|
GFT Z MAIN BODY EXT ESBE-36-73
|
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-36-73
|
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 TFFB-22-111-ZT
|
Facility
|
IP
|
$37,670.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,301.00 |
| Max. Negotiated Rate |
$36,163.20 |
| Rate for Payer: Aetna Commercial |
$29,005.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,382.60
|
| Rate for Payer: Cash Price |
$18,835.00
|
| Rate for Payer: Cigna Commercial |
$31,266.10
|
| Rate for Payer: First Health Commercial |
$35,786.50
|
| Rate for Payer: Humana Commercial |
$32,019.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,889.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,800.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,149.60
|
| Rate for Payer: Ohio Health Group HMO |
$28,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,772.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,992.30
|
| Rate for Payer: PHCS Commercial |
$36,163.20
|
| Rate for Payer: United Healthcare All Payer |
$33,149.60
|
|
|
GFT Z MAIN BODY TFFB-22-111-ZT
|
Facility
|
OP
|
$37,670.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,301.00 |
| Max. Negotiated Rate |
$36,163.20 |
| Rate for Payer: Aetna Commercial |
$29,005.90
|
| Rate for Payer: Anthem Medicaid |
$12,954.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,382.60
|
| Rate for Payer: Cash Price |
$18,835.00
|
| Rate for Payer: Cigna Commercial |
$31,266.10
|
| Rate for Payer: First Health Commercial |
$35,786.50
|
| Rate for Payer: Humana Commercial |
$32,019.50
|
| Rate for Payer: Humana KY Medicaid |
$12,954.71
|
| Rate for Payer: Kentucky WC Medicaid |
$13,086.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,889.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,800.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,214.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,149.60
|
| Rate for Payer: Ohio Health Group HMO |
$28,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,772.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,992.30
|
| Rate for Payer: PHCS Commercial |
$36,163.20
|
| Rate for Payer: United Healthcare All Payer |
$33,149.60
|
|
|
GFT Z MAIN BODY TFFB-22-125-ZT
|
Facility
|
IP
|
$37,670.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,301.00 |
| Max. Negotiated Rate |
$36,163.20 |
| Rate for Payer: Aetna Commercial |
$29,005.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,382.60
|
| Rate for Payer: Cash Price |
$18,835.00
|
| Rate for Payer: Cigna Commercial |
$31,266.10
|
| Rate for Payer: First Health Commercial |
$35,786.50
|
| Rate for Payer: Humana Commercial |
$32,019.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,889.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,800.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,149.60
|
| Rate for Payer: Ohio Health Group HMO |
$28,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,772.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,992.30
|
| Rate for Payer: PHCS Commercial |
$36,163.20
|
| Rate for Payer: United Healthcare All Payer |
$33,149.60
|
|
|
GFT Z MAIN BODY TFFB-22-125-ZT
|
Facility
|
OP
|
$37,670.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,301.00 |
| Max. Negotiated Rate |
$36,163.20 |
| Rate for Payer: Aetna Commercial |
$29,005.90
|
| Rate for Payer: Anthem Medicaid |
$12,954.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,382.60
|
| Rate for Payer: Cash Price |
$18,835.00
|
| Rate for Payer: Cigna Commercial |
$31,266.10
|
| Rate for Payer: First Health Commercial |
$35,786.50
|
| Rate for Payer: Humana Commercial |
$32,019.50
|
| Rate for Payer: Humana KY Medicaid |
$12,954.71
|
| Rate for Payer: Kentucky WC Medicaid |
$13,086.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,889.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,800.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,214.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,149.60
|
| Rate for Payer: Ohio Health Group HMO |
$28,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,772.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,992.30
|
| Rate for Payer: PHCS Commercial |
$36,163.20
|
| Rate for Payer: United Healthcare All Payer |
$33,149.60
|
|
|
GFT Z MAIN BODY TFFB-22-140-ZT
|
Facility
|
OP
|
$37,670.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,301.00 |
| Max. Negotiated Rate |
$36,163.20 |
| Rate for Payer: Aetna Commercial |
$29,005.90
|
| Rate for Payer: Anthem Medicaid |
$12,954.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,382.60
|
| Rate for Payer: Cash Price |
$18,835.00
|
| Rate for Payer: Cigna Commercial |
$31,266.10
|
| Rate for Payer: First Health Commercial |
$35,786.50
|
| Rate for Payer: Humana Commercial |
$32,019.50
|
| Rate for Payer: Humana KY Medicaid |
$12,954.71
|
| Rate for Payer: Kentucky WC Medicaid |
$13,086.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,889.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,800.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,214.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,149.60
|
| Rate for Payer: Ohio Health Group HMO |
$28,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,772.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,992.30
|
| Rate for Payer: PHCS Commercial |
$36,163.20
|
| Rate for Payer: United Healthcare All Payer |
$33,149.60
|
|
|
GFT Z MAIN BODY TFFB-22-140-ZT
|
Facility
|
IP
|
$37,670.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,301.00 |
| Max. Negotiated Rate |
$36,163.20 |
| Rate for Payer: Aetna Commercial |
$29,005.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,382.60
|
| Rate for Payer: Cash Price |
$18,835.00
|
| Rate for Payer: Cigna Commercial |
$31,266.10
|
| Rate for Payer: First Health Commercial |
$35,786.50
|
| Rate for Payer: Humana Commercial |
$32,019.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,889.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,800.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,149.60
|
| Rate for Payer: Ohio Health Group HMO |
$28,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,772.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,992.30
|
| Rate for Payer: PHCS Commercial |
$36,163.20
|
| Rate for Payer: United Healthcare All Payer |
$33,149.60
|
|
|
GFT Z MAIN BODY TFFB-24-111-ZT
|
Facility
|
IP
|
$41,767.14
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,530.14 |
| Max. Negotiated Rate |
$40,096.45 |
| Rate for Payer: Aetna Commercial |
$32,160.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,578.37
|
| Rate for Payer: Cash Price |
$20,883.57
|
| Rate for Payer: Cigna Commercial |
$34,666.73
|
| Rate for Payer: First Health Commercial |
$39,678.78
|
| Rate for Payer: Humana Commercial |
$35,502.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,249.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,824.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,530.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,755.08
|
| Rate for Payer: Ohio Health Group HMO |
$31,325.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,413.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,337.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,819.33
|
| Rate for Payer: PHCS Commercial |
$40,096.45
|
| Rate for Payer: United Healthcare All Payer |
$36,755.08
|
|
|
GFT Z MAIN BODY TFFB-24-111-ZT
|
Facility
|
OP
|
$41,767.14
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,530.14 |
| Max. Negotiated Rate |
$40,096.45 |
| Rate for Payer: Aetna Commercial |
$32,160.70
|
| Rate for Payer: Anthem Medicaid |
$14,363.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,578.37
|
| Rate for Payer: Cash Price |
$20,883.57
|
| Rate for Payer: Cigna Commercial |
$34,666.73
|
| Rate for Payer: First Health Commercial |
$39,678.78
|
| Rate for Payer: Humana Commercial |
$35,502.07
|
| Rate for Payer: Humana KY Medicaid |
$14,363.72
|
| Rate for Payer: Kentucky WC Medicaid |
$14,509.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,249.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,824.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,530.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,651.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,755.08
|
| Rate for Payer: Ohio Health Group HMO |
$31,325.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,413.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,337.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,819.33
|
| Rate for Payer: PHCS Commercial |
$40,096.45
|
| Rate for Payer: United Healthcare All Payer |
$36,755.08
|
|
|
GFT Z MAIN BODY TFFB-24-125-ZT
|
Facility
|
OP
|
$37,670.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,301.00 |
| Max. Negotiated Rate |
$36,163.20 |
| Rate for Payer: Aetna Commercial |
$29,005.90
|
| Rate for Payer: Anthem Medicaid |
$12,954.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,382.60
|
| Rate for Payer: Cash Price |
$18,835.00
|
| Rate for Payer: Cigna Commercial |
$31,266.10
|
| Rate for Payer: First Health Commercial |
$35,786.50
|
| Rate for Payer: Humana Commercial |
$32,019.50
|
| Rate for Payer: Humana KY Medicaid |
$12,954.71
|
| Rate for Payer: Kentucky WC Medicaid |
$13,086.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,889.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,800.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,214.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,149.60
|
| Rate for Payer: Ohio Health Group HMO |
$28,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,772.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,992.30
|
| Rate for Payer: PHCS Commercial |
$36,163.20
|
| Rate for Payer: United Healthcare All Payer |
$33,149.60
|
|
|
GFT Z MAIN BODY TFFB-24-125-ZT
|
Facility
|
IP
|
$37,670.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,301.00 |
| Max. Negotiated Rate |
$36,163.20 |
| Rate for Payer: Aetna Commercial |
$29,005.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,382.60
|
| Rate for Payer: Cash Price |
$18,835.00
|
| Rate for Payer: Cigna Commercial |
$31,266.10
|
| Rate for Payer: First Health Commercial |
$35,786.50
|
| Rate for Payer: Humana Commercial |
$32,019.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,889.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,800.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,149.60
|
| Rate for Payer: Ohio Health Group HMO |
$28,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,772.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,992.30
|
| Rate for Payer: PHCS Commercial |
$36,163.20
|
| Rate for Payer: United Healthcare All Payer |
$33,149.60
|
|
|
GFT Z MAIN BODY TFFB-24-140-ZT
|
Facility
|
IP
|
$37,670.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,301.00 |
| Max. Negotiated Rate |
$36,163.20 |
| Rate for Payer: Aetna Commercial |
$29,005.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,382.60
|
| Rate for Payer: Cash Price |
$18,835.00
|
| Rate for Payer: Cigna Commercial |
$31,266.10
|
| Rate for Payer: First Health Commercial |
$35,786.50
|
| Rate for Payer: Humana Commercial |
$32,019.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,889.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,800.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,149.60
|
| Rate for Payer: Ohio Health Group HMO |
$28,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,772.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,992.30
|
| Rate for Payer: PHCS Commercial |
$36,163.20
|
| Rate for Payer: United Healthcare All Payer |
$33,149.60
|
|
|
GFT Z MAIN BODY TFFB-24-140-ZT
|
Facility
|
OP
|
$37,670.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,301.00 |
| Max. Negotiated Rate |
$36,163.20 |
| Rate for Payer: Aetna Commercial |
$29,005.90
|
| Rate for Payer: Anthem Medicaid |
$12,954.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,382.60
|
| Rate for Payer: Cash Price |
$18,835.00
|
| Rate for Payer: Cigna Commercial |
$31,266.10
|
| Rate for Payer: First Health Commercial |
$35,786.50
|
| Rate for Payer: Humana Commercial |
$32,019.50
|
| Rate for Payer: Humana KY Medicaid |
$12,954.71
|
| Rate for Payer: Kentucky WC Medicaid |
$13,086.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,889.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,800.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,214.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,149.60
|
| Rate for Payer: Ohio Health Group HMO |
$28,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,772.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,992.30
|
| Rate for Payer: PHCS Commercial |
$36,163.20
|
| Rate for Payer: United Healthcare All Payer |
$33,149.60
|
|
|
GFT Z MAIN BODY TFFB-26-111-ZT
|
Facility
|
IP
|
$36,717.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,015.25 |
| Max. Negotiated Rate |
$35,248.80 |
| Rate for Payer: Aetna Commercial |
$28,272.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,639.65
|
| Rate for Payer: Cash Price |
$18,358.75
|
| Rate for Payer: Cigna Commercial |
$30,475.53
|
| Rate for Payer: First Health Commercial |
$34,881.62
|
| Rate for Payer: Humana Commercial |
$31,209.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,108.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,097.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,015.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,311.40
|
| Rate for Payer: Ohio Health Group HMO |
$27,538.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,374.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,944.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,335.08
|
| Rate for Payer: PHCS Commercial |
$35,248.80
|
| Rate for Payer: United Healthcare All Payer |
$32,311.40
|
|
|
GFT Z MAIN BODY TFFB-26-111-ZT
|
Facility
|
OP
|
$36,717.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,015.25 |
| Max. Negotiated Rate |
$35,248.80 |
| Rate for Payer: Aetna Commercial |
$28,272.47
|
| Rate for Payer: Anthem Medicaid |
$12,627.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,639.65
|
| Rate for Payer: Cash Price |
$18,358.75
|
| Rate for Payer: Cigna Commercial |
$30,475.53
|
| Rate for Payer: First Health Commercial |
$34,881.62
|
| Rate for Payer: Humana Commercial |
$31,209.88
|
| Rate for Payer: Humana KY Medicaid |
$12,627.15
|
| Rate for Payer: Kentucky WC Medicaid |
$12,755.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,108.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,097.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,015.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,880.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,311.40
|
| Rate for Payer: Ohio Health Group HMO |
$27,538.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,374.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,944.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,335.08
|
| Rate for Payer: PHCS Commercial |
$35,248.80
|
| Rate for Payer: United Healthcare All Payer |
$32,311.40
|
|
|
GFT Z MAIN BODY TFFB-26-125-ZT
|
Facility
|
OP
|
$37,670.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,301.00 |
| Max. Negotiated Rate |
$36,163.20 |
| Rate for Payer: Aetna Commercial |
$29,005.90
|
| Rate for Payer: Anthem Medicaid |
$12,954.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,382.60
|
| Rate for Payer: Cash Price |
$18,835.00
|
| Rate for Payer: Cigna Commercial |
$31,266.10
|
| Rate for Payer: First Health Commercial |
$35,786.50
|
| Rate for Payer: Humana Commercial |
$32,019.50
|
| Rate for Payer: Humana KY Medicaid |
$12,954.71
|
| Rate for Payer: Kentucky WC Medicaid |
$13,086.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,889.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,800.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,214.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,149.60
|
| Rate for Payer: Ohio Health Group HMO |
$28,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,772.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,992.30
|
| Rate for Payer: PHCS Commercial |
$36,163.20
|
| Rate for Payer: United Healthcare All Payer |
$33,149.60
|
|
|
GFT Z MAIN BODY TFFB-26-125-ZT
|
Facility
|
IP
|
$37,670.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,301.00 |
| Max. Negotiated Rate |
$36,163.20 |
| Rate for Payer: Aetna Commercial |
$29,005.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,382.60
|
| Rate for Payer: Cash Price |
$18,835.00
|
| Rate for Payer: Cigna Commercial |
$31,266.10
|
| Rate for Payer: First Health Commercial |
$35,786.50
|
| Rate for Payer: Humana Commercial |
$32,019.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,889.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,800.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,149.60
|
| Rate for Payer: Ohio Health Group HMO |
$28,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,772.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,992.30
|
| Rate for Payer: PHCS Commercial |
$36,163.20
|
| Rate for Payer: United Healthcare All Payer |
$33,149.60
|
|
|
GFT Z MAIN BODY TFFB-26-140-ZT
|
Facility
|
OP
|
$37,670.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,301.00 |
| Max. Negotiated Rate |
$36,163.20 |
| Rate for Payer: Aetna Commercial |
$29,005.90
|
| Rate for Payer: Anthem Medicaid |
$12,954.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,382.60
|
| Rate for Payer: Cash Price |
$18,835.00
|
| Rate for Payer: Cigna Commercial |
$31,266.10
|
| Rate for Payer: First Health Commercial |
$35,786.50
|
| Rate for Payer: Humana Commercial |
$32,019.50
|
| Rate for Payer: Humana KY Medicaid |
$12,954.71
|
| Rate for Payer: Kentucky WC Medicaid |
$13,086.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,889.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,800.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,214.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,149.60
|
| Rate for Payer: Ohio Health Group HMO |
$28,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,772.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,992.30
|
| Rate for Payer: PHCS Commercial |
$36,163.20
|
| Rate for Payer: United Healthcare All Payer |
$33,149.60
|
|
|
GFT Z MAIN BODY TFFB-26-140-ZT
|
Facility
|
IP
|
$37,670.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,301.00 |
| Max. Negotiated Rate |
$36,163.20 |
| Rate for Payer: Aetna Commercial |
$29,005.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,382.60
|
| Rate for Payer: Cash Price |
$18,835.00
|
| Rate for Payer: Cigna Commercial |
$31,266.10
|
| Rate for Payer: First Health Commercial |
$35,786.50
|
| Rate for Payer: Humana Commercial |
$32,019.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,889.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,800.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,149.60
|
| Rate for Payer: Ohio Health Group HMO |
$28,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,772.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,992.30
|
| Rate for Payer: PHCS Commercial |
$36,163.20
|
| Rate for Payer: United Healthcare All Payer |
$33,149.60
|
|
|
GFT Z MAIN BODY TFFB-28-111-ZT
|
Facility
|
OP
|
$69,810.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,943.12 |
| Max. Negotiated Rate |
$67,017.98 |
| Rate for Payer: Aetna Commercial |
$53,754.01
|
| Rate for Payer: Anthem Medicaid |
$24,007.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,452.11
|
| Rate for Payer: Cash Price |
$34,905.20
|
| Rate for Payer: Cigna Commercial |
$57,942.63
|
| Rate for Payer: First Health Commercial |
$66,319.88
|
| Rate for Payer: Humana Commercial |
$59,338.84
|
| Rate for Payer: Humana KY Medicaid |
$24,007.80
|
| Rate for Payer: Kentucky WC Medicaid |
$24,252.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,244.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,520.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,943.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,489.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,433.15
|
| Rate for Payer: Ohio Health Group HMO |
$52,357.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55,848.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60,735.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,169.18
|
| Rate for Payer: PHCS Commercial |
$67,017.98
|
| Rate for Payer: United Healthcare All Payer |
$61,433.15
|
|
|
GFT Z MAIN BODY TFFB-28-111-ZT
|
Facility
|
IP
|
$69,810.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,943.12 |
| Max. Negotiated Rate |
$67,017.98 |
| Rate for Payer: Aetna Commercial |
$53,754.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,452.11
|
| Rate for Payer: Cash Price |
$34,905.20
|
| Rate for Payer: Cigna Commercial |
$57,942.63
|
| Rate for Payer: First Health Commercial |
$66,319.88
|
| Rate for Payer: Humana Commercial |
$59,338.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,244.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,520.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,943.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,433.15
|
| Rate for Payer: Ohio Health Group HMO |
$52,357.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55,848.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60,735.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,169.18
|
| Rate for Payer: PHCS Commercial |
$67,017.98
|
| Rate for Payer: United Healthcare All Payer |
$61,433.15
|
|
|
GFT Z MAIN BODY TFFB-28-125-ZT
|
Facility
|
IP
|
$37,670.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,301.00 |
| Max. Negotiated Rate |
$36,163.20 |
| Rate for Payer: Aetna Commercial |
$29,005.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,382.60
|
| Rate for Payer: Cash Price |
$18,835.00
|
| Rate for Payer: Cigna Commercial |
$31,266.10
|
| Rate for Payer: First Health Commercial |
$35,786.50
|
| Rate for Payer: Humana Commercial |
$32,019.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,889.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,800.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,149.60
|
| Rate for Payer: Ohio Health Group HMO |
$28,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,772.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,992.30
|
| Rate for Payer: PHCS Commercial |
$36,163.20
|
| Rate for Payer: United Healthcare All Payer |
$33,149.60
|
|
|
GFT Z MAIN BODY TFFB-28-125-ZT
|
Facility
|
OP
|
$37,670.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,301.00 |
| Max. Negotiated Rate |
$36,163.20 |
| Rate for Payer: Aetna Commercial |
$29,005.90
|
| Rate for Payer: Anthem Medicaid |
$12,954.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,382.60
|
| Rate for Payer: Cash Price |
$18,835.00
|
| Rate for Payer: Cigna Commercial |
$31,266.10
|
| Rate for Payer: First Health Commercial |
$35,786.50
|
| Rate for Payer: Humana Commercial |
$32,019.50
|
| Rate for Payer: Humana KY Medicaid |
$12,954.71
|
| Rate for Payer: Kentucky WC Medicaid |
$13,086.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,889.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,800.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,214.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,149.60
|
| Rate for Payer: Ohio Health Group HMO |
$28,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,772.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,992.30
|
| Rate for Payer: PHCS Commercial |
$36,163.20
|
| Rate for Payer: United Healthcare All Payer |
$33,149.60
|
|
|
GFT Z MAIN BODY TFFB-28-140-ZT
|
Facility
|
OP
|
$37,670.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,301.00 |
| Max. Negotiated Rate |
$36,163.20 |
| Rate for Payer: Aetna Commercial |
$29,005.90
|
| Rate for Payer: Anthem Medicaid |
$12,954.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,382.60
|
| Rate for Payer: Cash Price |
$18,835.00
|
| Rate for Payer: Cigna Commercial |
$31,266.10
|
| Rate for Payer: First Health Commercial |
$35,786.50
|
| Rate for Payer: Humana Commercial |
$32,019.50
|
| Rate for Payer: Humana KY Medicaid |
$12,954.71
|
| Rate for Payer: Kentucky WC Medicaid |
$13,086.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,889.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,800.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,301.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,214.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,149.60
|
| Rate for Payer: Ohio Health Group HMO |
$28,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,772.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,992.30
|
| Rate for Payer: PHCS Commercial |
$36,163.20
|
| Rate for Payer: United Healthcare All Payer |
$33,149.60
|
|
