|
GFT ILIAC LMB OVTN P 14*18*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*18*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*18*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*18*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*22*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*22*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*22*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*22*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*22*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*22*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*22*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*22*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 ILI LMB OVTN P 14*14*100-E
|
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 ILI LMB OVTN P 14*14*100-E
|
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 INTUITRAK BI 22-16-100BLS
|
Facility
|
IP
|
$70,521.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,156.30 |
| Max. Negotiated Rate |
$67,700.16 |
| Rate for Payer: Aetna Commercial |
$54,301.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,006.38
|
| Rate for Payer: Cash Price |
$35,260.50
|
| Rate for Payer: Cigna Commercial |
$58,532.43
|
| Rate for Payer: First Health Commercial |
$66,994.95
|
| Rate for Payer: Humana Commercial |
$59,942.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,827.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,044.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,156.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,058.48
|
| Rate for Payer: Ohio Health Group HMO |
$52,890.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,353.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,659.49
|
| Rate for Payer: PHCS Commercial |
$67,700.16
|
| Rate for Payer: United Healthcare All Payer |
$62,058.48
|
|
|
GFT INTUITRAK BI 22-16-100BLS
|
Facility
|
OP
|
$70,521.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,156.30 |
| Max. Negotiated Rate |
$67,700.16 |
| Rate for Payer: Aetna Commercial |
$54,301.17
|
| Rate for Payer: Anthem Medicaid |
$24,252.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,006.38
|
| Rate for Payer: Cash Price |
$35,260.50
|
| Rate for Payer: Cigna Commercial |
$58,532.43
|
| Rate for Payer: First Health Commercial |
$66,994.95
|
| Rate for Payer: Humana Commercial |
$59,942.85
|
| Rate for Payer: Humana KY Medicaid |
$24,252.17
|
| Rate for Payer: Kentucky WC Medicaid |
$24,499.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,827.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,044.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,156.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,738.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,058.48
|
| Rate for Payer: Ohio Health Group HMO |
$52,890.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,353.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,659.49
|
| Rate for Payer: PHCS Commercial |
$67,700.16
|
| Rate for Payer: United Healthcare All Payer |
$62,058.48
|
|
|
GFT INTUITRAK BI 25-16-100BLS
|
Facility
|
OP
|
$68,621.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,586.30 |
| Max. Negotiated Rate |
$65,876.16 |
| Rate for Payer: Aetna Commercial |
$52,838.17
|
| Rate for Payer: Anthem Medicaid |
$23,598.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,524.38
|
| Rate for Payer: Cash Price |
$34,310.50
|
| Rate for Payer: Cigna Commercial |
$56,955.43
|
| Rate for Payer: First Health Commercial |
$65,189.95
|
| Rate for Payer: Humana Commercial |
$58,327.85
|
| Rate for Payer: Humana KY Medicaid |
$23,598.76
|
| Rate for Payer: Kentucky WC Medicaid |
$23,838.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,269.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,642.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,586.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,072.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,386.48
|
| Rate for Payer: Ohio Health Group HMO |
$51,465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,700.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,348.49
|
| Rate for Payer: PHCS Commercial |
$65,876.16
|
| Rate for Payer: United Healthcare All Payer |
$60,386.48
|
|
|
GFT INTUITRAK BI 25-16-100BLS
|
Facility
|
IP
|
$68,621.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,586.30 |
| Max. Negotiated Rate |
$65,876.16 |
| Rate for Payer: Aetna Commercial |
$52,838.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,524.38
|
| Rate for Payer: Cash Price |
$34,310.50
|
| Rate for Payer: Cigna Commercial |
$56,955.43
|
| Rate for Payer: First Health Commercial |
$65,189.95
|
| Rate for Payer: Humana Commercial |
$58,327.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,269.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,642.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,586.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,386.48
|
| Rate for Payer: Ohio Health Group HMO |
$51,465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,700.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,348.49
|
| Rate for Payer: PHCS Commercial |
$65,876.16
|
| Rate for Payer: United Healthcare All Payer |
$60,386.48
|
|
|
GFT INTUITRAK BI 28-16-100BLS
|
Facility
|
IP
|
$70,521.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,156.30 |
| Max. Negotiated Rate |
$67,700.16 |
| Rate for Payer: Aetna Commercial |
$54,301.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,006.38
|
| Rate for Payer: Cash Price |
$35,260.50
|
| Rate for Payer: Cigna Commercial |
$58,532.43
|
| Rate for Payer: First Health Commercial |
$66,994.95
|
| Rate for Payer: Humana Commercial |
$59,942.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,827.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,044.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,156.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,058.48
|
| Rate for Payer: Ohio Health Group HMO |
$52,890.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,353.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,659.49
|
| Rate for Payer: PHCS Commercial |
$67,700.16
|
| Rate for Payer: United Healthcare All Payer |
$62,058.48
|
|
|
GFT INTUITRAK BI 28-16-100BLS
|
Facility
|
OP
|
$70,521.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,156.30 |
| Max. Negotiated Rate |
$67,700.16 |
| Rate for Payer: Aetna Commercial |
$54,301.17
|
| Rate for Payer: Anthem Medicaid |
$24,252.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,006.38
|
| Rate for Payer: Cash Price |
$35,260.50
|
| Rate for Payer: Cigna Commercial |
$58,532.43
|
| Rate for Payer: First Health Commercial |
$66,994.95
|
| Rate for Payer: Humana Commercial |
$59,942.85
|
| Rate for Payer: Humana KY Medicaid |
$24,252.17
|
| Rate for Payer: Kentucky WC Medicaid |
$24,499.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,827.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,044.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,156.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,738.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,058.48
|
| Rate for Payer: Ohio Health Group HMO |
$52,890.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,353.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,659.49
|
| Rate for Payer: PHCS Commercial |
$67,700.16
|
| Rate for Payer: United Healthcare All Payer |
$62,058.48
|
|
|
GFT MAIN BDY BIFR 22*40*13*40
|
Facility
|
OP
|
$73,504.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,051.20 |
| Max. Negotiated Rate |
$70,563.84 |
| Rate for Payer: Aetna Commercial |
$56,598.08
|
| Rate for Payer: Anthem Medicaid |
$25,278.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,333.12
|
| Rate for Payer: Cash Price |
$36,752.00
|
| Rate for Payer: Cigna Commercial |
$61,008.32
|
| Rate for Payer: First Health Commercial |
$69,828.80
|
| Rate for Payer: Humana Commercial |
$62,478.40
|
| Rate for Payer: Humana KY Medicaid |
$25,278.03
|
| Rate for Payer: Kentucky WC Medicaid |
$25,535.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,273.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,245.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,051.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,785.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,683.52
|
| Rate for Payer: Ohio Health Group HMO |
$55,128.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,803.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,948.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,717.76
|
| Rate for Payer: PHCS Commercial |
$70,563.84
|
| Rate for Payer: United Healthcare All Payer |
$64,683.52
|
|
|
GFT MAIN BDY BIFR 22*40*13*40
|
Facility
|
IP
|
$73,504.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,051.20 |
| Max. Negotiated Rate |
$70,563.84 |
| Rate for Payer: Aetna Commercial |
$56,598.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,333.12
|
| Rate for Payer: Cash Price |
$36,752.00
|
| Rate for Payer: Cigna Commercial |
$61,008.32
|
| Rate for Payer: First Health Commercial |
$69,828.80
|
| Rate for Payer: Humana Commercial |
$62,478.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,273.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,245.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,051.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,683.52
|
| Rate for Payer: Ohio Health Group HMO |
$55,128.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,803.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,948.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,717.76
|
| Rate for Payer: PHCS Commercial |
$70,563.84
|
| Rate for Payer: United Healthcare All Payer |
$64,683.52
|
|
|
GFT MAIN BDY BIFR 22*60*13*40
|
Facility
|
OP
|
$73,504.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,051.20 |
| Max. Negotiated Rate |
$70,563.84 |
| Rate for Payer: Aetna Commercial |
$56,598.08
|
| Rate for Payer: Anthem Medicaid |
$25,278.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,333.12
|
| Rate for Payer: Cash Price |
$36,752.00
|
| Rate for Payer: Cigna Commercial |
$61,008.32
|
| Rate for Payer: First Health Commercial |
$69,828.80
|
| Rate for Payer: Humana Commercial |
$62,478.40
|
| Rate for Payer: Humana KY Medicaid |
$25,278.03
|
| Rate for Payer: Kentucky WC Medicaid |
$25,535.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,273.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,245.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,051.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,785.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,683.52
|
| Rate for Payer: Ohio Health Group HMO |
$55,128.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,803.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,948.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,717.76
|
| Rate for Payer: PHCS Commercial |
$70,563.84
|
| Rate for Payer: United Healthcare All Payer |
$64,683.52
|
|
|
GFT MAIN BDY BIFR 22*60*13*40
|
Facility
|
IP
|
$73,504.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,051.20 |
| Max. Negotiated Rate |
$70,563.84 |
| Rate for Payer: Aetna Commercial |
$56,598.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,333.12
|
| Rate for Payer: Cash Price |
$36,752.00
|
| Rate for Payer: Cigna Commercial |
$61,008.32
|
| Rate for Payer: First Health Commercial |
$69,828.80
|
| Rate for Payer: Humana Commercial |
$62,478.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,273.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,245.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,051.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,683.52
|
| Rate for Payer: Ohio Health Group HMO |
$55,128.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,803.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,948.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,717.76
|
| Rate for Payer: PHCS Commercial |
$70,563.84
|
| Rate for Payer: United Healthcare All Payer |
$64,683.52
|
|
|
GFT MAIN BDY BIFR 22*60*16*40
|
Facility
|
OP
|
$73,504.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,051.20 |
| Max. Negotiated Rate |
$70,563.84 |
| Rate for Payer: Aetna Commercial |
$56,598.08
|
| Rate for Payer: Anthem Medicaid |
$25,278.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,333.12
|
| Rate for Payer: Cash Price |
$36,752.00
|
| Rate for Payer: Cigna Commercial |
$61,008.32
|
| Rate for Payer: First Health Commercial |
$69,828.80
|
| Rate for Payer: Humana Commercial |
$62,478.40
|
| Rate for Payer: Humana KY Medicaid |
$25,278.03
|
| Rate for Payer: Kentucky WC Medicaid |
$25,535.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,273.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,245.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,051.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,785.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,683.52
|
| Rate for Payer: Ohio Health Group HMO |
$55,128.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,803.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,948.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,717.76
|
| Rate for Payer: PHCS Commercial |
$70,563.84
|
| Rate for Payer: United Healthcare All Payer |
$64,683.52
|
|
