|
GFT ILIAC EXT R I20-13/C88F SA
|
Facility
|
IP
|
$20,746.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,223.88 |
| Max. Negotiated Rate |
$19,916.40 |
| Rate for Payer: Aetna Commercial |
$15,974.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,182.08
|
| Rate for Payer: Cash Price |
$10,373.12
|
| Rate for Payer: Cigna Commercial |
$17,219.39
|
| Rate for Payer: First Health Commercial |
$19,708.94
|
| Rate for Payer: Humana Commercial |
$17,634.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,011.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,310.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,223.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,256.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,559.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,597.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,049.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,314.91
|
| Rate for Payer: PHCS Commercial |
$19,916.40
|
| Rate for Payer: United Healthcare All Payer |
$18,256.70
|
|
|
GFT ILIAC EXT R I20-13/C88F SA
|
Facility
|
OP
|
$20,746.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,223.88 |
| Max. Negotiated Rate |
$19,916.40 |
| Rate for Payer: Aetna Commercial |
$15,974.61
|
| Rate for Payer: Anthem Medicaid |
$7,134.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,182.08
|
| Rate for Payer: Cash Price |
$10,373.12
|
| Rate for Payer: Cigna Commercial |
$17,219.39
|
| Rate for Payer: First Health Commercial |
$19,708.94
|
| Rate for Payer: Humana Commercial |
$17,634.31
|
| Rate for Payer: Humana KY Medicaid |
$7,134.64
|
| Rate for Payer: Kentucky WC Medicaid |
$7,207.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,011.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,310.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,223.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,277.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,256.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,559.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,597.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,049.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,314.91
|
| Rate for Payer: PHCS Commercial |
$19,916.40
|
| Rate for Payer: United Healthcare All Payer |
$18,256.70
|
|
|
GFT ILIAC EXT R I20-20/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 I20-20/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 IS20-25/C65 SA
|
Facility
|
OP
|
$20,746.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,223.88 |
| Max. Negotiated Rate |
$19,916.40 |
| Rate for Payer: Aetna Commercial |
$15,974.61
|
| Rate for Payer: Anthem Medicaid |
$7,134.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,182.08
|
| Rate for Payer: Cash Price |
$10,373.12
|
| Rate for Payer: Cigna Commercial |
$17,219.39
|
| Rate for Payer: First Health Commercial |
$19,708.94
|
| Rate for Payer: Humana Commercial |
$17,634.31
|
| Rate for Payer: Humana KY Medicaid |
$7,134.64
|
| Rate for Payer: Kentucky WC Medicaid |
$7,207.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,011.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,310.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,223.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,277.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,256.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,559.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,597.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,049.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,314.91
|
| Rate for Payer: PHCS Commercial |
$19,916.40
|
| Rate for Payer: United Healthcare All Payer |
$18,256.70
|
|
|
GFT ILIAC EXT R IS20-25/C65 SA
|
Facility
|
IP
|
$20,746.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,223.88 |
| Max. Negotiated Rate |
$19,916.40 |
| Rate for Payer: Aetna Commercial |
$15,974.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,182.08
|
| Rate for Payer: Cash Price |
$10,373.12
|
| Rate for Payer: Cigna Commercial |
$17,219.39
|
| Rate for Payer: First Health Commercial |
$19,708.94
|
| Rate for Payer: Humana Commercial |
$17,634.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,011.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,310.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,223.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,256.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,559.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,597.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,049.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,314.91
|
| Rate for Payer: PHCS Commercial |
$19,916.40
|
| Rate for Payer: United Healthcare All Payer |
$18,256.70
|
|
|
GFT ILIAC LMBOVTN IX 14*10*140
|
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 LMBOVTN IX 14*10*140
|
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 LMBOVTN IX 14*10*160
|
Facility
|
IP
|
$23,746.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,123.88 |
| Max. Negotiated Rate |
$22,796.40 |
| Rate for Payer: Aetna Commercial |
$18,284.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,522.08
|
| Rate for Payer: Cash Price |
$11,873.12
|
| Rate for Payer: Cigna Commercial |
$19,709.39
|
| Rate for Payer: First Health Commercial |
$22,558.94
|
| Rate for Payer: Humana Commercial |
$20,184.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,471.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,524.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,123.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,896.70
|
| Rate for Payer: Ohio Health Group HMO |
$17,809.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,997.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,659.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,384.91
|
| Rate for Payer: PHCS Commercial |
$22,796.40
|
| Rate for Payer: United Healthcare All Payer |
$20,896.70
|
|
|
GFT ILIAC LMBOVTN IX 14*10*160
|
Facility
|
OP
|
$23,746.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,123.88 |
| Max. Negotiated Rate |
$22,796.40 |
| Rate for Payer: Aetna Commercial |
$18,284.61
|
| Rate for Payer: Anthem Medicaid |
$8,166.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,522.08
|
| Rate for Payer: Cash Price |
$11,873.12
|
| Rate for Payer: Cigna Commercial |
$19,709.39
|
| Rate for Payer: First Health Commercial |
$22,558.94
|
| Rate for Payer: Humana Commercial |
$20,184.31
|
| Rate for Payer: Humana KY Medicaid |
$8,166.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,249.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,471.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,524.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,123.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,330.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,896.70
|
| Rate for Payer: Ohio Health Group HMO |
$17,809.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,997.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,659.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,384.91
|
| Rate for Payer: PHCS Commercial |
$22,796.40
|
| Rate for Payer: United Healthcare All Payer |
$20,896.70
|
|
|
GFT ILIAC LMB OVTN IX 14*10*80
|
Facility
|
IP
|
$23,746.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,123.88 |
| Max. Negotiated Rate |
$22,796.40 |
| Rate for Payer: Aetna Commercial |
$18,284.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,522.08
|
| Rate for Payer: Cash Price |
$11,873.12
|
| Rate for Payer: Cigna Commercial |
$19,709.39
|
| Rate for Payer: First Health Commercial |
$22,558.94
|
| Rate for Payer: Humana Commercial |
$20,184.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,471.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,524.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,123.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,896.70
|
| Rate for Payer: Ohio Health Group HMO |
$17,809.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,997.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,659.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,384.91
|
| Rate for Payer: PHCS Commercial |
$22,796.40
|
| Rate for Payer: United Healthcare All Payer |
$20,896.70
|
|
|
GFT ILIAC LMB OVTN IX 14*10*80
|
Facility
|
OP
|
$23,746.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,123.88 |
| Max. Negotiated Rate |
$22,796.40 |
| Rate for Payer: Aetna Commercial |
$18,284.61
|
| Rate for Payer: Anthem Medicaid |
$8,166.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,522.08
|
| Rate for Payer: Cash Price |
$11,873.12
|
| Rate for Payer: Cigna Commercial |
$19,709.39
|
| Rate for Payer: First Health Commercial |
$22,558.94
|
| Rate for Payer: Humana Commercial |
$20,184.31
|
| Rate for Payer: Humana KY Medicaid |
$8,166.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,249.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,471.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,524.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,123.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,330.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,896.70
|
| Rate for Payer: Ohio Health Group HMO |
$17,809.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,997.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,659.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,384.91
|
| Rate for Payer: PHCS Commercial |
$22,796.40
|
| Rate for Payer: United Healthcare All Payer |
$20,896.70
|
|
|
GFT ILIAC LMBOVTN IX 14*12*100
|
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 LMBOVTN IX 14*12*100
|
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 LMBOVTN IX 14*12*140
|
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 LMBOVTN IX 14*12*140
|
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 LMBOVTN IX 14*12*160
|
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 LMBOVTN IX 14*12*160
|
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 LMB OVTN IX 14*12*80
|
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 LMB OVTN IX 14*12*80
|
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 LMBOVTN IX 14*14*140
|
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 LMBOVTN IX 14*14*140
|
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 LMBOVTN IX 14*14*160
|
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 LMBOVTN IX 14*14*160
|
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 LMB OVTN IX 14*14*80
|
Facility
|
OP
|
$23,746.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,123.88 |
| Max. Negotiated Rate |
$22,796.40 |
| Rate for Payer: Aetna Commercial |
$18,284.61
|
| Rate for Payer: Anthem Medicaid |
$8,166.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,522.08
|
| Rate for Payer: Cash Price |
$11,873.12
|
| Rate for Payer: Cigna Commercial |
$19,709.39
|
| Rate for Payer: First Health Commercial |
$22,558.94
|
| Rate for Payer: Humana Commercial |
$20,184.31
|
| Rate for Payer: Humana KY Medicaid |
$8,166.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,249.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,471.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,524.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,123.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,330.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,896.70
|
| Rate for Payer: Ohio Health Group HMO |
$17,809.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,997.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,659.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,384.91
|
| Rate for Payer: PHCS Commercial |
$22,796.40
|
| Rate for Payer: United Healthcare All Payer |
$20,896.70
|
|
