|
GFT Z MAIN BODY TFFB-28-140-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-30-111-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-30-111-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-30-125-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-30-125-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-30-140-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-30-140-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-32-125-ZT
|
Facility
|
OP
|
$38,648.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,594.62 |
| Max. Negotiated Rate |
$37,102.80 |
| Rate for Payer: Aetna Commercial |
$29,759.54
|
| Rate for Payer: Anthem Medicaid |
$13,291.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,146.03
|
| Rate for Payer: Cash Price |
$19,324.38
|
| Rate for Payer: Cigna Commercial |
$32,078.46
|
| Rate for Payer: First Health Commercial |
$36,716.31
|
| Rate for Payer: Humana Commercial |
$32,851.44
|
| Rate for Payer: Humana KY Medicaid |
$13,291.31
|
| Rate for Payer: Kentucky WC Medicaid |
$13,426.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,691.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,522.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,594.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,557.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,010.90
|
| Rate for Payer: Ohio Health Group HMO |
$28,986.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,919.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,624.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,667.64
|
| Rate for Payer: PHCS Commercial |
$37,102.80
|
| Rate for Payer: United Healthcare All Payer |
$34,010.90
|
|
|
GFT Z MAIN BODY TFFB-32-125-ZT
|
Facility
|
IP
|
$38,648.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,594.62 |
| Max. Negotiated Rate |
$37,102.80 |
| Rate for Payer: Aetna Commercial |
$29,759.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,146.03
|
| Rate for Payer: Cash Price |
$19,324.38
|
| Rate for Payer: Cigna Commercial |
$32,078.46
|
| Rate for Payer: First Health Commercial |
$36,716.31
|
| Rate for Payer: Humana Commercial |
$32,851.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,691.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,522.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,594.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,010.90
|
| Rate for Payer: Ohio Health Group HMO |
$28,986.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,919.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,624.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,667.64
|
| Rate for Payer: PHCS Commercial |
$37,102.80
|
| Rate for Payer: United Healthcare All Payer |
$34,010.90
|
|
|
GFT Z MAIN BODY TFFB-32-140-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-32-140-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-36-113-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-36-113-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-36-131-ZT
|
Facility
|
IP
|
$40,696.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,208.88 |
| Max. Negotiated Rate |
$39,068.40 |
| Rate for Payer: Aetna Commercial |
$31,336.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,743.08
|
| Rate for Payer: Cash Price |
$20,348.12
|
| Rate for Payer: Cigna Commercial |
$33,777.89
|
| Rate for Payer: First Health Commercial |
$38,661.44
|
| Rate for Payer: Humana Commercial |
$34,591.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,370.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,033.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,208.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,812.70
|
| Rate for Payer: Ohio Health Group HMO |
$30,522.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,557.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,405.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,080.41
|
| Rate for Payer: PHCS Commercial |
$39,068.40
|
| Rate for Payer: United Healthcare All Payer |
$35,812.70
|
|
|
GFT Z MAIN BODY TFFB-36-131-ZT
|
Facility
|
OP
|
$40,696.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,208.88 |
| Max. Negotiated Rate |
$39,068.40 |
| Rate for Payer: Aetna Commercial |
$31,336.11
|
| Rate for Payer: Anthem Medicaid |
$13,995.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,743.08
|
| Rate for Payer: Cash Price |
$20,348.12
|
| Rate for Payer: Cigna Commercial |
$33,777.89
|
| Rate for Payer: First Health Commercial |
$38,661.44
|
| Rate for Payer: Humana Commercial |
$34,591.81
|
| Rate for Payer: Humana KY Medicaid |
$13,995.44
|
| Rate for Payer: Kentucky WC Medicaid |
$14,137.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,370.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,033.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,208.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,276.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,812.70
|
| Rate for Payer: Ohio Health Group HMO |
$30,522.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,557.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,405.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,080.41
|
| Rate for Payer: PHCS Commercial |
$39,068.40
|
| Rate for Payer: United Healthcare All Payer |
$35,812.70
|
|
|
GFT Z MAIN BODY TFFB-36-149-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-36-149-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 MN BODY EX ESBE-32-58-ZT
|
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 MN BODY EX ESBE-32-58-ZT
|
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 PRX T ZTEG-2PT-32-160-US
|
Facility
|
OP
|
$72,820.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,846.00 |
| Max. Negotiated Rate |
$69,907.20 |
| Rate for Payer: Aetna Commercial |
$56,071.40
|
| Rate for Payer: Anthem Medicaid |
$25,042.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,799.60
|
| Rate for Payer: Cash Price |
$36,410.00
|
| Rate for Payer: Cigna Commercial |
$60,440.60
|
| Rate for Payer: First Health Commercial |
$69,179.00
|
| Rate for Payer: Humana Commercial |
$61,897.00
|
| Rate for Payer: Humana KY Medicaid |
$25,042.80
|
| Rate for Payer: Kentucky WC Medicaid |
$25,297.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,712.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,741.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,846.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,545.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,081.60
|
| Rate for Payer: Ohio Health Group HMO |
$54,615.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,353.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,245.80
|
| Rate for Payer: PHCS Commercial |
$69,907.20
|
| Rate for Payer: United Healthcare All Payer |
$64,081.60
|
|
|
GFT Z PRX T ZTEG-2PT-32-160-US
|
Facility
|
IP
|
$72,820.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,846.00 |
| Max. Negotiated Rate |
$69,907.20 |
| Rate for Payer: Aetna Commercial |
$56,071.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,799.60
|
| Rate for Payer: Cash Price |
$36,410.00
|
| Rate for Payer: Cigna Commercial |
$60,440.60
|
| Rate for Payer: First Health Commercial |
$69,179.00
|
| Rate for Payer: Humana Commercial |
$61,897.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,712.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,741.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,846.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,081.60
|
| Rate for Payer: Ohio Health Group HMO |
$54,615.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,353.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,245.80
|
| Rate for Payer: PHCS Commercial |
$69,907.20
|
| Rate for Payer: United Healthcare All Payer |
$64,081.60
|
|
|
GFT Z PRX T ZTEG-2PT-32-200-US
|
Facility
|
IP
|
$72,820.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,846.00 |
| Max. Negotiated Rate |
$69,907.20 |
| Rate for Payer: Aetna Commercial |
$56,071.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,799.60
|
| Rate for Payer: Cash Price |
$36,410.00
|
| Rate for Payer: Cigna Commercial |
$60,440.60
|
| Rate for Payer: First Health Commercial |
$69,179.00
|
| Rate for Payer: Humana Commercial |
$61,897.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,712.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,741.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,846.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,081.60
|
| Rate for Payer: Ohio Health Group HMO |
$54,615.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,353.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,245.80
|
| Rate for Payer: PHCS Commercial |
$69,907.20
|
| Rate for Payer: United Healthcare All Payer |
$64,081.60
|
|
|
GFT Z PRX T ZTEG-2PT-32-200-US
|
Facility
|
OP
|
$72,820.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,846.00 |
| Max. Negotiated Rate |
$69,907.20 |
| Rate for Payer: Aetna Commercial |
$56,071.40
|
| Rate for Payer: Anthem Medicaid |
$25,042.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,799.60
|
| Rate for Payer: Cash Price |
$36,410.00
|
| Rate for Payer: Cigna Commercial |
$60,440.60
|
| Rate for Payer: First Health Commercial |
$69,179.00
|
| Rate for Payer: Humana Commercial |
$61,897.00
|
| Rate for Payer: Humana KY Medicaid |
$25,042.80
|
| Rate for Payer: Kentucky WC Medicaid |
$25,297.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,712.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,741.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,846.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,545.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,081.60
|
| Rate for Payer: Ohio Health Group HMO |
$54,615.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,353.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,245.80
|
| Rate for Payer: PHCS Commercial |
$69,907.20
|
| Rate for Payer: United Healthcare All Payer |
$64,081.60
|
|
|
GFT Z PRX T ZTEG-2PT-34-157-US
|
Facility
|
IP
|
$72,820.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,846.00 |
| Max. Negotiated Rate |
$69,907.20 |
| Rate for Payer: Aetna Commercial |
$56,071.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,799.60
|
| Rate for Payer: Cash Price |
$36,410.00
|
| Rate for Payer: Cigna Commercial |
$60,440.60
|
| Rate for Payer: First Health Commercial |
$69,179.00
|
| Rate for Payer: Humana Commercial |
$61,897.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,712.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,741.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,846.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,081.60
|
| Rate for Payer: Ohio Health Group HMO |
$54,615.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,353.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,245.80
|
| Rate for Payer: PHCS Commercial |
$69,907.20
|
| Rate for Payer: United Healthcare All Payer |
$64,081.60
|
|
|
GFT Z PRX T ZTEG-2PT-34-157-US
|
Facility
|
OP
|
$72,820.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,846.00 |
| Max. Negotiated Rate |
$69,907.20 |
| Rate for Payer: Aetna Commercial |
$56,071.40
|
| Rate for Payer: Anthem Medicaid |
$25,042.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,799.60
|
| Rate for Payer: Cash Price |
$36,410.00
|
| Rate for Payer: Cigna Commercial |
$60,440.60
|
| Rate for Payer: First Health Commercial |
$69,179.00
|
| Rate for Payer: Humana Commercial |
$61,897.00
|
| Rate for Payer: Humana KY Medicaid |
$25,042.80
|
| Rate for Payer: Kentucky WC Medicaid |
$25,297.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,712.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,741.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,846.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,545.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,081.60
|
| Rate for Payer: Ohio Health Group HMO |
$54,615.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,353.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,245.80
|
| Rate for Payer: PHCS Commercial |
$69,907.20
|
| Rate for Payer: United Healthcare All Payer |
$64,081.60
|
|
