|
GFT DIST EXT TALENT 34*34*48MM
|
Facility
|
OP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,687.50 |
| Max. Negotiated Rate |
$24,600.00 |
| Rate for Payer: Aetna Commercial |
$19,731.25
|
| Rate for Payer: Anthem Medicaid |
$8,812.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,987.50
|
| Rate for Payer: Cash Price |
$12,812.50
|
| Rate for Payer: Cigna Commercial |
$21,268.75
|
| Rate for Payer: First Health Commercial |
$24,343.75
|
| Rate for Payer: Humana Commercial |
$21,781.25
|
| Rate for Payer: Humana KY Medicaid |
$8,812.44
|
| Rate for Payer: Kentucky WC Medicaid |
$8,902.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,012.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,911.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,687.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,989.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,550.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,293.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,681.25
|
| Rate for Payer: PHCS Commercial |
$24,600.00
|
| Rate for Payer: United Healthcare All Payer |
$22,550.00
|
|
|
GFT DIST EXT TALENT 36*36*46MM
|
Facility
|
IP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,687.50 |
| Max. Negotiated Rate |
$24,600.00 |
| Rate for Payer: Aetna Commercial |
$19,731.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,987.50
|
| Rate for Payer: Cash Price |
$12,812.50
|
| Rate for Payer: Cigna Commercial |
$21,268.75
|
| Rate for Payer: First Health Commercial |
$24,343.75
|
| Rate for Payer: Humana Commercial |
$21,781.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,012.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,911.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,687.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,550.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,293.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,681.25
|
| Rate for Payer: PHCS Commercial |
$24,600.00
|
| Rate for Payer: United Healthcare All Payer |
$22,550.00
|
|
|
GFT DIST EXT TALENT 36*36*46MM
|
Facility
|
OP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,687.50 |
| Max. Negotiated Rate |
$24,600.00 |
| Rate for Payer: Aetna Commercial |
$19,731.25
|
| Rate for Payer: Anthem Medicaid |
$8,812.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,987.50
|
| Rate for Payer: Cash Price |
$12,812.50
|
| Rate for Payer: Cigna Commercial |
$21,268.75
|
| Rate for Payer: First Health Commercial |
$24,343.75
|
| Rate for Payer: Humana Commercial |
$21,781.25
|
| Rate for Payer: Humana KY Medicaid |
$8,812.44
|
| Rate for Payer: Kentucky WC Medicaid |
$8,902.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,012.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,911.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,687.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,989.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,550.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,293.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,681.25
|
| Rate for Payer: PHCS Commercial |
$24,600.00
|
| Rate for Payer: United Healthcare All Payer |
$22,550.00
|
|
|
GFT DIST EXT TALENT 38*38*46MM
|
Facility
|
OP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,687.50 |
| Max. Negotiated Rate |
$24,600.00 |
| Rate for Payer: Aetna Commercial |
$19,731.25
|
| Rate for Payer: Anthem Medicaid |
$8,812.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,987.50
|
| Rate for Payer: Cash Price |
$12,812.50
|
| Rate for Payer: Cigna Commercial |
$21,268.75
|
| Rate for Payer: First Health Commercial |
$24,343.75
|
| Rate for Payer: Humana Commercial |
$21,781.25
|
| Rate for Payer: Humana KY Medicaid |
$8,812.44
|
| Rate for Payer: Kentucky WC Medicaid |
$8,902.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,012.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,911.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,687.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,989.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,550.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,293.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,681.25
|
| Rate for Payer: PHCS Commercial |
$24,600.00
|
| Rate for Payer: United Healthcare All Payer |
$22,550.00
|
|
|
GFT DIST EXT TALENT 38*38*46MM
|
Facility
|
IP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,687.50 |
| Max. Negotiated Rate |
$24,600.00 |
| Rate for Payer: Aetna Commercial |
$19,731.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,987.50
|
| Rate for Payer: Cash Price |
$12,812.50
|
| Rate for Payer: Cigna Commercial |
$21,268.75
|
| Rate for Payer: First Health Commercial |
$24,343.75
|
| Rate for Payer: Humana Commercial |
$21,781.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,012.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,911.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,687.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,550.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,293.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,681.25
|
| Rate for Payer: PHCS Commercial |
$24,600.00
|
| Rate for Payer: United Healthcare All Payer |
$22,550.00
|
|
|
GFT DIST EXT TALENT 40*40*46MM
|
Facility
|
IP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,687.50 |
| Max. Negotiated Rate |
$24,600.00 |
| Rate for Payer: Aetna Commercial |
$19,731.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,987.50
|
| Rate for Payer: Cash Price |
$12,812.50
|
| Rate for Payer: Cigna Commercial |
$21,268.75
|
| Rate for Payer: First Health Commercial |
$24,343.75
|
| Rate for Payer: Humana Commercial |
$21,781.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,012.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,911.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,687.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,550.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,293.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,681.25
|
| Rate for Payer: PHCS Commercial |
$24,600.00
|
| Rate for Payer: United Healthcare All Payer |
$22,550.00
|
|
|
GFT DIST EXT TALENT 40*40*46MM
|
Facility
|
OP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,687.50 |
| Max. Negotiated Rate |
$24,600.00 |
| Rate for Payer: Aetna Commercial |
$19,731.25
|
| Rate for Payer: Anthem Medicaid |
$8,812.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,987.50
|
| Rate for Payer: Cash Price |
$12,812.50
|
| Rate for Payer: Cigna Commercial |
$21,268.75
|
| Rate for Payer: First Health Commercial |
$24,343.75
|
| Rate for Payer: Humana Commercial |
$21,781.25
|
| Rate for Payer: Humana KY Medicaid |
$8,812.44
|
| Rate for Payer: Kentucky WC Medicaid |
$8,902.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,012.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,911.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,687.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,989.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,550.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,293.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,681.25
|
| Rate for Payer: PHCS Commercial |
$24,600.00
|
| Rate for Payer: United Healthcare All Payer |
$22,550.00
|
|
|
GFT DIST EXT TALENT 42*42*54MM
|
Facility
|
OP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,687.50 |
| Max. Negotiated Rate |
$24,600.00 |
| Rate for Payer: Aetna Commercial |
$19,731.25
|
| Rate for Payer: Anthem Medicaid |
$8,812.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,987.50
|
| Rate for Payer: Cash Price |
$12,812.50
|
| Rate for Payer: Cigna Commercial |
$21,268.75
|
| Rate for Payer: First Health Commercial |
$24,343.75
|
| Rate for Payer: Humana Commercial |
$21,781.25
|
| Rate for Payer: Humana KY Medicaid |
$8,812.44
|
| Rate for Payer: Kentucky WC Medicaid |
$8,902.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,012.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,911.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,687.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,989.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,550.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,293.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,681.25
|
| Rate for Payer: PHCS Commercial |
$24,600.00
|
| Rate for Payer: United Healthcare All Payer |
$22,550.00
|
|
|
GFT DIST EXT TALENT 42*42*54MM
|
Facility
|
IP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,687.50 |
| Max. Negotiated Rate |
$24,600.00 |
| Rate for Payer: Aetna Commercial |
$19,731.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,987.50
|
| Rate for Payer: Cash Price |
$12,812.50
|
| Rate for Payer: Cigna Commercial |
$21,268.75
|
| Rate for Payer: First Health Commercial |
$24,343.75
|
| Rate for Payer: Humana Commercial |
$21,781.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,012.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,911.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,687.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,550.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,293.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,681.25
|
| Rate for Payer: PHCS Commercial |
$24,600.00
|
| Rate for Payer: United Healthcare All Payer |
$22,550.00
|
|
|
GFT DIST EXT TALENT 44*44*54MM
|
Facility
|
OP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,687.50 |
| Max. Negotiated Rate |
$24,600.00 |
| Rate for Payer: Aetna Commercial |
$19,731.25
|
| Rate for Payer: Anthem Medicaid |
$8,812.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,987.50
|
| Rate for Payer: Cash Price |
$12,812.50
|
| Rate for Payer: Cigna Commercial |
$21,268.75
|
| Rate for Payer: First Health Commercial |
$24,343.75
|
| Rate for Payer: Humana Commercial |
$21,781.25
|
| Rate for Payer: Humana KY Medicaid |
$8,812.44
|
| Rate for Payer: Kentucky WC Medicaid |
$8,902.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,012.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,911.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,687.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,989.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,550.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,293.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,681.25
|
| Rate for Payer: PHCS Commercial |
$24,600.00
|
| Rate for Payer: United Healthcare All Payer |
$22,550.00
|
|
|
GFT DIST EXT TALENT 44*44*54MM
|
Facility
|
IP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,687.50 |
| Max. Negotiated Rate |
$24,600.00 |
| Rate for Payer: Aetna Commercial |
$19,731.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,987.50
|
| Rate for Payer: Cash Price |
$12,812.50
|
| Rate for Payer: Cigna Commercial |
$21,268.75
|
| Rate for Payer: First Health Commercial |
$24,343.75
|
| Rate for Payer: Humana Commercial |
$21,781.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,012.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,911.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,687.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,550.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,293.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,681.25
|
| Rate for Payer: PHCS Commercial |
$24,600.00
|
| Rate for Payer: United Healthcare All Payer |
$22,550.00
|
|
|
GFT DIST EXT TALENT 46*46*52MM
|
Facility
|
OP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,687.50 |
| Max. Negotiated Rate |
$24,600.00 |
| Rate for Payer: Aetna Commercial |
$19,731.25
|
| Rate for Payer: Anthem Medicaid |
$8,812.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,987.50
|
| Rate for Payer: Cash Price |
$12,812.50
|
| Rate for Payer: Cigna Commercial |
$21,268.75
|
| Rate for Payer: First Health Commercial |
$24,343.75
|
| Rate for Payer: Humana Commercial |
$21,781.25
|
| Rate for Payer: Humana KY Medicaid |
$8,812.44
|
| Rate for Payer: Kentucky WC Medicaid |
$8,902.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,012.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,911.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,687.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,989.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,550.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,293.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,681.25
|
| Rate for Payer: PHCS Commercial |
$24,600.00
|
| Rate for Payer: United Healthcare All Payer |
$22,550.00
|
|
|
GFT DIST EXT TALENT 46*46*52MM
|
Facility
|
IP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,687.50 |
| Max. Negotiated Rate |
$24,600.00 |
| Rate for Payer: Aetna Commercial |
$19,731.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,987.50
|
| Rate for Payer: Cash Price |
$12,812.50
|
| Rate for Payer: Cigna Commercial |
$21,268.75
|
| Rate for Payer: First Health Commercial |
$24,343.75
|
| Rate for Payer: Humana Commercial |
$21,781.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,012.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,911.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,687.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,550.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,293.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,681.25
|
| Rate for Payer: PHCS Commercial |
$24,600.00
|
| Rate for Payer: United Healthcare All Payer |
$22,550.00
|
|
|
GFT DIST TALENT 26MM*22MM*114M
|
Facility
|
OP
|
$75,100.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,530.00 |
| Max. Negotiated Rate |
$72,096.00 |
| Rate for Payer: Aetna Commercial |
$57,827.00
|
| Rate for Payer: Anthem Medicaid |
$25,826.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,578.00
|
| Rate for Payer: Cash Price |
$37,550.00
|
| Rate for Payer: Cigna Commercial |
$62,333.00
|
| Rate for Payer: First Health Commercial |
$71,345.00
|
| Rate for Payer: Humana Commercial |
$63,835.00
|
| Rate for Payer: Humana KY Medicaid |
$25,826.89
|
| Rate for Payer: Kentucky WC Medicaid |
$26,089.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,582.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,423.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,530.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,345.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,088.00
|
| Rate for Payer: Ohio Health Group HMO |
$56,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,337.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,819.00
|
| Rate for Payer: PHCS Commercial |
$72,096.00
|
| Rate for Payer: United Healthcare All Payer |
$66,088.00
|
|
|
GFT DIST TALENT 26MM*22MM*114M
|
Facility
|
IP
|
$75,100.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,530.00 |
| Max. Negotiated Rate |
$72,096.00 |
| Rate for Payer: Aetna Commercial |
$57,827.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,578.00
|
| Rate for Payer: Cash Price |
$37,550.00
|
| Rate for Payer: Cigna Commercial |
$62,333.00
|
| Rate for Payer: First Health Commercial |
$71,345.00
|
| Rate for Payer: Humana Commercial |
$63,835.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,582.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,423.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,530.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,088.00
|
| Rate for Payer: Ohio Health Group HMO |
$56,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,337.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,819.00
|
| Rate for Payer: PHCS Commercial |
$72,096.00
|
| Rate for Payer: United Healthcare All Payer |
$66,088.00
|
|
|
GFT DIST TALENT 28MM*24MM*113M
|
Facility
|
IP
|
$75,100.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,530.00 |
| Max. Negotiated Rate |
$72,096.00 |
| Rate for Payer: Aetna Commercial |
$57,827.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,578.00
|
| Rate for Payer: Cash Price |
$37,550.00
|
| Rate for Payer: Cigna Commercial |
$62,333.00
|
| Rate for Payer: First Health Commercial |
$71,345.00
|
| Rate for Payer: Humana Commercial |
$63,835.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,582.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,423.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,530.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,088.00
|
| Rate for Payer: Ohio Health Group HMO |
$56,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,337.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,819.00
|
| Rate for Payer: PHCS Commercial |
$72,096.00
|
| Rate for Payer: United Healthcare All Payer |
$66,088.00
|
|
|
GFT DIST TALENT 28MM*24MM*113M
|
Facility
|
OP
|
$75,100.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,530.00 |
| Max. Negotiated Rate |
$72,096.00 |
| Rate for Payer: Aetna Commercial |
$57,827.00
|
| Rate for Payer: Anthem Medicaid |
$25,826.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,578.00
|
| Rate for Payer: Cash Price |
$37,550.00
|
| Rate for Payer: Cigna Commercial |
$62,333.00
|
| Rate for Payer: First Health Commercial |
$71,345.00
|
| Rate for Payer: Humana Commercial |
$63,835.00
|
| Rate for Payer: Humana KY Medicaid |
$25,826.89
|
| Rate for Payer: Kentucky WC Medicaid |
$26,089.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,582.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,423.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,530.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,345.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,088.00
|
| Rate for Payer: Ohio Health Group HMO |
$56,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,337.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,819.00
|
| Rate for Payer: PHCS Commercial |
$72,096.00
|
| Rate for Payer: United Healthcare All Payer |
$66,088.00
|
|
|
GFT DIST TALENT 30MM*26MM*113M
|
Facility
|
IP
|
$75,100.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,530.00 |
| Max. Negotiated Rate |
$72,096.00 |
| Rate for Payer: Aetna Commercial |
$57,827.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,578.00
|
| Rate for Payer: Cash Price |
$37,550.00
|
| Rate for Payer: Cigna Commercial |
$62,333.00
|
| Rate for Payer: First Health Commercial |
$71,345.00
|
| Rate for Payer: Humana Commercial |
$63,835.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,582.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,423.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,530.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,088.00
|
| Rate for Payer: Ohio Health Group HMO |
$56,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,337.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,819.00
|
| Rate for Payer: PHCS Commercial |
$72,096.00
|
| Rate for Payer: United Healthcare All Payer |
$66,088.00
|
|
|
GFT DIST TALENT 30MM*26MM*113M
|
Facility
|
OP
|
$75,100.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,530.00 |
| Max. Negotiated Rate |
$72,096.00 |
| Rate for Payer: Aetna Commercial |
$57,827.00
|
| Rate for Payer: Anthem Medicaid |
$25,826.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,578.00
|
| Rate for Payer: Cash Price |
$37,550.00
|
| Rate for Payer: Cigna Commercial |
$62,333.00
|
| Rate for Payer: First Health Commercial |
$71,345.00
|
| Rate for Payer: Humana Commercial |
$63,835.00
|
| Rate for Payer: Humana KY Medicaid |
$25,826.89
|
| Rate for Payer: Kentucky WC Medicaid |
$26,089.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,582.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,423.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,530.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,345.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,088.00
|
| Rate for Payer: Ohio Health Group HMO |
$56,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,337.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,819.00
|
| Rate for Payer: PHCS Commercial |
$72,096.00
|
| Rate for Payer: United Healthcare All Payer |
$66,088.00
|
|
|
GFT DIST TALENT 32MM*28MM*113M
|
Facility
|
OP
|
$75,100.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,530.00 |
| Max. Negotiated Rate |
$72,096.00 |
| Rate for Payer: Aetna Commercial |
$57,827.00
|
| Rate for Payer: Anthem Medicaid |
$25,826.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,578.00
|
| Rate for Payer: Cash Price |
$37,550.00
|
| Rate for Payer: Cigna Commercial |
$62,333.00
|
| Rate for Payer: First Health Commercial |
$71,345.00
|
| Rate for Payer: Humana Commercial |
$63,835.00
|
| Rate for Payer: Humana KY Medicaid |
$25,826.89
|
| Rate for Payer: Kentucky WC Medicaid |
$26,089.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,582.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,423.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,530.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,345.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,088.00
|
| Rate for Payer: Ohio Health Group HMO |
$56,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,337.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,819.00
|
| Rate for Payer: PHCS Commercial |
$72,096.00
|
| Rate for Payer: United Healthcare All Payer |
$66,088.00
|
|
|
GFT DIST TALENT 32MM*28MM*113M
|
Facility
|
IP
|
$75,100.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,530.00 |
| Max. Negotiated Rate |
$72,096.00 |
| Rate for Payer: Aetna Commercial |
$57,827.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,578.00
|
| Rate for Payer: Cash Price |
$37,550.00
|
| Rate for Payer: Cigna Commercial |
$62,333.00
|
| Rate for Payer: First Health Commercial |
$71,345.00
|
| Rate for Payer: Humana Commercial |
$63,835.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,582.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,423.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,530.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,088.00
|
| Rate for Payer: Ohio Health Group HMO |
$56,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,337.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,819.00
|
| Rate for Payer: PHCS Commercial |
$72,096.00
|
| Rate for Payer: United Healthcare All Payer |
$66,088.00
|
|
|
GFT DIST TALENT 34MM*30MM*113M
|
Facility
|
IP
|
$75,100.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,530.00 |
| Max. Negotiated Rate |
$72,096.00 |
| Rate for Payer: Aetna Commercial |
$57,827.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,578.00
|
| Rate for Payer: Cash Price |
$37,550.00
|
| Rate for Payer: Cigna Commercial |
$62,333.00
|
| Rate for Payer: First Health Commercial |
$71,345.00
|
| Rate for Payer: Humana Commercial |
$63,835.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,582.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,423.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,530.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,088.00
|
| Rate for Payer: Ohio Health Group HMO |
$56,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,337.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,819.00
|
| Rate for Payer: PHCS Commercial |
$72,096.00
|
| Rate for Payer: United Healthcare All Payer |
$66,088.00
|
|
|
GFT DIST TALENT 34MM*30MM*113M
|
Facility
|
OP
|
$75,100.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,530.00 |
| Max. Negotiated Rate |
$72,096.00 |
| Rate for Payer: Aetna Commercial |
$57,827.00
|
| Rate for Payer: Anthem Medicaid |
$25,826.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,578.00
|
| Rate for Payer: Cash Price |
$37,550.00
|
| Rate for Payer: Cigna Commercial |
$62,333.00
|
| Rate for Payer: First Health Commercial |
$71,345.00
|
| Rate for Payer: Humana Commercial |
$63,835.00
|
| Rate for Payer: Humana KY Medicaid |
$25,826.89
|
| Rate for Payer: Kentucky WC Medicaid |
$26,089.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,582.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,423.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,530.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,345.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,088.00
|
| Rate for Payer: Ohio Health Group HMO |
$56,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,337.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,819.00
|
| Rate for Payer: PHCS Commercial |
$72,096.00
|
| Rate for Payer: United Healthcare All Payer |
$66,088.00
|
|
|
GFT DIST TALENT 36MM*32MM*112M
|
Facility
|
OP
|
$75,100.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,530.00 |
| Max. Negotiated Rate |
$72,096.00 |
| Rate for Payer: Aetna Commercial |
$57,827.00
|
| Rate for Payer: Anthem Medicaid |
$25,826.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,578.00
|
| Rate for Payer: Cash Price |
$37,550.00
|
| Rate for Payer: Cigna Commercial |
$62,333.00
|
| Rate for Payer: First Health Commercial |
$71,345.00
|
| Rate for Payer: Humana Commercial |
$63,835.00
|
| Rate for Payer: Humana KY Medicaid |
$25,826.89
|
| Rate for Payer: Kentucky WC Medicaid |
$26,089.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,582.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,423.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,530.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,345.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,088.00
|
| Rate for Payer: Ohio Health Group HMO |
$56,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,337.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,819.00
|
| Rate for Payer: PHCS Commercial |
$72,096.00
|
| Rate for Payer: United Healthcare All Payer |
$66,088.00
|
|
|
GFT DIST TALENT 36MM*32MM*112M
|
Facility
|
IP
|
$75,100.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,530.00 |
| Max. Negotiated Rate |
$72,096.00 |
| Rate for Payer: Aetna Commercial |
$57,827.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,578.00
|
| Rate for Payer: Cash Price |
$37,550.00
|
| Rate for Payer: Cigna Commercial |
$62,333.00
|
| Rate for Payer: First Health Commercial |
$71,345.00
|
| Rate for Payer: Humana Commercial |
$63,835.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,582.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,423.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,530.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,088.00
|
| Rate for Payer: Ohio Health Group HMO |
$56,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,337.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,819.00
|
| Rate for Payer: PHCS Commercial |
$72,096.00
|
| Rate for Payer: United Healthcare All Payer |
$66,088.00
|
|
