|
GFT Z MAIN BODY EXT ESBE-30-39
|
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-30-39
|
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-30-58
|
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-30-58
|
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-32-39
|
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-32-39
|
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-32-58
|
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-32-58
|
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-36-73
|
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-36-73
|
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 TFFB-22-111-ZT
|
Facility
|
IP
|
$36,598.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,757.84 |
| Max. Negotiated Rate |
$35,134.85 |
| Rate for Payer: Aetna Commercial |
$28,181.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,547.06
|
| Rate for Payer: Cash Price |
$18,299.40
|
| Rate for Payer: Cigna Commercial |
$30,377.00
|
| Rate for Payer: First Health Commercial |
$34,768.86
|
| Rate for Payer: Humana Commercial |
$31,108.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,011.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,009.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,979.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,206.94
|
| Rate for Payer: Ohio Health Group HMO |
$27,449.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,319.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,345.63
|
| Rate for Payer: PHCS Commercial |
$35,134.85
|
| Rate for Payer: United Healthcare All Payer |
$32,206.94
|
|
|
GFT Z MAIN BODY TFFB-22-111-ZT
|
Facility
|
OP
|
$36,598.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,757.84 |
| Max. Negotiated Rate |
$35,134.85 |
| Rate for Payer: Aetna Commercial |
$28,181.08
|
| Rate for Payer: Anthem Medicaid |
$12,586.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,547.06
|
| Rate for Payer: Cash Price |
$18,299.40
|
| Rate for Payer: Cigna Commercial |
$30,377.00
|
| Rate for Payer: First Health Commercial |
$34,768.86
|
| Rate for Payer: Humana Commercial |
$31,108.98
|
| Rate for Payer: Humana KY Medicaid |
$12,586.33
|
| Rate for Payer: Kentucky WC Medicaid |
$12,714.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,011.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,009.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,979.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,838.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,206.94
|
| Rate for Payer: Ohio Health Group HMO |
$27,449.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,319.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,345.63
|
| Rate for Payer: PHCS Commercial |
$35,134.85
|
| Rate for Payer: United Healthcare All Payer |
$32,206.94
|
|
|
GFT Z MAIN BODY TFFB-22-125-ZT
|
Facility
|
IP
|
$36,598.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,757.84 |
| Max. Negotiated Rate |
$35,134.85 |
| Rate for Payer: Aetna Commercial |
$28,181.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,547.06
|
| Rate for Payer: Cash Price |
$18,299.40
|
| Rate for Payer: Cigna Commercial |
$30,377.00
|
| Rate for Payer: First Health Commercial |
$34,768.86
|
| Rate for Payer: Humana Commercial |
$31,108.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,011.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,009.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,979.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,206.94
|
| Rate for Payer: Ohio Health Group HMO |
$27,449.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,319.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,345.63
|
| Rate for Payer: PHCS Commercial |
$35,134.85
|
| Rate for Payer: United Healthcare All Payer |
$32,206.94
|
|
|
GFT Z MAIN BODY TFFB-22-125-ZT
|
Facility
|
OP
|
$36,598.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,757.84 |
| Max. Negotiated Rate |
$35,134.85 |
| Rate for Payer: Aetna Commercial |
$28,181.08
|
| Rate for Payer: Anthem Medicaid |
$12,586.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,547.06
|
| Rate for Payer: Cash Price |
$18,299.40
|
| Rate for Payer: Cigna Commercial |
$30,377.00
|
| Rate for Payer: First Health Commercial |
$34,768.86
|
| Rate for Payer: Humana Commercial |
$31,108.98
|
| Rate for Payer: Humana KY Medicaid |
$12,586.33
|
| Rate for Payer: Kentucky WC Medicaid |
$12,714.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,011.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,009.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,979.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,838.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,206.94
|
| Rate for Payer: Ohio Health Group HMO |
$27,449.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,319.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,345.63
|
| Rate for Payer: PHCS Commercial |
$35,134.85
|
| Rate for Payer: United Healthcare All Payer |
$32,206.94
|
|
|
GFT Z MAIN BODY TFFB-22-140-ZT
|
Facility
|
OP
|
$36,598.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,757.84 |
| Max. Negotiated Rate |
$35,134.85 |
| Rate for Payer: Aetna Commercial |
$28,181.08
|
| Rate for Payer: Anthem Medicaid |
$12,586.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,547.06
|
| Rate for Payer: Cash Price |
$18,299.40
|
| Rate for Payer: Cigna Commercial |
$30,377.00
|
| Rate for Payer: First Health Commercial |
$34,768.86
|
| Rate for Payer: Humana Commercial |
$31,108.98
|
| Rate for Payer: Humana KY Medicaid |
$12,586.33
|
| Rate for Payer: Kentucky WC Medicaid |
$12,714.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,011.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,009.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,979.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,838.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,206.94
|
| Rate for Payer: Ohio Health Group HMO |
$27,449.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,319.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,345.63
|
| Rate for Payer: PHCS Commercial |
$35,134.85
|
| Rate for Payer: United Healthcare All Payer |
$32,206.94
|
|
|
GFT Z MAIN BODY TFFB-22-140-ZT
|
Facility
|
IP
|
$36,598.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,757.84 |
| Max. Negotiated Rate |
$35,134.85 |
| Rate for Payer: Aetna Commercial |
$28,181.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,547.06
|
| Rate for Payer: Cash Price |
$18,299.40
|
| Rate for Payer: Cigna Commercial |
$30,377.00
|
| Rate for Payer: First Health Commercial |
$34,768.86
|
| Rate for Payer: Humana Commercial |
$31,108.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,011.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,009.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,979.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,206.94
|
| Rate for Payer: Ohio Health Group HMO |
$27,449.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,319.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,345.63
|
| Rate for Payer: PHCS Commercial |
$35,134.85
|
| Rate for Payer: United Healthcare All Payer |
$32,206.94
|
|
|
GFT Z MAIN BODY TFFB-24-111-ZT
|
Facility
|
OP
|
$40,586.68
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,276.27 |
| Max. Negotiated Rate |
$38,963.21 |
| Rate for Payer: Aetna Commercial |
$31,251.74
|
| Rate for Payer: Anthem Medicaid |
$13,957.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,657.61
|
| Rate for Payer: Cash Price |
$20,293.34
|
| Rate for Payer: Cigna Commercial |
$33,686.94
|
| Rate for Payer: First Health Commercial |
$38,557.35
|
| Rate for Payer: Humana Commercial |
$34,498.68
|
| Rate for Payer: Humana KY Medicaid |
$13,957.76
|
| Rate for Payer: Kentucky WC Medicaid |
$14,099.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,281.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,176.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,237.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,716.28
|
| Rate for Payer: Ohio Health Group HMO |
$30,440.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,117.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,276.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,581.87
|
| Rate for Payer: PHCS Commercial |
$38,963.21
|
| Rate for Payer: United Healthcare All Payer |
$35,716.28
|
|
|
GFT Z MAIN BODY TFFB-24-111-ZT
|
Facility
|
IP
|
$40,586.68
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,276.27 |
| Max. Negotiated Rate |
$38,963.21 |
| Rate for Payer: Aetna Commercial |
$31,251.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,657.61
|
| Rate for Payer: Cash Price |
$20,293.34
|
| Rate for Payer: Cigna Commercial |
$33,686.94
|
| Rate for Payer: First Health Commercial |
$38,557.35
|
| Rate for Payer: Humana Commercial |
$34,498.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,281.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,952.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,176.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,716.28
|
| Rate for Payer: Ohio Health Group HMO |
$30,440.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,117.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,276.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,581.87
|
| Rate for Payer: PHCS Commercial |
$38,963.21
|
| Rate for Payer: United Healthcare All Payer |
$35,716.28
|
|
|
GFT Z MAIN BODY TFFB-24-125-ZT
|
Facility
|
IP
|
$36,598.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,757.84 |
| Max. Negotiated Rate |
$35,134.85 |
| Rate for Payer: Aetna Commercial |
$28,181.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,547.06
|
| Rate for Payer: Cash Price |
$18,299.40
|
| Rate for Payer: Cigna Commercial |
$30,377.00
|
| Rate for Payer: First Health Commercial |
$34,768.86
|
| Rate for Payer: Humana Commercial |
$31,108.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,011.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,009.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,979.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,206.94
|
| Rate for Payer: Ohio Health Group HMO |
$27,449.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,319.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,345.63
|
| Rate for Payer: PHCS Commercial |
$35,134.85
|
| Rate for Payer: United Healthcare All Payer |
$32,206.94
|
|
|
GFT Z MAIN BODY TFFB-24-125-ZT
|
Facility
|
OP
|
$36,598.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,757.84 |
| Max. Negotiated Rate |
$35,134.85 |
| Rate for Payer: Aetna Commercial |
$28,181.08
|
| Rate for Payer: Anthem Medicaid |
$12,586.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,547.06
|
| Rate for Payer: Cash Price |
$18,299.40
|
| Rate for Payer: Cigna Commercial |
$30,377.00
|
| Rate for Payer: First Health Commercial |
$34,768.86
|
| Rate for Payer: Humana Commercial |
$31,108.98
|
| Rate for Payer: Humana KY Medicaid |
$12,586.33
|
| Rate for Payer: Kentucky WC Medicaid |
$12,714.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,011.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,009.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,979.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,838.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,206.94
|
| Rate for Payer: Ohio Health Group HMO |
$27,449.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,319.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,345.63
|
| Rate for Payer: PHCS Commercial |
$35,134.85
|
| Rate for Payer: United Healthcare All Payer |
$32,206.94
|
|
|
GFT Z MAIN BODY TFFB-24-140-ZT
|
Facility
|
OP
|
$36,598.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,757.84 |
| Max. Negotiated Rate |
$35,134.85 |
| Rate for Payer: Aetna Commercial |
$28,181.08
|
| Rate for Payer: Anthem Medicaid |
$12,586.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,547.06
|
| Rate for Payer: Cash Price |
$18,299.40
|
| Rate for Payer: Cigna Commercial |
$30,377.00
|
| Rate for Payer: First Health Commercial |
$34,768.86
|
| Rate for Payer: Humana Commercial |
$31,108.98
|
| Rate for Payer: Humana KY Medicaid |
$12,586.33
|
| Rate for Payer: Kentucky WC Medicaid |
$12,714.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,011.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,009.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,979.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,838.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,206.94
|
| Rate for Payer: Ohio Health Group HMO |
$27,449.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,319.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,345.63
|
| Rate for Payer: PHCS Commercial |
$35,134.85
|
| Rate for Payer: United Healthcare All Payer |
$32,206.94
|
|
|
GFT Z MAIN BODY TFFB-24-140-ZT
|
Facility
|
IP
|
$36,598.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,757.84 |
| Max. Negotiated Rate |
$35,134.85 |
| Rate for Payer: Aetna Commercial |
$28,181.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,547.06
|
| Rate for Payer: Cash Price |
$18,299.40
|
| Rate for Payer: Cigna Commercial |
$30,377.00
|
| Rate for Payer: First Health Commercial |
$34,768.86
|
| Rate for Payer: Humana Commercial |
$31,108.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,011.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,009.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,979.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,206.94
|
| Rate for Payer: Ohio Health Group HMO |
$27,449.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,319.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,345.63
|
| Rate for Payer: PHCS Commercial |
$35,134.85
|
| Rate for Payer: United Healthcare All Payer |
$32,206.94
|
|
|
GFT Z MAIN BODY TFFB-26-111-ZT
|
Facility
|
IP
|
$35,671.70
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,637.32 |
| Max. Negotiated Rate |
$34,244.83 |
| Rate for Payer: Aetna Commercial |
$27,467.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,823.93
|
| Rate for Payer: Cash Price |
$17,835.85
|
| Rate for Payer: Cigna Commercial |
$29,607.51
|
| Rate for Payer: First Health Commercial |
$33,888.12
|
| Rate for Payer: Humana Commercial |
$30,320.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,250.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,325.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,701.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,391.10
|
| Rate for Payer: Ohio Health Group HMO |
$26,753.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,134.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,637.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,058.23
|
| Rate for Payer: PHCS Commercial |
$34,244.83
|
| Rate for Payer: United Healthcare All Payer |
$31,391.10
|
|
|
GFT Z MAIN BODY TFFB-26-111-ZT
|
Facility
|
OP
|
$35,671.70
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,637.32 |
| Max. Negotiated Rate |
$34,244.83 |
| Rate for Payer: Aetna Commercial |
$27,467.21
|
| Rate for Payer: Anthem Medicaid |
$12,267.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,823.93
|
| Rate for Payer: Cash Price |
$17,835.85
|
| Rate for Payer: Cigna Commercial |
$29,607.51
|
| Rate for Payer: First Health Commercial |
$33,888.12
|
| Rate for Payer: Humana Commercial |
$30,320.94
|
| Rate for Payer: Humana KY Medicaid |
$12,267.50
|
| Rate for Payer: Kentucky WC Medicaid |
$12,392.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,250.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,325.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,701.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,513.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,391.10
|
| Rate for Payer: Ohio Health Group HMO |
$26,753.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,134.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,637.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,058.23
|
| Rate for Payer: PHCS Commercial |
$34,244.83
|
| Rate for Payer: United Healthcare All Payer |
$31,391.10
|
|
|
GFT Z MAIN BODY TFFB-26-125-ZT
|
Facility
|
IP
|
$36,598.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,757.84 |
| Max. Negotiated Rate |
$35,134.85 |
| Rate for Payer: Aetna Commercial |
$28,181.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,547.06
|
| Rate for Payer: Cash Price |
$18,299.40
|
| Rate for Payer: Cigna Commercial |
$30,377.00
|
| Rate for Payer: First Health Commercial |
$34,768.86
|
| Rate for Payer: Humana Commercial |
$31,108.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,011.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,009.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,979.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,206.94
|
| Rate for Payer: Ohio Health Group HMO |
$27,449.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,319.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,345.63
|
| Rate for Payer: PHCS Commercial |
$35,134.85
|
| Rate for Payer: United Healthcare All Payer |
$32,206.94
|
|
