|
GFT Z PRX T ZTEG-2PT-34-197-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-34-197-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-36-157-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-36-157-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
|
|
|
GFT Z PRX T ZTEG-2PT-36-197-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-36-197-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-38-152-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-38-152-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-38-202-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-38-202-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-40-158-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-40-158-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-40-208-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-40-208-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-42-158-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-42-158-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-42-208-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-42-208-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 RENU ANC AX1-2-26-113-ZT
|
Facility
|
IP
|
$29,427.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,828.25 |
| Max. Negotiated Rate |
$28,250.40 |
| Rate for Payer: Aetna Commercial |
$22,659.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,953.45
|
| Rate for Payer: Cash Price |
$14,713.75
|
| Rate for Payer: Cigna Commercial |
$24,424.83
|
| Rate for Payer: First Health Commercial |
$27,956.12
|
| Rate for Payer: Humana Commercial |
$25,013.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,130.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,717.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,828.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,896.20
|
| Rate for Payer: Ohio Health Group HMO |
$22,070.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,542.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,601.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,304.97
|
| Rate for Payer: PHCS Commercial |
$28,250.40
|
| Rate for Payer: United Healthcare All Payer |
$25,896.20
|
|
|
GFT Z RENU ANC AX1-2-26-113-ZT
|
Facility
|
OP
|
$29,427.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,828.25 |
| Max. Negotiated Rate |
$28,250.40 |
| Rate for Payer: Aetna Commercial |
$22,659.17
|
| Rate for Payer: Anthem Medicaid |
$10,120.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,953.45
|
| Rate for Payer: Cash Price |
$14,713.75
|
| Rate for Payer: Cigna Commercial |
$24,424.83
|
| Rate for Payer: First Health Commercial |
$27,956.12
|
| Rate for Payer: Humana Commercial |
$25,013.38
|
| Rate for Payer: Humana KY Medicaid |
$10,120.12
|
| Rate for Payer: Kentucky WC Medicaid |
$10,223.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,130.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,717.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,828.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,323.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,896.20
|
| Rate for Payer: Ohio Health Group HMO |
$22,070.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,542.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,601.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,304.97
|
| Rate for Payer: PHCS Commercial |
$28,250.40
|
| Rate for Payer: United Healthcare All Payer |
$25,896.20
|
|
|
GIAPREZA 2.5MG/ML VIAL (1ML)
|
Facility
|
IP
|
$3,515.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003082
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$1,054.50 |
| Max. Negotiated Rate |
$3,374.40 |
| Rate for Payer: Aetna Commercial |
$2,706.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,741.70
|
| Rate for Payer: Cash Price |
$1,757.50
|
| Rate for Payer: Cigna Commercial |
$2,917.45
|
| Rate for Payer: First Health Commercial |
$3,339.25
|
| Rate for Payer: Humana Commercial |
$2,987.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,882.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,594.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,054.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,093.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,636.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,812.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,058.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,425.35
|
| Rate for Payer: PHCS Commercial |
$3,374.40
|
| Rate for Payer: United Healthcare All Payer |
$3,093.20
|
|
|
GIAPREZA 2.5MG/ML VIAL (1ML)
|
Facility
|
OP
|
$3,515.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003082
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$1,054.50 |
| Max. Negotiated Rate |
$3,374.40 |
| Rate for Payer: Aetna Commercial |
$2,706.55
|
| Rate for Payer: Anthem Medicaid |
$1,208.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,741.70
|
| Rate for Payer: Cash Price |
$1,757.50
|
| Rate for Payer: Cigna Commercial |
$2,917.45
|
| Rate for Payer: First Health Commercial |
$3,339.25
|
| Rate for Payer: Humana Commercial |
$2,987.75
|
| Rate for Payer: Humana KY Medicaid |
$1,208.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,221.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,882.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,594.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,054.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,233.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,093.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,636.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,812.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,058.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,425.35
|
| Rate for Payer: PHCS Commercial |
$3,374.40
|
| Rate for Payer: United Healthcare All Payer |
$3,093.20
|
|
|
GIARDIA LAMBLIA DFA DETECTION
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 87269
|
| Hospital Charge Code |
30001342
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.61 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem Medicaid |
$13.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.61
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Humana KY Medicaid |
$13.61
|
| Rate for Payer: Humana Medicare Advantage |
$13.61
|
| Rate for Payer: Kentucky WC Medicaid |
$13.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.02
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
GIARDIA LAMBLIA DFA DETECTION
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 87269
|
| Hospital Charge Code |
30001342
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.57
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.02
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
GII CR DEEP FLEX INSRT S 7-8 9
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
