|
GLIDEWIRE STD 0.35*180 STRGHT
|
Facility
|
IP
|
$778.65
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.22 |
| Max. Negotiated Rate |
$747.50 |
| Rate for Payer: Aetna Commercial |
$599.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$607.35
|
| Rate for Payer: Cash Price |
$389.32
|
| Rate for Payer: Cigna Commercial |
$646.28
|
| Rate for Payer: First Health Commercial |
$739.72
|
| Rate for Payer: Humana Commercial |
$661.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$638.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$574.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$685.21
|
| Rate for Payer: Ohio Health Group HMO |
$583.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.38
|
| Rate for Payer: PHCS Commercial |
$747.50
|
| Rate for Payer: United Healthcare All Payer |
$685.21
|
|
|
GLIDEWIRE STRAIGHT .035*180CM
|
Facility
|
OP
|
$786.39
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.23 |
| Max. Negotiated Rate |
$754.93 |
| Rate for Payer: Aetna Commercial |
$605.52
|
| Rate for Payer: Anthem Medicaid |
$270.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$613.38
|
| Rate for Payer: Cash Price |
$393.20
|
| Rate for Payer: Cigna Commercial |
$652.70
|
| Rate for Payer: First Health Commercial |
$747.07
|
| Rate for Payer: Humana Commercial |
$668.43
|
| Rate for Payer: Humana KY Medicaid |
$270.44
|
| Rate for Payer: Kentucky WC Medicaid |
$273.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$644.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$580.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$692.02
|
| Rate for Payer: Ohio Health Group HMO |
$589.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.78
|
| Rate for Payer: PHCS Commercial |
$754.93
|
| Rate for Payer: United Healthcare All Payer |
$692.02
|
|
|
GLIDEWIRE STRAIGHT .035*180CM
|
Facility
|
IP
|
$786.39
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.23 |
| Max. Negotiated Rate |
$754.93 |
| Rate for Payer: Aetna Commercial |
$605.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$613.38
|
| Rate for Payer: Cash Price |
$393.20
|
| Rate for Payer: Cigna Commercial |
$652.70
|
| Rate for Payer: First Health Commercial |
$747.07
|
| Rate for Payer: Humana Commercial |
$668.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$644.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$580.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$692.02
|
| Rate for Payer: Ohio Health Group HMO |
$589.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.78
|
| Rate for Payer: PHCS Commercial |
$754.93
|
| Rate for Payer: United Healthcare All Payer |
$692.02
|
|
|
GLOBAL ADVANTAGE CTA HD 44*18
|
Facility
|
IP
|
$11,942.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,552.50 |
| Max. Negotiated Rate |
$11,464.60 |
| Rate for Payer: Aetna Commercial |
$9,195.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,314.99
|
| Rate for Payer: Cash Price |
$5,971.14
|
| Rate for Payer: Cigna Commercial |
$9,912.10
|
| Rate for Payer: First Health Commercial |
$11,345.18
|
| Rate for Payer: Humana Commercial |
$10,150.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,792.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,813.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,509.22
|
| Rate for Payer: Ohio Health Group HMO |
$8,956.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,388.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,552.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,702.11
|
| Rate for Payer: PHCS Commercial |
$11,464.60
|
| Rate for Payer: United Healthcare All Payer |
$10,509.22
|
|
|
GLOBAL ADVANTAGE CTA HD 44*18
|
Facility
|
OP
|
$11,942.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,552.50 |
| Max. Negotiated Rate |
$11,464.60 |
| Rate for Payer: Aetna Commercial |
$9,195.56
|
| Rate for Payer: Anthem Medicaid |
$4,106.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,314.99
|
| Rate for Payer: Cash Price |
$5,971.14
|
| Rate for Payer: Cigna Commercial |
$9,912.10
|
| Rate for Payer: First Health Commercial |
$11,345.18
|
| Rate for Payer: Humana Commercial |
$10,150.95
|
| Rate for Payer: Humana KY Medicaid |
$4,106.95
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,792.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,813.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,189.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,509.22
|
| Rate for Payer: Ohio Health Group HMO |
$8,956.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,388.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,552.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,702.11
|
| Rate for Payer: PHCS Commercial |
$11,464.60
|
| Rate for Payer: United Healthcare All Payer |
$10,509.22
|
|
|
GLOBAL ADVANTAGE CTA HD 44*23
|
Facility
|
OP
|
$12,826.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,667.44 |
| Max. Negotiated Rate |
$12,313.44 |
| Rate for Payer: Aetna Commercial |
$9,876.40
|
| Rate for Payer: Anthem Medicaid |
$4,411.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,004.67
|
| Rate for Payer: Cash Price |
$6,413.25
|
| Rate for Payer: Cigna Commercial |
$10,646.00
|
| Rate for Payer: First Health Commercial |
$12,185.18
|
| Rate for Payer: Humana Commercial |
$10,902.52
|
| Rate for Payer: Humana KY Medicaid |
$4,411.03
|
| Rate for Payer: Kentucky WC Medicaid |
$4,455.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,517.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,465.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,847.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,499.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,287.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,619.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,565.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,667.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,976.22
|
| Rate for Payer: PHCS Commercial |
$12,313.44
|
| Rate for Payer: United Healthcare All Payer |
$11,287.32
|
|
|
GLOBAL ADVANTAGE CTA HD 44*23
|
Facility
|
IP
|
$12,826.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,667.44 |
| Max. Negotiated Rate |
$12,313.44 |
| Rate for Payer: Aetna Commercial |
$9,876.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,004.67
|
| Rate for Payer: Cash Price |
$6,413.25
|
| Rate for Payer: Cigna Commercial |
$10,646.00
|
| Rate for Payer: First Health Commercial |
$12,185.18
|
| Rate for Payer: Humana Commercial |
$10,902.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,517.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,465.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,847.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,287.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,619.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,565.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,667.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,976.22
|
| Rate for Payer: PHCS Commercial |
$12,313.44
|
| Rate for Payer: United Healthcare All Payer |
$11,287.32
|
|
|
GLOBAL ADVANTAGE CTA HD 48*18
|
Facility
|
OP
|
$18,011.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,341.53 |
| Max. Negotiated Rate |
$17,291.33 |
| Rate for Payer: Aetna Commercial |
$13,869.09
|
| Rate for Payer: Anthem Medicaid |
$6,194.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,049.20
|
| Rate for Payer: Cash Price |
$9,005.90
|
| Rate for Payer: Cigna Commercial |
$14,949.79
|
| Rate for Payer: First Health Commercial |
$17,111.21
|
| Rate for Payer: Humana Commercial |
$15,310.03
|
| Rate for Payer: Humana KY Medicaid |
$6,194.26
|
| Rate for Payer: Kentucky WC Medicaid |
$6,257.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,769.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,292.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,403.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,318.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,850.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,508.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,602.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,341.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,583.66
|
| Rate for Payer: PHCS Commercial |
$17,291.33
|
| Rate for Payer: United Healthcare All Payer |
$15,850.38
|
|
|
GLOBAL ADVANTAGE CTA HD 48*18
|
Facility
|
IP
|
$18,011.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,341.53 |
| Max. Negotiated Rate |
$17,291.33 |
| Rate for Payer: Aetna Commercial |
$13,869.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,049.20
|
| Rate for Payer: Cash Price |
$9,005.90
|
| Rate for Payer: Cigna Commercial |
$14,949.79
|
| Rate for Payer: First Health Commercial |
$17,111.21
|
| Rate for Payer: Humana Commercial |
$15,310.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,769.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,292.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,403.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,850.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,508.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,602.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,341.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,583.66
|
| Rate for Payer: PHCS Commercial |
$17,291.33
|
| Rate for Payer: United Healthcare All Payer |
$15,850.38
|
|
|
GLOBAL ADVANTAGE CTA HD 52*18
|
Facility
|
IP
|
$18,011.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,341.53 |
| Max. Negotiated Rate |
$17,291.33 |
| Rate for Payer: Aetna Commercial |
$13,869.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,049.20
|
| Rate for Payer: Cash Price |
$9,005.90
|
| Rate for Payer: Cigna Commercial |
$14,949.79
|
| Rate for Payer: First Health Commercial |
$17,111.21
|
| Rate for Payer: Humana Commercial |
$15,310.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,769.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,292.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,403.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,850.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,508.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,602.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,341.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,583.66
|
| Rate for Payer: PHCS Commercial |
$17,291.33
|
| Rate for Payer: United Healthcare All Payer |
$15,850.38
|
|
|
GLOBAL ADVANTAGE CTA HD 52*18
|
Facility
|
OP
|
$18,011.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,341.53 |
| Max. Negotiated Rate |
$17,291.33 |
| Rate for Payer: Aetna Commercial |
$13,869.09
|
| Rate for Payer: Anthem Medicaid |
$6,194.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,049.20
|
| Rate for Payer: Cash Price |
$9,005.90
|
| Rate for Payer: Cigna Commercial |
$14,949.79
|
| Rate for Payer: First Health Commercial |
$17,111.21
|
| Rate for Payer: Humana Commercial |
$15,310.03
|
| Rate for Payer: Humana KY Medicaid |
$6,194.26
|
| Rate for Payer: Kentucky WC Medicaid |
$6,257.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,769.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,292.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,403.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,318.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,850.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,508.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,602.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,341.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,583.66
|
| Rate for Payer: PHCS Commercial |
$17,291.33
|
| Rate for Payer: United Healthcare All Payer |
$15,850.38
|
|
|
GLOBAL ADVANTAGE CTA HD 52*23
|
Facility
|
OP
|
$20,787.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,702.31 |
| Max. Negotiated Rate |
$19,955.52 |
| Rate for Payer: Aetna Commercial |
$16,005.99
|
| Rate for Payer: Anthem Medicaid |
$7,148.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,213.86
|
| Rate for Payer: Cash Price |
$10,393.50
|
| Rate for Payer: Cigna Commercial |
$17,253.21
|
| Rate for Payer: First Health Commercial |
$19,747.65
|
| Rate for Payer: Humana Commercial |
$17,668.95
|
| Rate for Payer: Humana KY Medicaid |
$7,148.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,221.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,045.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,340.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,236.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,292.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,292.56
|
| Rate for Payer: Ohio Health Group HMO |
$15,590.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,157.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,702.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,443.97
|
| Rate for Payer: PHCS Commercial |
$19,955.52
|
| Rate for Payer: United Healthcare All Payer |
$18,292.56
|
|
|
GLOBAL ADVANTAGE CTA HD 52*23
|
Facility
|
IP
|
$20,787.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,702.31 |
| Max. Negotiated Rate |
$19,955.52 |
| Rate for Payer: Aetna Commercial |
$16,005.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,213.86
|
| Rate for Payer: Cash Price |
$10,393.50
|
| Rate for Payer: Cigna Commercial |
$17,253.21
|
| Rate for Payer: First Health Commercial |
$19,747.65
|
| Rate for Payer: Humana Commercial |
$17,668.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,045.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,340.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,236.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,292.56
|
| Rate for Payer: Ohio Health Group HMO |
$15,590.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,157.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,702.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,443.97
|
| Rate for Payer: PHCS Commercial |
$19,955.52
|
| Rate for Payer: United Healthcare All Payer |
$18,292.56
|
|
|
GLOBAL ADVANTAGE CTA HD 56*18
|
Facility
|
IP
|
$11,942.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,552.50 |
| Max. Negotiated Rate |
$11,464.60 |
| Rate for Payer: Aetna Commercial |
$9,195.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,314.99
|
| Rate for Payer: Cash Price |
$5,971.14
|
| Rate for Payer: Cigna Commercial |
$9,912.10
|
| Rate for Payer: First Health Commercial |
$11,345.18
|
| Rate for Payer: Humana Commercial |
$10,150.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,792.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,813.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,509.22
|
| Rate for Payer: Ohio Health Group HMO |
$8,956.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,388.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,552.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,702.11
|
| Rate for Payer: PHCS Commercial |
$11,464.60
|
| Rate for Payer: United Healthcare All Payer |
$10,509.22
|
|
|
GLOBAL ADVANTAGE CTA HD 56*18
|
Facility
|
OP
|
$11,942.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,552.50 |
| Max. Negotiated Rate |
$11,464.60 |
| Rate for Payer: Aetna Commercial |
$9,195.56
|
| Rate for Payer: Anthem Medicaid |
$4,106.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,314.99
|
| Rate for Payer: Cash Price |
$5,971.14
|
| Rate for Payer: Cigna Commercial |
$9,912.10
|
| Rate for Payer: First Health Commercial |
$11,345.18
|
| Rate for Payer: Humana Commercial |
$10,150.95
|
| Rate for Payer: Humana KY Medicaid |
$4,106.95
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,792.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,813.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,189.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,509.22
|
| Rate for Payer: Ohio Health Group HMO |
$8,956.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,388.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,552.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,702.11
|
| Rate for Payer: PHCS Commercial |
$11,464.60
|
| Rate for Payer: United Healthcare All Payer |
$10,509.22
|
|
|
GLOBAL ADVANTAGE CTA HD 56*23
|
Facility
|
OP
|
$18,011.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,341.53 |
| Max. Negotiated Rate |
$17,291.33 |
| Rate for Payer: Aetna Commercial |
$13,869.09
|
| Rate for Payer: Anthem Medicaid |
$6,194.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,049.20
|
| Rate for Payer: Cash Price |
$9,005.90
|
| Rate for Payer: Cigna Commercial |
$14,949.79
|
| Rate for Payer: First Health Commercial |
$17,111.21
|
| Rate for Payer: Humana Commercial |
$15,310.03
|
| Rate for Payer: Humana KY Medicaid |
$6,194.26
|
| Rate for Payer: Kentucky WC Medicaid |
$6,257.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,769.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,292.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,403.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,318.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,850.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,508.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,602.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,341.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,583.66
|
| Rate for Payer: PHCS Commercial |
$17,291.33
|
| Rate for Payer: United Healthcare All Payer |
$15,850.38
|
|
|
GLOBAL ADVANTAGE CTA HD 56*23
|
Facility
|
IP
|
$18,011.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,341.53 |
| Max. Negotiated Rate |
$17,291.33 |
| Rate for Payer: Aetna Commercial |
$13,869.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,049.20
|
| Rate for Payer: Cash Price |
$9,005.90
|
| Rate for Payer: Cigna Commercial |
$14,949.79
|
| Rate for Payer: First Health Commercial |
$17,111.21
|
| Rate for Payer: Humana Commercial |
$15,310.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,769.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,292.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,403.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,850.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,508.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,602.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,341.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,583.66
|
| Rate for Payer: PHCS Commercial |
$17,291.33
|
| Rate for Payer: United Healthcare All Payer |
$15,850.38
|
|
|
GLOBAL ADVANTAGE CTS HD 48*23
|
Facility
|
IP
|
$11,942.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,552.50 |
| Max. Negotiated Rate |
$11,464.60 |
| Rate for Payer: Aetna Commercial |
$9,195.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,314.99
|
| Rate for Payer: Cash Price |
$5,971.14
|
| Rate for Payer: Cigna Commercial |
$9,912.10
|
| Rate for Payer: First Health Commercial |
$11,345.18
|
| Rate for Payer: Humana Commercial |
$10,150.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,792.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,813.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,509.22
|
| Rate for Payer: Ohio Health Group HMO |
$8,956.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,388.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,552.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,702.11
|
| Rate for Payer: PHCS Commercial |
$11,464.60
|
| Rate for Payer: United Healthcare All Payer |
$10,509.22
|
|
|
GLOBAL ADVANTAGE CTS HD 48*23
|
Facility
|
OP
|
$11,942.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,552.50 |
| Max. Negotiated Rate |
$11,464.60 |
| Rate for Payer: Aetna Commercial |
$9,195.56
|
| Rate for Payer: Anthem Medicaid |
$4,106.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,314.99
|
| Rate for Payer: Cash Price |
$5,971.14
|
| Rate for Payer: Cigna Commercial |
$9,912.10
|
| Rate for Payer: First Health Commercial |
$11,345.18
|
| Rate for Payer: Humana Commercial |
$10,150.95
|
| Rate for Payer: Humana KY Medicaid |
$4,106.95
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,792.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,813.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,189.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,509.22
|
| Rate for Payer: Ohio Health Group HMO |
$8,956.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,388.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,552.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,702.11
|
| Rate for Payer: PHCS Commercial |
$11,464.60
|
| Rate for Payer: United Healthcare All Payer |
$10,509.22
|
|
|
GLOBAL ADVANTAGE ECC HD 44*18
|
Facility
|
IP
|
$16,018.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.44 |
| Max. Negotiated Rate |
$15,378.05 |
| Rate for Payer: Aetna Commercial |
$12,334.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,494.66
|
| Rate for Payer: Cash Price |
$8,009.40
|
| Rate for Payer: Cigna Commercial |
$13,295.60
|
| Rate for Payer: First Health Commercial |
$15,217.86
|
| Rate for Payer: Humana Commercial |
$13,615.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,135.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,821.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,805.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,096.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,014.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,203.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,082.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,965.83
|
| Rate for Payer: PHCS Commercial |
$15,378.05
|
| Rate for Payer: United Healthcare All Payer |
$14,096.54
|
|
|
GLOBAL ADVANTAGE ECC HD 44*18
|
Facility
|
OP
|
$16,018.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.44 |
| Max. Negotiated Rate |
$15,378.05 |
| Rate for Payer: Aetna Commercial |
$12,334.48
|
| Rate for Payer: Anthem Medicaid |
$5,508.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,494.66
|
| Rate for Payer: Cash Price |
$8,009.40
|
| Rate for Payer: Cigna Commercial |
$13,295.60
|
| Rate for Payer: First Health Commercial |
$15,217.86
|
| Rate for Payer: Humana Commercial |
$13,615.98
|
| Rate for Payer: Humana KY Medicaid |
$5,508.87
|
| Rate for Payer: Kentucky WC Medicaid |
$5,564.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,135.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,821.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,805.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,619.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,096.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,014.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,203.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,082.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,965.83
|
| Rate for Payer: PHCS Commercial |
$15,378.05
|
| Rate for Payer: United Healthcare All Payer |
$14,096.54
|
|
|
GLOBAL ADVANTAGE ECC HD 44*21
|
Facility
|
IP
|
$15,565.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,023.48 |
| Max. Negotiated Rate |
$14,942.59 |
| Rate for Payer: Aetna Commercial |
$11,985.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,140.86
|
| Rate for Payer: Cash Price |
$7,782.60
|
| Rate for Payer: Cigna Commercial |
$12,919.12
|
| Rate for Payer: First Health Commercial |
$14,786.94
|
| Rate for Payer: Humana Commercial |
$13,230.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,763.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,487.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,669.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,697.38
|
| Rate for Payer: Ohio Health Group HMO |
$11,673.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,113.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,023.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,825.21
|
| Rate for Payer: PHCS Commercial |
$14,942.59
|
| Rate for Payer: United Healthcare All Payer |
$13,697.38
|
|
|
GLOBAL ADVANTAGE ECC HD 44*21
|
Facility
|
OP
|
$15,565.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,023.48 |
| Max. Negotiated Rate |
$14,942.59 |
| Rate for Payer: Aetna Commercial |
$11,985.20
|
| Rate for Payer: Anthem Medicaid |
$5,352.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,140.86
|
| Rate for Payer: Cash Price |
$7,782.60
|
| Rate for Payer: Cigna Commercial |
$12,919.12
|
| Rate for Payer: First Health Commercial |
$14,786.94
|
| Rate for Payer: Humana Commercial |
$13,230.42
|
| Rate for Payer: Humana KY Medicaid |
$5,352.87
|
| Rate for Payer: Kentucky WC Medicaid |
$5,407.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,763.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,487.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,669.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,460.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,697.38
|
| Rate for Payer: Ohio Health Group HMO |
$11,673.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,113.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,023.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,825.21
|
| Rate for Payer: PHCS Commercial |
$14,942.59
|
| Rate for Payer: United Healthcare All Payer |
$13,697.38
|
|
|
GLOBAL ADVANTAGE ECC HD 48*18
|
Facility
|
IP
|
$16,371.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,128.31 |
| Max. Negotiated Rate |
$15,716.74 |
| Rate for Payer: Aetna Commercial |
$12,606.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,769.85
|
| Rate for Payer: Cash Price |
$8,185.80
|
| Rate for Payer: Cigna Commercial |
$13,588.43
|
| Rate for Payer: First Health Commercial |
$15,553.02
|
| Rate for Payer: Humana Commercial |
$13,915.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,424.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,082.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,911.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,407.01
|
| Rate for Payer: Ohio Health Group HMO |
$12,278.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,274.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,128.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,075.20
|
| Rate for Payer: PHCS Commercial |
$15,716.74
|
| Rate for Payer: United Healthcare All Payer |
$14,407.01
|
|
|
GLOBAL ADVANTAGE ECC HD 48*18
|
Facility
|
OP
|
$16,371.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,128.31 |
| Max. Negotiated Rate |
$15,716.74 |
| Rate for Payer: Aetna Commercial |
$12,606.13
|
| Rate for Payer: Anthem Medicaid |
$5,630.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,769.85
|
| Rate for Payer: Cash Price |
$8,185.80
|
| Rate for Payer: Cigna Commercial |
$13,588.43
|
| Rate for Payer: First Health Commercial |
$15,553.02
|
| Rate for Payer: Humana Commercial |
$13,915.86
|
| Rate for Payer: Humana KY Medicaid |
$5,630.19
|
| Rate for Payer: Kentucky WC Medicaid |
$5,687.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,424.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,082.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,911.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,743.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,407.01
|
| Rate for Payer: Ohio Health Group HMO |
$12,278.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,274.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,128.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,075.20
|
| Rate for Payer: PHCS Commercial |
$15,716.74
|
| Rate for Payer: United Healthcare All Payer |
$14,407.01
|
|
