|
GFT Z DISTAL ZTEG-2D-30-127-US
|
Facility
|
IP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-30-127-US
|
Facility
|
OP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem Medicaid |
$9,715.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Humana KY Medicaid |
$9,715.17
|
| Rate for Payer: Kentucky WC Medicaid |
$9,814.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,910.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-30-147-US
|
Facility
|
OP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem Medicaid |
$9,715.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Humana KY Medicaid |
$9,715.17
|
| Rate for Payer: Kentucky WC Medicaid |
$9,814.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,910.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-30-147-US
|
Facility
|
IP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-30-207-US
|
Facility
|
IP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-30-207-US
|
Facility
|
OP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem Medicaid |
$9,715.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Humana KY Medicaid |
$9,715.17
|
| Rate for Payer: Kentucky WC Medicaid |
$9,814.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,910.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-32-127-US
|
Facility
|
OP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem Medicaid |
$9,715.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Humana KY Medicaid |
$9,715.17
|
| Rate for Payer: Kentucky WC Medicaid |
$9,814.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,910.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-32-127-US
|
Facility
|
IP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-32-147-US
|
Facility
|
IP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-32-147-US
|
Facility
|
OP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem Medicaid |
$9,715.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Humana KY Medicaid |
$9,715.17
|
| Rate for Payer: Kentucky WC Medicaid |
$9,814.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,910.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-32-207-US
|
Facility
|
IP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-32-207-US
|
Facility
|
OP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem Medicaid |
$9,715.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Humana KY Medicaid |
$9,715.17
|
| Rate for Payer: Kentucky WC Medicaid |
$9,814.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,910.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-34-136-US
|
Facility
|
OP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem Medicaid |
$9,715.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Humana KY Medicaid |
$9,715.17
|
| Rate for Payer: Kentucky WC Medicaid |
$9,814.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,910.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-34-136-US
|
Facility
|
IP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-34-186-US
|
Facility
|
IP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-34-186-US
|
Facility
|
OP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem Medicaid |
$9,715.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Humana KY Medicaid |
$9,715.17
|
| Rate for Payer: Kentucky WC Medicaid |
$9,814.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,910.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-36-136-US
|
Facility
|
IP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-36-136-US
|
Facility
|
OP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem Medicaid |
$9,715.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Humana KY Medicaid |
$9,715.17
|
| Rate for Payer: Kentucky WC Medicaid |
$9,814.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,910.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-36-186-US
|
Facility
|
IP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-36-186-US
|
Facility
|
OP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem Medicaid |
$9,715.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Humana KY Medicaid |
$9,715.17
|
| Rate for Payer: Kentucky WC Medicaid |
$9,814.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,910.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-38-136-US
|
Facility
|
OP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem Medicaid |
$9,715.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Humana KY Medicaid |
$9,715.17
|
| Rate for Payer: Kentucky WC Medicaid |
$9,814.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,910.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-38-136-US
|
Facility
|
IP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-38-186-US
|
Facility
|
OP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem Medicaid |
$9,715.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Humana KY Medicaid |
$9,715.17
|
| Rate for Payer: Kentucky WC Medicaid |
$9,814.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,910.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-38-186-US
|
Facility
|
IP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GFT Z DISTAL ZTEG-2D-40-144-US
|
Facility
|
OP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem Medicaid |
$9,715.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Humana KY Medicaid |
$9,715.17
|
| Rate for Payer: Kentucky WC Medicaid |
$9,814.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,910.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
