|
GFT Z DISTAL ZTEG-2D-40-144-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-40-198-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-40-198-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-42-144-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-42-144-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
|
|
|
GFT Z DISTAL ZTEG-2D-42-198-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-42-198-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 ILIAC LEG TFLE-10-105-ZT
|
Facility
|
OP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem Medicaid |
$4,984.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Humana KY Medicaid |
$4,984.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,035.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,084.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GFT Z ILIAC LEG TFLE-10-105-ZT
|
Facility
|
IP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GFT Z ILIAC LEG TFLE-10-122-ZT
|
Facility
|
OP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem Medicaid |
$4,984.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Humana KY Medicaid |
$4,984.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,035.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,084.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GFT Z ILIAC LEG TFLE-10-122-ZT
|
Facility
|
IP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GFT Z ILIAC LEG TFLE-10-37-ZT
|
Facility
|
IP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GFT Z ILIAC LEG TFLE-10-37-ZT
|
Facility
|
OP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem Medicaid |
$4,984.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Humana KY Medicaid |
$4,984.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,035.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,084.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GFT Z ILIAC LEG TFLE-10-54-ZT
|
Facility
|
OP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem Medicaid |
$4,984.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Humana KY Medicaid |
$4,984.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,035.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,084.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GFT Z ILIAC LEG TFLE-10-54-ZT
|
Facility
|
IP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GFT Z ILIAC LEG TFLE-10-71-ZT
|
Facility
|
OP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem Medicaid |
$4,984.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Humana KY Medicaid |
$4,984.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,035.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,084.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GFT Z ILIAC LEG TFLE-10-71-ZT
|
Facility
|
IP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GFT Z ILIAC LEG TFLE-10-88-ZT
|
Facility
|
IP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GFT Z ILIAC LEG TFLE-10-88-ZT
|
Facility
|
OP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem Medicaid |
$4,984.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Humana KY Medicaid |
$4,984.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,035.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,084.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GFT Z ILIAC LEG TFLE-12-107-ZT
|
Facility
|
IP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GFT Z ILIAC LEG TFLE-12-107-ZT
|
Facility
|
OP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem Medicaid |
$4,984.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Humana KY Medicaid |
$4,984.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,035.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,084.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GFT Z ILIAC LEG TFLE-12-124-ZT
|
Facility
|
OP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem Medicaid |
$4,984.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Humana KY Medicaid |
$4,984.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,035.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,084.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GFT Z ILIAC LEG TFLE-12-124-ZT
|
Facility
|
IP
|
$14,495.32
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,348.60 |
| Max. Negotiated Rate |
$13,915.51 |
| Rate for Payer: Aetna Commercial |
$11,161.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,306.35
|
| Rate for Payer: Cash Price |
$7,247.66
|
| Rate for Payer: Cigna Commercial |
$12,031.12
|
| Rate for Payer: First Health Commercial |
$13,770.55
|
| Rate for Payer: Humana Commercial |
$12,321.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,886.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,697.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,348.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,755.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,871.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,596.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,610.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,001.77
|
| Rate for Payer: PHCS Commercial |
$13,915.51
|
| Rate for Payer: United Healthcare All Payer |
$12,755.88
|
|
|
GFT Z ILIAC LEG TFLE-12-39-ZT
|
Facility
|
IP
|
$15,814.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,744.35 |
| Max. Negotiated Rate |
$15,181.92 |
| Rate for Payer: Aetna Commercial |
$12,177.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,335.31
|
| Rate for Payer: Cash Price |
$7,907.25
|
| Rate for Payer: Cigna Commercial |
$13,126.03
|
| Rate for Payer: First Health Commercial |
$15,023.77
|
| Rate for Payer: Humana Commercial |
$13,442.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,967.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,671.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,744.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,916.76
|
| Rate for Payer: Ohio Health Group HMO |
$11,860.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,651.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,758.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,912.00
|
| Rate for Payer: PHCS Commercial |
$15,181.92
|
| Rate for Payer: United Healthcare All Payer |
$13,916.76
|
|
|
GFT Z ILIAC LEG TFLE-12-39-ZT
|
Facility
|
OP
|
$15,814.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,744.35 |
| Max. Negotiated Rate |
$15,181.92 |
| Rate for Payer: Aetna Commercial |
$12,177.17
|
| Rate for Payer: Anthem Medicaid |
$5,438.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,335.31
|
| Rate for Payer: Cash Price |
$7,907.25
|
| Rate for Payer: Cigna Commercial |
$13,126.03
|
| Rate for Payer: First Health Commercial |
$15,023.77
|
| Rate for Payer: Humana Commercial |
$13,442.33
|
| Rate for Payer: Humana KY Medicaid |
$5,438.61
|
| Rate for Payer: Kentucky WC Medicaid |
$5,493.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,967.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,671.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,744.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,547.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,916.76
|
| Rate for Payer: Ohio Health Group HMO |
$11,860.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,651.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,758.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,912.00
|
| Rate for Payer: PHCS Commercial |
$15,181.92
|
| Rate for Payer: United Healthcare All Payer |
$13,916.76
|
|
