|
GFT Z ILIAC LEG TFLE-24-39-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-24-39-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-24-56-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-24-56-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-24-73-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-24-73-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-24-90-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-24-90-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-8-105-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-8-105-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-8-122-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-8-122-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 ZSLE-11-107-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 ZSLE-11-107-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 ZSLE-11-56-ZT
|
Facility
|
IP
|
$21,121.25
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,336.38 |
| Max. Negotiated Rate |
$20,276.40 |
| Rate for Payer: Aetna Commercial |
$16,263.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,474.58
|
| Rate for Payer: Cash Price |
$10,560.62
|
| Rate for Payer: Cigna Commercial |
$17,530.64
|
| Rate for Payer: First Health Commercial |
$20,065.19
|
| Rate for Payer: Humana Commercial |
$17,953.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,319.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,587.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,336.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,586.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,840.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,897.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,375.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,573.66
|
| Rate for Payer: PHCS Commercial |
$20,276.40
|
| Rate for Payer: United Healthcare All Payer |
$18,586.70
|
|
|
GFT Z ILIAC LEG ZSLE-11-56-ZT
|
Facility
|
OP
|
$21,121.25
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,336.38 |
| Max. Negotiated Rate |
$20,276.40 |
| Rate for Payer: Aetna Commercial |
$16,263.36
|
| Rate for Payer: Anthem Medicaid |
$7,263.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,474.58
|
| Rate for Payer: Cash Price |
$10,560.62
|
| Rate for Payer: Cigna Commercial |
$17,530.64
|
| Rate for Payer: First Health Commercial |
$20,065.19
|
| Rate for Payer: Humana Commercial |
$17,953.06
|
| Rate for Payer: Humana KY Medicaid |
$7,263.60
|
| Rate for Payer: Kentucky WC Medicaid |
$7,337.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,319.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,587.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,336.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,409.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,586.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,840.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,897.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,375.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,573.66
|
| Rate for Payer: PHCS Commercial |
$20,276.40
|
| Rate for Payer: United Healthcare All Payer |
$18,586.70
|
|
|
GFT Z ILIAC LEG ZSLE-13-122-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 ZSLE-13-122-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 ZSLE-24-90-ZT
|
Facility
|
IP
|
$19,179.06
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,753.72 |
| Max. Negotiated Rate |
$18,411.90 |
| Rate for Payer: Aetna Commercial |
$14,767.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,959.67
|
| Rate for Payer: Cash Price |
$9,589.53
|
| Rate for Payer: Cigna Commercial |
$15,918.62
|
| Rate for Payer: First Health Commercial |
$18,220.11
|
| Rate for Payer: Humana Commercial |
$16,302.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,726.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,154.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,753.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,877.57
|
| Rate for Payer: Ohio Health Group HMO |
$14,384.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,343.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,685.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,233.55
|
| Rate for Payer: PHCS Commercial |
$18,411.90
|
| Rate for Payer: United Healthcare All Payer |
$16,877.57
|
|
|
GFT Z ILIAC LEG ZSLE-24-90-ZT
|
Facility
|
OP
|
$19,179.06
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,753.72 |
| Max. Negotiated Rate |
$18,411.90 |
| Rate for Payer: Aetna Commercial |
$14,767.88
|
| Rate for Payer: Anthem Medicaid |
$6,595.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,959.67
|
| Rate for Payer: Cash Price |
$9,589.53
|
| Rate for Payer: Cigna Commercial |
$15,918.62
|
| Rate for Payer: First Health Commercial |
$18,220.11
|
| Rate for Payer: Humana Commercial |
$16,302.20
|
| Rate for Payer: Humana KY Medicaid |
$6,595.68
|
| Rate for Payer: Kentucky WC Medicaid |
$6,662.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,726.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,154.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,753.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,728.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,877.57
|
| Rate for Payer: Ohio Health Group HMO |
$14,384.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,343.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,685.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,233.55
|
| Rate for Payer: PHCS Commercial |
$18,411.90
|
| Rate for Payer: United Healthcare All Payer |
$16,877.57
|
|
|
GFT Z MAIN BDY EXT ESBE2639ZT
|
Facility
|
IP
|
$10,843.67
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,253.10 |
| Max. Negotiated Rate |
$10,409.92 |
| Rate for Payer: Aetna Commercial |
$8,349.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,458.06
|
| Rate for Payer: Cash Price |
$5,421.84
|
| Rate for Payer: Cigna Commercial |
$9,000.25
|
| Rate for Payer: First Health Commercial |
$10,301.49
|
| Rate for Payer: Humana Commercial |
$9,217.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,891.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,002.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,253.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,542.43
|
| Rate for Payer: Ohio Health Group HMO |
$8,132.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,674.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,433.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,482.13
|
| Rate for Payer: PHCS Commercial |
$10,409.92
|
| Rate for Payer: United Healthcare All Payer |
$9,542.43
|
|
|
GFT Z MAIN BDY EXT ESBE2639ZT
|
Facility
|
OP
|
$10,843.67
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,253.10 |
| Max. Negotiated Rate |
$10,409.92 |
| Rate for Payer: Aetna Commercial |
$8,349.63
|
| Rate for Payer: Anthem Medicaid |
$3,729.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,458.06
|
| Rate for Payer: Cash Price |
$5,421.84
|
| Rate for Payer: Cigna Commercial |
$9,000.25
|
| Rate for Payer: First Health Commercial |
$10,301.49
|
| Rate for Payer: Humana Commercial |
$9,217.12
|
| Rate for Payer: Humana KY Medicaid |
$3,729.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,767.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,891.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,002.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,253.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,803.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,542.43
|
| Rate for Payer: Ohio Health Group HMO |
$8,132.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,674.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,433.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,482.13
|
| Rate for Payer: PHCS Commercial |
$10,409.92
|
| Rate for Payer: United Healthcare All Payer |
$9,542.43
|
|
|
GFT Z MAIN BDY EXT ESBE3039ZT
|
Facility
|
OP
|
$10,843.67
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,253.10 |
| Max. Negotiated Rate |
$10,409.92 |
| Rate for Payer: Aetna Commercial |
$8,349.63
|
| Rate for Payer: Anthem Medicaid |
$3,729.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,458.06
|
| Rate for Payer: Cash Price |
$5,421.84
|
| Rate for Payer: Cigna Commercial |
$9,000.25
|
| Rate for Payer: First Health Commercial |
$10,301.49
|
| Rate for Payer: Humana Commercial |
$9,217.12
|
| Rate for Payer: Humana KY Medicaid |
$3,729.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,767.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,891.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,002.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,253.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,803.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,542.43
|
| Rate for Payer: Ohio Health Group HMO |
$8,132.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,674.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,433.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,482.13
|
| Rate for Payer: PHCS Commercial |
$10,409.92
|
| Rate for Payer: United Healthcare All Payer |
$9,542.43
|
|
|
GFT Z MAIN BDY EXT ESBE3039ZT
|
Facility
|
IP
|
$10,843.67
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,253.10 |
| Max. Negotiated Rate |
$10,409.92 |
| Rate for Payer: Aetna Commercial |
$8,349.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,458.06
|
| Rate for Payer: Cash Price |
$5,421.84
|
| Rate for Payer: Cigna Commercial |
$9,000.25
|
| Rate for Payer: First Health Commercial |
$10,301.49
|
| Rate for Payer: Humana Commercial |
$9,217.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,891.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,002.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,253.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,542.43
|
| Rate for Payer: Ohio Health Group HMO |
$8,132.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,674.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,433.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,482.13
|
| Rate for Payer: PHCS Commercial |
$10,409.92
|
| Rate for Payer: United Healthcare All Payer |
$9,542.43
|
|
|
GFT Z MAIN BDY EXT ESBE3650ZT
|
Facility
|
IP
|
$12,623.62
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,787.09 |
| Max. Negotiated Rate |
$12,118.68 |
| Rate for Payer: Aetna Commercial |
$9,720.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,846.42
|
| Rate for Payer: Cash Price |
$6,311.81
|
| Rate for Payer: Cigna Commercial |
$10,477.60
|
| Rate for Payer: First Health Commercial |
$11,992.44
|
| Rate for Payer: Humana Commercial |
$10,730.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,351.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,316.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,787.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,108.79
|
| Rate for Payer: Ohio Health Group HMO |
$9,467.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,098.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,982.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,710.30
|
| Rate for Payer: PHCS Commercial |
$12,118.68
|
| Rate for Payer: United Healthcare All Payer |
$11,108.79
|
|
