|
GFT MAIN BDY BIFR 22*60*16*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*70*16*30
|
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*70*16*30
|
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*70*20*30
|
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*70*20*30
|
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*80*16*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*80*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
|
|
|
GFT MAIN BDY BIFR 22*80*20*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*80*20*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*90*16*30
|
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*90*16*30
|
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*90*20*30
|
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*90*20*30
|
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 25*100*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
|
|
|
GFT MAIN BDY BIFR 25*100*16*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 25*100*20*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 25*100*20*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 25*110*16*30
|
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 25*110*16*30
|
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 25*110*20*30
|
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 25*110*20*30
|
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 25*120*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
|
|
|
GFT MAIN BDY BIFR 25*120*16*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 25*120*20*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 25*120*20*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
|
|
