|
GFT Z ILIAC LEG TFLE-16-90-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-18-39-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-18-39-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
|
|
|
GFT Z ILIAC LEG TFLE-18-56-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-18-56-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
|
|
|
GFT Z ILIAC LEG TFLE-18-73-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-18-73-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-18-90-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-18-90-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
|
|
|
GFT Z ILIAC LEG TFLE-20-39-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-20-39-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-20-56-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-20-56-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-20-73-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-20-73-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-20-90-ZT
|
Facility
|
IP
|
$14,385.22
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,315.57 |
| Max. Negotiated Rate |
$13,809.81 |
| Rate for Payer: Aetna Commercial |
$11,076.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,220.47
|
| Rate for Payer: Cash Price |
$7,192.61
|
| Rate for Payer: Cigna Commercial |
$11,939.73
|
| Rate for Payer: First Health Commercial |
$13,665.96
|
| Rate for Payer: Humana Commercial |
$12,227.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,795.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,616.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,315.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,658.99
|
| Rate for Payer: Ohio Health Group HMO |
$10,788.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,508.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,515.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,925.80
|
| Rate for Payer: PHCS Commercial |
$13,809.81
|
| Rate for Payer: United Healthcare All Payer |
$12,658.99
|
|
|
GFT Z ILIAC LEG TFLE-20-90-ZT
|
Facility
|
OP
|
$14,385.22
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,315.57 |
| Max. Negotiated Rate |
$13,809.81 |
| Rate for Payer: Aetna Commercial |
$11,076.62
|
| Rate for Payer: Anthem Medicaid |
$4,947.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,220.47
|
| Rate for Payer: Cash Price |
$7,192.61
|
| Rate for Payer: Cigna Commercial |
$11,939.73
|
| Rate for Payer: First Health Commercial |
$13,665.96
|
| Rate for Payer: Humana Commercial |
$12,227.44
|
| Rate for Payer: Humana KY Medicaid |
$4,947.08
|
| Rate for Payer: Kentucky WC Medicaid |
$4,997.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,795.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,616.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,315.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,046.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,658.99
|
| Rate for Payer: Ohio Health Group HMO |
$10,788.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,508.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,515.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,925.80
|
| Rate for Payer: PHCS Commercial |
$13,809.81
|
| Rate for Payer: United Healthcare All Payer |
$12,658.99
|
|
|
GFT Z ILIAC LEG TFLE-22-39-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-22-39-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-22-56-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-22-56-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-22-73-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
|
|
|
GFT Z ILIAC LEG TFLE-22-73-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-22-90-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-22-90-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
|
|
