for Payer: Aetna Commercial |
$14,306.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,492.10
|
| Rate for Payer: Cash Price |
$9,289.81
|
| Rate for Payer: Cigna Commercial |
$15,421.08
|
| Rate for Payer: First Health Commercial |
$17,650.64
|
| Rate for Payer: Humana Commercial |
$15,792.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,235.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,711.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,573.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,350.07
|
| Rate for Payer: Ohio Health Group HMO |
$13,934.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,715.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,759.68
|
| Rate for Payer: PHCS Commercial |
$17,836.44
|
| Rate for Payer: United Healthcare All Payer |
$16,350.07
|
|
|
GFT Z ILIAC LEG ZSLE-24-90-ZT
|
Facility
|
OP
|
$18,579.62
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.35 |
| Max. Negotiated Rate |
$17,836.44 |
| Rate for Payer: Aetna Commercial |
$14,306.31
|
| Rate for Payer: Anthem Medicaid |
$6,389.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,492.10
|
| Rate for Payer: Cash Price |
$9,289.81
|
| Rate for Payer: Cigna Commercial |
$15,421.08
|
| Rate for Payer: First Health Commercial |
$17,650.64
|
| Rate for Payer: Humana Commercial |
$15,792.68
|
| Rate for Payer: Humana KY Medicaid |
$6,389.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6,454.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,235.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,711.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,573.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,517.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,350.07
|
| Rate for Payer: Ohio Health Group HMO |
$13,934.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,715.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,759.68
|
| Rate for Payer: PHCS Commercial |
$17,836.44
|
| Rate for Payer: United Healthcare All Payer |
$16,350.07
|
|
|
GFT Z MAIN BDY EXT ESBE2639ZT
|
Facility
|
OP
|
$10,603.65
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.47 |
| Max. Negotiated Rate |
$10,179.50 |
| Rate for Payer: Aetna Commercial |
$8,164.81
|
| Rate for Payer: Anthem Medicaid |
$3,646.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,270.85
|
| Rate for Payer: Cash Price |
$5,301.82
|
| Rate for Payer: Cigna Commercial |
$8,801.03
|
| Rate for Payer: First Health Commercial |
$10,073.47
|
| Rate for Payer: Humana Commercial |
$9,013.10
|
| Rate for Payer: Humana KY Medicaid |
$3,646.60
|
| Rate for Payer: Kentucky WC Medicaid |
$3,683.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,694.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,825.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,181.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,719.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,331.21
|
| Rate for Payer: Ohio Health Group HMO |
$7,952.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,287.13
|
| Rate for Payer: PHCS Commercial |
$10,179.50
|
| Rate for Payer: United Healthcare All Payer |
$9,331.21
|
|
|
GFT Z MAIN BDY EXT ESBE2639ZT
|
Facility
|
IP
|
$10,603.65
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.47 |
| Max. Negotiated Rate |
$10,179.50 |
| Rate for Payer: Aetna Commercial |
$8,164.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,270.85
|
| Rate for Payer: Cash Price |
$5,301.82
|
| Rate for Payer: Cigna Commercial |
$8,801.03
|
| Rate for Payer: First Health Commercial |
$10,073.47
|
| Rate for Payer: Humana Commercial |
$9,013.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,694.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,825.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,181.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,331.21
|
| Rate for Payer: Ohio Health Group HMO |
$7,952.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,287.13
|
| Rate for Payer: PHCS Commercial |
$10,179.50
|
| Rate for Payer: United Healthcare All Payer |
$9,331.21
|
|
|
GFT Z MAIN BDY EXT ESBE3039ZT
|
Facility
|
OP
|
$10,603.65
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.47 |
| Max. Negotiated Rate |
$10,179.50 |
| Rate for Payer: Aetna Commercial |
$8,164.81
|
| Rate for Payer: Anthem Medicaid |
$3,646.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,270.85
|
| Rate for Payer: Cash Price |
$5,301.82
|
| Rate for Payer: Cigna Commercial |
$8,801.03
|
| Rate for Payer: First Health Commercial |
$10,073.47
|
| Rate for Payer: Humana Commercial |
$9,013.10
|
| Rate for Payer: Humana KY Medicaid |
$3,646.60
|
| Rate for Payer: Kentucky WC Medicaid |
$3,683.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,694.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,825.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,181.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,719.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,331.21
|
| Rate for Payer: Ohio Health Group HMO |
$7,952.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,287.13
|
| Rate for Payer: PHCS Commercial |
$10,179.50
|
| Rate for Payer: United Healthcare All Payer |
$9,331.21
|
|
|
GFT Z MAIN BDY EXT ESBE3039ZT
|
Facility
|
IP
|
$10,603.65
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.47 |
| Max. Negotiated Rate |
$10,179.50 |
| Rate for Payer: Aetna Commercial |
$8,164.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,270.85
|
| Rate for Payer: Cash Price |
$5,301.82
|
| Rate for Payer: Cigna Commercial |
$8,801.03
|
| Rate for Payer: First Health Commercial |
$10,073.47
|
| Rate for Payer: Humana Commercial |
$9,013.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,694.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,825.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,181.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,331.21
|
| Rate for Payer: Ohio Health Group HMO |
$7,952.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,287.13
|
| Rate for Payer: PHCS Commercial |
$10,179.50
|
| Rate for Payer: United Healthcare All Payer |
$9,331.21
|
|
|
GFT Z MAIN BDY EXT ESBE3650ZT
|
Facility
|
OP
|
$12,373.90
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.61 |
| Max. Negotiated Rate |
$11,878.94 |
| Rate for Payer: Aetna Commercial |
$9,527.90
|
| Rate for Payer: Anthem Medicaid |
$4,255.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,651.64
|
| Rate for Payer: Cash Price |
$6,186.95
|
| Rate for Payer: Cigna Commercial |
$10,270.34
|
| Rate for Payer: First Health Commercial |
$11,755.20
|
| Rate for Payer: Humana Commercial |
$10,517.82
|
| Rate for Payer: Humana KY Medicaid |
$4,255.38
|
| Rate for Payer: Kentucky WC Medicaid |
$4,298.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,146.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,131.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,712.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,340.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,889.03
|
| Rate for Payer: Ohio Health Group HMO |
$9,280.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,835.91
|
| Rate for Payer: PHCS Commercial |
$11,878.94
|
| Rate for Payer: United Healthcare All Payer |
$10,889.03
|
|
|
GFT Z MAIN BDY EXT ESBE3650ZT
|
Facility
|
IP
|
$12,373.90
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.61 |
| Max. Negotiated Rate |
$11,878.94 |
| Rate for Payer: Aetna Commercial |
$9,527.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,651.64
|
| Rate for Payer: Cash Price |
$6,186.95
|
| Rate for Payer: Cigna Commercial |
$10,270.34
|
| Rate for Payer: First Health Commercial |
$11,755.20
|
| Rate for Payer: Humana Commercial |
$10,517.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,146.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,131.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,712.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,889.03
|
| Rate for Payer: Ohio Health Group HMO |
$9,280.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,835.91
|
| Rate for Payer: PHCS Commercial |
$11,878.94
|
| Rate for Payer: United Healthcare All Payer |
$10,889.03
|
|
|
GFT Z MAIN BODY EXT ESBE-22-39
|
Facility
|
IP
|
$9,687.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.38 |
| Max. Negotiated Rate |
$9,300.05 |
| Rate for Payer: Aetna Commercial |
$7,459.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,556.29
|
| Rate for Payer: Cash Price |
$4,843.77
|
| Rate for Payer: Cigna Commercial |
$8,040.67
|
| Rate for Payer: First Health Commercial |
$9,203.17
|
| Rate for Payer: Humana Commercial |
$8,234.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,149.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,525.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,003.14
|
| Rate for Payer: PHCS Commercial |
$9,300.05
|
| Rate for Payer: United Healthcare All Payer |
$8,525.04
|
|
|
GFT Z MAIN BODY EXT ESBE-22-39
|
Facility
|
OP
|
$9,687.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.38 |
| Max. Negotiated Rate |
$9,300.05 |
| Rate for Payer: Aetna Commercial |
$7,459.41
|
| Rate for Payer: Anthem Medicaid |
$3,331.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,556.29
|
| Rate for Payer: Cash Price |
$4,843.77
|
| Rate for Payer: Cigna Commercial |
$8,040.67
|
| Rate for Payer: First Health Commercial |
$9,203.17
|
| Rate for Payer: Humana Commercial |
$8,234.42
|
| Rate for Payer: Humana KY Medicaid |
$3,331.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,365.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,149.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,398.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,525.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,003.14
|
| Rate for Payer: PHCS Commercial |
$9,300.05
|
| Rate for Payer: United Healthcare All Payer |
$8,525.04
|
|
|
GFT Z MAIN BODY EXT ESBE-22-58
|
Facility
|
OP
|
$9,687.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.38 |
| Max. Negotiated Rate |
$9,300.05 |
| Rate for Payer: Aetna Commercial |
$7,459.41
|
| Rate for Payer: Anthem Medicaid |
$3,331.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,556.29
|
| Rate for Payer: Cash Price |
$4,843.77
|
| Rate for Payer: Cigna Commercial |
$8,040.67
|
| Rate for Payer: First Health Commercial |
$9,203.17
|
| Rate for Payer: Humana Commercial |
$8,234.42
|
| Rate for Payer: Humana KY Medicaid |
$3,331.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,365.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,149.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,398.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,525.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,003.14
|
| Rate for Payer: PHCS Commercial |
$9,300.05
|
| Rate for Payer: United Healthcare All Payer |
$8,525.04
|
|
|
GFT Z MAIN BODY EXT ESBE-22-58
|
Facility
|
IP
|
$9,687.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.38 |
| Max. Negotiated Rate |
$9,300.05 |
| Rate for Payer: Aetna Commercial |
$7,459.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,556.29
|
| Rate for Payer: Cash Price |
$4,843.77
|
| Rate for Payer: Cigna Commercial |
$8,040.67
|
| Rate for Payer: First Health Commercial |
$9,203.17
|
| Rate for Payer: Humana Commercial |
$8,234.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,149.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,525.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,003.14
|
| Rate for Payer: PHCS Commercial |
$9,300.05
|
| Rate for Payer: United Healthcare All Payer |
$8,525.04
|
|
|
GFT Z MAIN BODY EXT ESBE-24-39
|
Facility
|
OP
|
$9,687.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.38 |
| Max. Negotiated Rate |
$9,300.05 |
| Rate for Payer: Aetna Commercial |
$7,459.41
|
| Rate for Payer: Anthem Medicaid |
$3,331.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,556.29
|
| Rate for Payer: Cash Price |
$4,843.77
|
| Rate for Payer: Cigna Commercial |
$8,040.67
|
| Rate for Payer: First Health Commercial |
$9,203.17
|
| Rate for Payer: Humana Commercial |
$8,234.42
|
| Rate for Payer: Humana KY Medicaid |
$3,331.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,365.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,149.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,398.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,525.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,003.14
|
| Rate for Payer: PHCS Commercial |
$9,300.05
|
| Rate for Payer: United Healthcare All Payer |
$8,525.04
|
|
|
GFT Z MAIN BODY EXT ESBE-24-39
|
Facility
|
IP
|
$9,687.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.38 |
| Max. Negotiated Rate |
$9,300.05 |
| Rate for Payer: Aetna Commercial |
$7,459.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,556.29
|
| Rate for Payer: Cash Price |
$4,843.77
|
| Rate for Payer: Cigna Commercial |
$8,040.67
|
| Rate for Payer: First Health Commercial |
$9,203.17
|
| Rate for Payer: Humana Commercial |
$8,234.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,149.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,525.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,003.14
|
| Rate for Payer: PHCS Commercial |
$9,300.05
|
| Rate for Payer: United Healthcare All Payer |
$8,525.04
|
|
|
GFT Z MAIN BODY EXT ESBE-24-58
|
Facility
|
IP
|
$9,384.60
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.00 |
| Max. Negotiated Rate |
$9,009.22 |
| Rate for Payer: Aetna Commercial |
$7,226.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,319.99
|
| Rate for Payer: Cash Price |
$4,692.30
|
| Rate for Payer: Cigna Commercial |
$7,789.22
|
| Rate for Payer: First Health Commercial |
$8,915.37
|
| Rate for Payer: Humana Commercial |
$7,976.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,695.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,925.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,815.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,258.45
|
| Rate for Payer: Ohio Health Group HMO |
$7,038.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,876.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,909.23
|
| Rate for Payer: PHCS Commercial |
$9,009.22
|
| Rate for Payer: United Healthcare All Payer |
$8,258.45
|
|
|
GFT Z MAIN BODY EXT ESBE-24-58
|
Facility
|
OP
|
$9,384.60
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.00 |
| Max. Negotiated Rate |
$9,009.22 |
| Rate for Payer: Aetna Commercial |
$7,226.14
|
| Rate for Payer: Anthem Medicaid |
$3,227.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,319.99
|
| Rate for Payer: Cash Price |
$4,692.30
|
| Rate for Payer: Cigna Commercial |
$7,789.22
|
| Rate for Payer: First Health Commercial |
$8,915.37
|
| Rate for Payer: Humana Commercial |
$7,976.91
|
| Rate for Payer: Humana KY Medicaid |
$3,227.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,260.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,695.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,925.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,815.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,292.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,258.45
|
| Rate for Payer: Ohio Health Group HMO |
$7,038.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,876.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,909.23
|
| Rate for Payer: PHCS Commercial |
$9,009.22
|
| Rate for Payer: United Healthcare All Payer |
$8,258.45
|
|
|
GFT Z MAIN BODY EXT ESBE-26-39
|
Facility
|
IP
|
$9,687.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.38 |
| Max. Negotiated Rate |
$9,300.05 |
| Rate for Payer: Aetna Commercial |
$7,459.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,556.29
|
| Rate for Payer: Cash Price |
$4,843.77
|
| Rate for Payer: Cigna Commercial |
$8,040.67
|
| Rate for Payer: First Health Commercial |
$9,203.17
|
| Rate for Payer: Humana Commercial |
$8,234.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,149.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,525.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,003.14
|
| Rate for Payer: PHCS Commercial |
$9,300.05
|
| Rate for Payer: United Healthcare All Payer |
$8,525.04
|
|
|
GFT Z MAIN BODY EXT ESBE-26-39
|
Facility
|
OP
|
$9,687.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.38 |
| Max. Negotiated Rate |
$9,300.05 |
| Rate for Payer: Aetna Commercial |
$7,459.41
|
| Rate for Payer: Anthem Medicaid |
$3,331.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,556.29
|
| Rate for Payer: Cash Price |
$4,843.77
|
| Rate for Payer: Cigna Commercial |
$8,040.67
|
| Rate for Payer: First Health Commercial |
$9,203.17
|
| Rate for Payer: Humana Commercial |
$8,234.42
|
| Rate for Payer: Humana KY Medicaid |
$3,331.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,365.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,149.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,398.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,525.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,003.14
|
| Rate for Payer: PHCS Commercial |
$9,300.05
|
| Rate for Payer: United Healthcare All Payer |
$8,525.04
|
|
|
GFT Z MAIN BODY EXT ESBE-26-58
|
Facility
|
OP
|
$9,687.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.38 |
| Max. Negotiated Rate |
$9,300.05 |
| Rate for Payer: Aetna Commercial |
$7,459.41
|
| Rate for Payer: Anthem Medicaid |
$3,331.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,556.29
|
| Rate for Payer: Cash Price |
$4,843.77
|
| Rate for Payer: Cigna Commercial |
$8,040.67
|
| Rate for Payer: First Health Commercial |
$9,203.17
|
| Rate for Payer: Humana Commercial |
$8,234.42
|
| Rate for Payer: Humana KY Medicaid |
$3,331.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,365.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,149.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,398.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,525.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,003.14
|
| Rate for Payer: PHCS Commercial |
$9,300.05
|
| Rate for Payer: United Healthcare All Payer |
$8,525.04
|
|
|
GFT Z MAIN BODY EXT ESBE-26-58
|
Facility
|
IP
|
$9,687.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.38 |
| Max. Negotiated Rate |
$9,300.05 |
| Rate for Payer: Aetna Commercial |
$7,459.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,556.29
|
| Rate for Payer: Cash Price |
$4,843.77
|
| Rate for Payer: Cigna Commercial |
$8,040.67
|
| Rate for Payer: First Health Commercial |
$9,203.17
|
| Rate for Payer: Humana Commercial |
$8,234.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,149.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,525.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,003.14
|
| Rate for Payer: PHCS Commercial |
$9,300.05
|
| Rate for Payer: United Healthcare All Payer |
$8,525.04
|
|
|
GFT Z MAIN BODY EXT ESBE-28-39
|
Facility
|
OP
|
$9,687.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.38 |
| Max. Negotiated Rate |
$9,300.05 |
| Rate for Payer: Aetna Commercial |
$7,459.41
|
| Rate for Payer: Anthem Medicaid |
$3,331.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,556.29
|
| Rate for Payer: Cash Price |
$4,843.77
|
| Rate for Payer: Cigna Commercial |
$8,040.67
|
| Rate for Payer: First Health Commercial |
$9,203.17
|
| Rate for Payer: Humana Commercial |
$8,234.42
|
| Rate for Payer: Humana KY Medicaid |
$3,331.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,365.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,149.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,398.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,525.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,003.14
|
| Rate for Payer: PHCS Commercial |
$9,300.05
|
| Rate for Payer: United Healthcare All Payer |
$8,525.04
|
|
|
GFT Z MAIN BODY EXT ESBE-28-39
|
Facility
|
IP
|
$9,687.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.38 |
| Max. Negotiated Rate |
$9,300.05 |
| Rate for Payer: Aetna Commercial |
$7,459.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,556.29
|
| Rate for Payer: Cash Price |
$4,843.77
|
| Rate for Payer: Cigna Commercial |
$8,040.67
|
| Rate for Payer: First Health Commercial |
$9,203.17
|
| Rate for Payer: Humana Commercial |
$8,234.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,149.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,525.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,003.14
|
| Rate for Payer: PHCS Commercial |
$9,300.05
|
| Rate for Payer: United Healthcare All Payer |
$8,525.04
|
|
|
GFT Z MAIN BODY EXT ESBE-28-58
|
Facility
|
IP
|
$9,687.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.38 |
| Max. Negotiated Rate |
$9,300.05 |
| Rate for Payer: Aetna Commercial |
$7,459.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,556.29
|
| Rate for Payer: Cash Price |
$4,843.77
|
| Rate for Payer: Cigna Commercial |
$8,040.67
|
| Rate for Payer: First Health Commercial |
$9,203.17
|
| Rate for Payer: Humana Commercial |
$8,234.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,149.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,525.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,003.14
|
| Rate for Payer: PHCS Commercial |
$9,300.05
|
| Rate for Payer: United Healthcare All Payer |
$8,525.04
|
|
|
GFT Z MAIN BODY EXT ESBE-28-58
|
Facility
|
OP
|
$9,687.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.38 |
| Max. Negotiated Rate |
$9,300.05 |
| Rate for Payer: Aetna Commercial |
$7,459.41
|
| Rate for Payer: Anthem Medicaid |
$3,331.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,556.29
|
| Rate for Payer: Cash Price |
$4,843.77
|
| Rate for Payer: Cigna Commercial |
$8,040.67
|
| Rate for Payer: First Health Commercial |
$9,203.17
|
| Rate for Payer: Humana Commercial |
$8,234.42
|
| Rate for Payer: Humana KY Medicaid |
$3,331.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,365.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,149.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,398.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,525.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,003.14
|
| Rate for Payer: PHCS Commercial |
$9,300.05
|
| Rate for Payer: United Healthcare All Payer |
$8,525.04
|
|
