|
GFT ILIAC LMBOVTN IX 14*22*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 LMBOVTN IX 14*22*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 LMB OVTN IX 14*22*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 LMB OVTN IX 14*22*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 LMBOVTN IX 14*28*100
|
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*28*100
|
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*28*120
|
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*28*120
|
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*28*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*28*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*28*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*28*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*28*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*28*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 LMB OVTN P 14*10*100
|
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 LMB OVTN P 14*10*100
|
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 LMB OVTN P 14*10*120
|
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 LMB OVTN P 14*10*120
|
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 LMB OVTN P 14*10*140
|
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 LMB OVTN P 14*10*140
|
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 LMB OVTN P 14*10*80
|
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 LMB OVTN P 14*10*80
|
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 LMB OVTN P 14*12*100
|
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 LMB OVTN P 14*12*100
|
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 LMB OVTN P 14*12*120
|
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
|
|
