|
GFT Z MAIN BDY EXT ESBE3650ZT
|
Facility
|
OP
|
$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 Medicaid |
$4,341.26
|
| 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: Humana KY Medicaid |
$4,341.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,385.45
|
| 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: Molina Healthcare Medicaid |
$4,428.37
|
| 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
|
|
|
GFT Z MAIN BODY EXT ESBE-22-39
|
Facility
|
OP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem Medicaid |
$3,400.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Humana KY Medicaid |
$3,400.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,434.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,468.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
|
GFT Z MAIN BODY EXT ESBE-22-39
|
Facility
|
IP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
|
GFT Z MAIN BODY EXT ESBE-22-58
|
Facility
|
OP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem Medicaid |
$3,400.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Humana KY Medicaid |
$3,400.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,434.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,468.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
|
GFT Z MAIN BODY EXT ESBE-22-58
|
Facility
|
IP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
|
GFT Z MAIN BODY EXT ESBE-24-39
|
Facility
|
IP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
|
GFT Z MAIN BODY EXT ESBE-24-39
|
Facility
|
OP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem Medicaid |
$3,400.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Humana KY Medicaid |
$3,400.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,434.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,468.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
|
GFT Z MAIN BODY EXT ESBE-24-58
|
Facility
|
IP
|
$9,584.60
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,875.38 |
| Max. Negotiated Rate |
$9,201.22 |
| Rate for Payer: Aetna Commercial |
$7,380.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,475.99
|
| Rate for Payer: Cash Price |
$4,792.30
|
| Rate for Payer: Cigna Commercial |
$7,955.22
|
| Rate for Payer: First Health Commercial |
$9,105.37
|
| Rate for Payer: Humana Commercial |
$8,146.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,859.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,073.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,875.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,434.45
|
| Rate for Payer: Ohio Health Group HMO |
$7,188.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,667.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,338.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,613.37
|
| Rate for Payer: PHCS Commercial |
$9,201.22
|
| Rate for Payer: United Healthcare All Payer |
$8,434.45
|
|
|
GFT Z MAIN BODY EXT ESBE-24-58
|
Facility
|
OP
|
$9,584.60
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,875.38 |
| Max. Negotiated Rate |
$9,201.22 |
| Rate for Payer: Aetna Commercial |
$7,380.14
|
| Rate for Payer: Anthem Medicaid |
$3,296.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,475.99
|
| Rate for Payer: Cash Price |
$4,792.30
|
| Rate for Payer: Cigna Commercial |
$7,955.22
|
| Rate for Payer: First Health Commercial |
$9,105.37
|
| Rate for Payer: Humana Commercial |
$8,146.91
|
| Rate for Payer: Humana KY Medicaid |
$3,296.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,329.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,859.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,073.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,875.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,362.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,434.45
|
| Rate for Payer: Ohio Health Group HMO |
$7,188.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,667.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,338.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,613.37
|
| Rate for Payer: PHCS Commercial |
$9,201.22
|
| Rate for Payer: United Healthcare All Payer |
$8,434.45
|
|
|
GFT Z MAIN BODY EXT ESBE-26-39
|
Facility
|
IP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
|
GFT Z MAIN BODY EXT ESBE-26-39
|
Facility
|
OP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem Medicaid |
$3,400.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Humana KY Medicaid |
$3,400.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,434.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,468.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
|
GFT Z MAIN BODY EXT ESBE-26-58
|
Facility
|
OP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem Medicaid |
$3,400.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Humana KY Medicaid |
$3,400.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,434.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,468.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
|
GFT Z MAIN BODY EXT ESBE-26-58
|
Facility
|
IP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
|
GFT Z MAIN BODY EXT ESBE-28-39
|
Facility
|
IP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
|
GFT Z MAIN BODY EXT ESBE-28-39
|
Facility
|
OP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem Medicaid |
$3,400.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Humana KY Medicaid |
$3,400.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,434.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,468.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
|
GFT Z MAIN BODY EXT ESBE-28-58
|
Facility
|
IP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
|
GFT Z MAIN BODY EXT ESBE-28-58
|
Facility
|
OP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem Medicaid |
$3,400.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Humana KY Medicaid |
$3,400.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,434.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,468.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
|
GFT Z MAIN BODY EXT ESBE-30-39
|
Facility
|
IP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
|
GFT Z MAIN BODY EXT ESBE-30-39
|
Facility
|
OP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem Medicaid |
$3,400.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Humana KY Medicaid |
$3,400.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,434.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,468.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
|
GFT Z MAIN BODY EXT ESBE-30-58
|
Facility
|
IP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
|
GFT Z MAIN BODY EXT ESBE-30-58
|
Facility
|
OP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem Medicaid |
$3,400.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Humana KY Medicaid |
$3,400.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,434.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,468.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
|
GFT Z MAIN BODY EXT ESBE-32-39
|
Facility
|
OP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem Medicaid |
$3,400.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Humana KY Medicaid |
$3,400.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,434.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,468.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
|
GFT Z MAIN BODY EXT ESBE-32-39
|
Facility
|
IP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
|
GFT Z MAIN BODY EXT ESBE-32-58
|
Facility
|
IP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
|
GFT Z MAIN BODY EXT ESBE-32-58
|
Facility
|
OP
|
$9,887.55
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,966.26 |
| Max. Negotiated Rate |
$9,492.05 |
| Rate for Payer: Aetna Commercial |
$7,613.41
|
| Rate for Payer: Anthem Medicaid |
$3,400.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.29
|
| Rate for Payer: Cash Price |
$4,943.77
|
| Rate for Payer: Cigna Commercial |
$8,206.67
|
| Rate for Payer: First Health Commercial |
$9,393.17
|
| Rate for Payer: Humana Commercial |
$8,404.42
|
| Rate for Payer: Humana KY Medicaid |
$3,400.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,434.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,107.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,468.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,415.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,910.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,602.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,822.41
|
| Rate for Payer: PHCS Commercial |
$9,492.05
|
| Rate for Payer: United Healthcare All Payer |
$8,701.04
|
|
