|
GFT ILIAC EXT OVTN IX 12*12*45
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
GFT ILIAC EXT OVTN IX 14*14*45
|
Facility
|
IP
|
$26,371.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,911.38 |
| Max. Negotiated Rate |
$25,316.40 |
| Rate for Payer: Aetna Commercial |
$20,305.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,569.58
|
| Rate for Payer: Cash Price |
$13,185.62
|
| Rate for Payer: Cigna Commercial |
$21,888.14
|
| Rate for Payer: First Health Commercial |
$25,052.69
|
| Rate for Payer: Humana Commercial |
$22,415.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,624.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,461.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,911.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,206.70
|
| Rate for Payer: Ohio Health Group HMO |
$19,778.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,097.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,942.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,196.16
|
| Rate for Payer: PHCS Commercial |
$25,316.40
|
| Rate for Payer: United Healthcare All Payer |
$23,206.70
|
|
|
GFT ILIAC EXT OVTN IX 14*14*45
|
Facility
|
OP
|
$26,371.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,911.38 |
| Max. Negotiated Rate |
$25,316.40 |
| Rate for Payer: Aetna Commercial |
$20,305.86
|
| Rate for Payer: Anthem Medicaid |
$9,069.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,569.58
|
| Rate for Payer: Cash Price |
$13,185.62
|
| Rate for Payer: Cigna Commercial |
$21,888.14
|
| Rate for Payer: First Health Commercial |
$25,052.69
|
| Rate for Payer: Humana Commercial |
$22,415.56
|
| Rate for Payer: Humana KY Medicaid |
$9,069.07
|
| Rate for Payer: Kentucky WC Medicaid |
$9,161.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,624.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,461.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,911.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,251.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,206.70
|
| Rate for Payer: Ohio Health Group HMO |
$19,778.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,097.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,942.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,196.16
|
| Rate for Payer: PHCS Commercial |
$25,316.40
|
| Rate for Payer: United Healthcare All Payer |
$23,206.70
|
|
|
GFT ILIAC EXT OVTN IX 18*18*45
|
Facility
|
OP
|
$26,371.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,911.38 |
| Max. Negotiated Rate |
$25,316.40 |
| Rate for Payer: Aetna Commercial |
$20,305.86
|
| Rate for Payer: Anthem Medicaid |
$9,069.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,569.58
|
| Rate for Payer: Cash Price |
$13,185.62
|
| Rate for Payer: Cigna Commercial |
$21,888.14
|
| Rate for Payer: First Health Commercial |
$25,052.69
|
| Rate for Payer: Humana Commercial |
$22,415.56
|
| Rate for Payer: Humana KY Medicaid |
$9,069.07
|
| Rate for Payer: Kentucky WC Medicaid |
$9,161.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,624.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,461.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,911.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,251.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,206.70
|
| Rate for Payer: Ohio Health Group HMO |
$19,778.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,097.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,942.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,196.16
|
| Rate for Payer: PHCS Commercial |
$25,316.40
|
| Rate for Payer: United Healthcare All Payer |
$23,206.70
|
|
|
GFT ILIAC EXT OVTN IX 18*18*45
|
Facility
|
IP
|
$26,371.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,911.38 |
| Max. Negotiated Rate |
$25,316.40 |
| Rate for Payer: Aetna Commercial |
$20,305.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,569.58
|
| Rate for Payer: Cash Price |
$13,185.62
|
| Rate for Payer: Cigna Commercial |
$21,888.14
|
| Rate for Payer: First Health Commercial |
$25,052.69
|
| Rate for Payer: Humana Commercial |
$22,415.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,624.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,461.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,911.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,206.70
|
| Rate for Payer: Ohio Health Group HMO |
$19,778.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,097.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,942.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,196.16
|
| Rate for Payer: PHCS Commercial |
$25,316.40
|
| Rate for Payer: United Healthcare All Payer |
$23,206.70
|
|
|
GFT ILIAC EXT OVTN IX 28*28*45
|
Facility
|
IP
|
$21,871.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,561.38 |
| Max. Negotiated Rate |
$20,996.40 |
| Rate for Payer: Aetna Commercial |
$16,840.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,059.58
|
| Rate for Payer: Cash Price |
$10,935.62
|
| Rate for Payer: Cigna Commercial |
$18,153.14
|
| Rate for Payer: First Health Commercial |
$20,777.69
|
| Rate for Payer: Humana Commercial |
$18,590.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,934.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,140.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,561.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,246.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,403.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,497.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,027.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,091.16
|
| Rate for Payer: PHCS Commercial |
$20,996.40
|
| Rate for Payer: United Healthcare All Payer |
$19,246.70
|
|
|
GFT ILIAC EXT OVTN IX 28*28*45
|
Facility
|
OP
|
$21,871.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,561.38 |
| Max. Negotiated Rate |
$20,996.40 |
| Rate for Payer: Aetna Commercial |
$16,840.86
|
| Rate for Payer: Anthem Medicaid |
$7,521.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,059.58
|
| Rate for Payer: Cash Price |
$10,935.62
|
| Rate for Payer: Cigna Commercial |
$18,153.14
|
| Rate for Payer: First Health Commercial |
$20,777.69
|
| Rate for Payer: Humana Commercial |
$18,590.56
|
| Rate for Payer: Humana KY Medicaid |
$7,521.52
|
| Rate for Payer: Kentucky WC Medicaid |
$7,598.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,934.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,140.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,561.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,672.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,246.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,403.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,497.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,027.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,091.16
|
| Rate for Payer: PHCS Commercial |
$20,996.40
|
| Rate for Payer: United Healthcare All Payer |
$19,246.70
|
|
|
GFT ILIAC EXT OVTN P 10*10*45
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
GFT ILIAC EXT OVTN P 10*10*45
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem Medicaid |
$6,878.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Humana KY Medicaid |
$6,878.00
|
| Rate for Payer: Kentucky WC Medicaid |
$6,948.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,016.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
GFT ILIAC EXT OVTN P 12*12*45
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem Medicaid |
$6,878.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Humana KY Medicaid |
$6,878.00
|
| Rate for Payer: Kentucky WC Medicaid |
$6,948.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,016.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
GFT ILIAC EXT OVTN P 12*12*45
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
GFT ILIAC EXT OVTN P 14*14*45
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem Medicaid |
$6,878.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Humana KY Medicaid |
$6,878.00
|
| Rate for Payer: Kentucky WC Medicaid |
$6,948.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,016.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
GFT ILIAC EXT OVTN P 14*14*45
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
GFT ILIAC EXT OVTN P 16*16*45
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
GFT ILIAC EXT OVTN P 16*16*45
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem Medicaid |
$6,878.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Humana KY Medicaid |
$6,878.00
|
| Rate for Payer: Kentucky WC Medicaid |
$6,948.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,016.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
GFT ILIAC EXT OVTN P 18*18*45
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
GFT ILIAC EXT OVTN P 18*18*45
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem Medicaid |
$6,878.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Humana KY Medicaid |
$6,878.00
|
| Rate for Payer: Kentucky WC Medicaid |
$6,948.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,016.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
GFT ILIAC EXT OVTN P 22*22*45
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
GFT ILIAC EXT OVTN P 22*22*45
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem Medicaid |
$6,878.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Humana KY Medicaid |
$6,878.00
|
| Rate for Payer: Kentucky WC Medicaid |
$6,948.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,016.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
GFT ILIAC EXT R I16-16/C55F SA
|
Facility
|
IP
|
$13,647.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,094.26 |
| Max. Negotiated Rate |
$13,101.65 |
| Rate for Payer: Aetna Commercial |
$10,508.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,645.09
|
| Rate for Payer: Cash Price |
$6,823.77
|
| Rate for Payer: Cigna Commercial |
$11,327.47
|
| Rate for Payer: First Health Commercial |
$12,965.17
|
| Rate for Payer: Humana Commercial |
$11,600.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,190.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,071.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,094.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,009.84
|
| Rate for Payer: Ohio Health Group HMO |
$10,235.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,918.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,873.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,416.81
|
| Rate for Payer: PHCS Commercial |
$13,101.65
|
| Rate for Payer: United Healthcare All Payer |
$12,009.84
|
|
|
GFT ILIAC EXT R I16-16/C55F SA
|
Facility
|
OP
|
$13,647.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,094.26 |
| Max. Negotiated Rate |
$13,101.65 |
| Rate for Payer: Aetna Commercial |
$10,508.61
|
| Rate for Payer: Anthem Medicaid |
$4,693.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,645.09
|
| Rate for Payer: Cash Price |
$6,823.77
|
| Rate for Payer: Cigna Commercial |
$11,327.47
|
| Rate for Payer: First Health Commercial |
$12,965.17
|
| Rate for Payer: Humana Commercial |
$11,600.42
|
| Rate for Payer: Humana KY Medicaid |
$4,693.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,741.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,190.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,071.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,094.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,787.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,009.84
|
| Rate for Payer: Ohio Health Group HMO |
$10,235.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,918.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,873.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,416.81
|
| Rate for Payer: PHCS Commercial |
$13,101.65
|
| Rate for Payer: United Healthcare All Payer |
$12,009.84
|
|
|
GFT ILIAC EXT R I16-16/C88 SA
|
Facility
|
OP
|
$16,221.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,866.45 |
| Max. Negotiated Rate |
$15,572.64 |
| Rate for Payer: Aetna Commercial |
$12,490.56
|
| Rate for Payer: Anthem Medicaid |
$5,578.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,652.77
|
| Rate for Payer: Cash Price |
$8,110.75
|
| Rate for Payer: Cigna Commercial |
$13,463.84
|
| Rate for Payer: First Health Commercial |
$15,410.42
|
| Rate for Payer: Humana Commercial |
$13,788.27
|
| Rate for Payer: Humana KY Medicaid |
$5,578.57
|
| Rate for Payer: Kentucky WC Medicaid |
$5,635.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,301.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,971.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,866.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,690.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,274.92
|
| Rate for Payer: Ohio Health Group HMO |
$12,166.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,977.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,112.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,192.83
|
| Rate for Payer: PHCS Commercial |
$15,572.64
|
| Rate for Payer: United Healthcare All Payer |
$14,274.92
|
|
|
GFT ILIAC EXT R I16-16/C88 SA
|
Facility
|
IP
|
$16,221.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,866.45 |
| Max. Negotiated Rate |
$15,572.64 |
| Rate for Payer: Aetna Commercial |
$12,490.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,652.77
|
| Rate for Payer: Cash Price |
$8,110.75
|
| Rate for Payer: Cigna Commercial |
$13,463.84
|
| Rate for Payer: First Health Commercial |
$15,410.42
|
| Rate for Payer: Humana Commercial |
$13,788.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,301.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,971.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,866.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,274.92
|
| Rate for Payer: Ohio Health Group HMO |
$12,166.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,977.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,112.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,192.83
|
| Rate for Payer: PHCS Commercial |
$15,572.64
|
| Rate for Payer: United Healthcare All Payer |
$14,274.92
|
|
|
GFT ILIAC EXT R I20-13/C70F SA
|
Facility
|
OP
|
$16,906.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,071.80 |
| Max. Negotiated Rate |
$16,229.76 |
| Rate for Payer: Aetna Commercial |
$13,017.62
|
| Rate for Payer: Anthem Medicaid |
$5,813.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,186.68
|
| Rate for Payer: Cash Price |
$8,453.00
|
| Rate for Payer: Cigna Commercial |
$14,031.98
|
| Rate for Payer: First Health Commercial |
$16,060.70
|
| Rate for Payer: Humana Commercial |
$14,370.10
|
| Rate for Payer: Humana KY Medicaid |
$5,813.97
|
| Rate for Payer: Kentucky WC Medicaid |
$5,873.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,862.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,476.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,071.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,930.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,877.28
|
| Rate for Payer: Ohio Health Group HMO |
$12,679.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,524.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,708.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,665.14
|
| Rate for Payer: PHCS Commercial |
$16,229.76
|
| Rate for Payer: United Healthcare All Payer |
$14,877.28
|
|
|
GFT ILIAC EXT R I20-13/C70F SA
|
Facility
|
IP
|
$16,906.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,071.80 |
| Max. Negotiated Rate |
$16,229.76 |
| Rate for Payer: Aetna Commercial |
$13,017.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,186.68
|
| Rate for Payer: Cash Price |
$8,453.00
|
| Rate for Payer: Cigna Commercial |
$14,031.98
|
| Rate for Payer: First Health Commercial |
$16,060.70
|
| Rate for Payer: Humana Commercial |
$14,370.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,862.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,476.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,071.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,877.28
|
| Rate for Payer: Ohio Health Group HMO |
$12,679.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,524.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,708.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,665.14
|
| Rate for Payer: PHCS Commercial |
$16,229.76
|
| Rate for Payer: United Healthcare All Payer |
$14,877.28
|
|
