|
GLOBAL ADVANTAGE ECC HD 48*21
|
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 48*21
|
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 52*18
|
Facility
|
OP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem Medicaid |
$3,770.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Humana KY Medicaid |
$3,770.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,809.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,846.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
GLOBAL ADVANTAGE ECC HD 52*18
|
Facility
|
IP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
GLOBAL ADVANTAGE ECC HD 52*21
|
Facility
|
IP
|
$13,998.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,819.76 |
| Max. Negotiated Rate |
$13,438.22 |
| Rate for Payer: Aetna Commercial |
$10,778.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,918.56
|
| Rate for Payer: Cash Price |
$6,999.08
|
| Rate for Payer: Cigna Commercial |
$11,618.46
|
| Rate for Payer: First Health Commercial |
$13,298.24
|
| Rate for Payer: Humana Commercial |
$11,898.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,478.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,330.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,199.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,318.37
|
| Rate for Payer: Ohio Health Group HMO |
$10,498.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,799.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,819.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,339.43
|
| Rate for Payer: PHCS Commercial |
$13,438.22
|
| Rate for Payer: United Healthcare All Payer |
$12,318.37
|
|
|
GLOBAL ADVANTAGE ECC HD 52*21
|
Facility
|
OP
|
$13,998.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,819.76 |
| Max. Negotiated Rate |
$13,438.22 |
| Rate for Payer: Aetna Commercial |
$10,778.58
|
| Rate for Payer: Anthem Medicaid |
$4,813.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,918.56
|
| Rate for Payer: Cash Price |
$6,999.08
|
| Rate for Payer: Cigna Commercial |
$11,618.46
|
| Rate for Payer: First Health Commercial |
$13,298.24
|
| Rate for Payer: Humana Commercial |
$11,898.43
|
| Rate for Payer: Humana KY Medicaid |
$4,813.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,862.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,478.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,330.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,199.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,910.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,318.37
|
| Rate for Payer: Ohio Health Group HMO |
$10,498.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,799.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,819.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,339.43
|
| Rate for Payer: PHCS Commercial |
$13,438.22
|
| Rate for Payer: United Healthcare All Payer |
$12,318.37
|
|
|
GLOBAL ADVANTAGE ECC HD 56*18
|
Facility
|
OP
|
$15,396.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,001.48 |
| Max. Negotiated Rate |
$14,780.16 |
| Rate for Payer: Aetna Commercial |
$11,854.92
|
| Rate for Payer: Anthem Medicaid |
$5,294.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,008.88
|
| Rate for Payer: Cash Price |
$7,698.00
|
| Rate for Payer: Cigna Commercial |
$12,778.68
|
| Rate for Payer: First Health Commercial |
$14,626.20
|
| Rate for Payer: Humana Commercial |
$13,086.60
|
| Rate for Payer: Humana KY Medicaid |
$5,294.68
|
| Rate for Payer: Kentucky WC Medicaid |
$5,348.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,624.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,362.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,618.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,400.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,548.48
|
| Rate for Payer: Ohio Health Group HMO |
$11,547.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,079.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,001.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,772.76
|
| Rate for Payer: PHCS Commercial |
$14,780.16
|
| Rate for Payer: United Healthcare All Payer |
$13,548.48
|
|
|
GLOBAL ADVANTAGE ECC HD 56*18
|
Facility
|
IP
|
$15,396.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,001.48 |
| Max. Negotiated Rate |
$14,780.16 |
| Rate for Payer: Aetna Commercial |
$11,854.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,008.88
|
| Rate for Payer: Cash Price |
$7,698.00
|
| Rate for Payer: Cigna Commercial |
$12,778.68
|
| Rate for Payer: First Health Commercial |
$14,626.20
|
| Rate for Payer: Humana Commercial |
$13,086.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,624.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,362.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,618.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,548.48
|
| Rate for Payer: Ohio Health Group HMO |
$11,547.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,079.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,001.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,772.76
|
| Rate for Payer: PHCS Commercial |
$14,780.16
|
| Rate for Payer: United Healthcare All Payer |
$13,548.48
|
|
|
GLOBAL ADVANTAGE ECC HD 56*21
|
Facility
|
IP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GLOBAL ADVANTAGE ECC HD 56*21
|
Facility
|
OP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem Medicaid |
$2,403.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Humana KY Medicaid |
$2,403.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,427.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
GLOBAL ADVANTAGE HUM HD 40*15
|
Facility
|
IP
|
$10,037.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.93 |
| Max. Negotiated Rate |
$9,636.43 |
| Rate for Payer: Aetna Commercial |
$7,729.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,829.60
|
| Rate for Payer: Cash Price |
$5,018.98
|
| Rate for Payer: Cigna Commercial |
$8,331.50
|
| Rate for Payer: First Health Commercial |
$9,536.05
|
| Rate for Payer: Humana Commercial |
$8,532.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,231.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,408.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,011.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,833.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,528.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,007.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,111.76
|
| Rate for Payer: PHCS Commercial |
$9,636.43
|
| Rate for Payer: United Healthcare All Payer |
$8,833.40
|
|
|
GLOBAL ADVANTAGE HUM HD 40*15
|
Facility
|
OP
|
$10,037.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.93 |
| Max. Negotiated Rate |
$9,636.43 |
| Rate for Payer: Aetna Commercial |
$7,729.22
|
| Rate for Payer: Anthem Medicaid |
$3,452.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,829.60
|
| Rate for Payer: Cash Price |
$5,018.98
|
| Rate for Payer: Cigna Commercial |
$8,331.50
|
| Rate for Payer: First Health Commercial |
$9,536.05
|
| Rate for Payer: Humana Commercial |
$8,532.26
|
| Rate for Payer: Humana KY Medicaid |
$3,452.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,487.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,231.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,408.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,011.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,521.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,833.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,528.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,007.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,111.76
|
| Rate for Payer: PHCS Commercial |
$9,636.43
|
| Rate for Payer: United Healthcare All Payer |
$8,833.40
|
|
|
GLOBAL ADVANTAGE HUM HD 40*18
|
Facility
|
IP
|
$14,187.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,844.43 |
| Max. Negotiated Rate |
$13,620.43 |
| Rate for Payer: Aetna Commercial |
$10,924.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,066.60
|
| Rate for Payer: Cash Price |
$7,093.98
|
| Rate for Payer: Cigna Commercial |
$11,776.00
|
| Rate for Payer: First Health Commercial |
$13,478.55
|
| Rate for Payer: Humana Commercial |
$12,059.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,634.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,470.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,256.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,485.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,640.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,837.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,844.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,398.26
|
| Rate for Payer: PHCS Commercial |
$13,620.43
|
| Rate for Payer: United Healthcare All Payer |
$12,485.40
|
|
|
GLOBAL ADVANTAGE HUM HD 40*18
|
Facility
|
OP
|
$14,187.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,844.43 |
| Max. Negotiated Rate |
$13,620.43 |
| Rate for Payer: Aetna Commercial |
$10,924.72
|
| Rate for Payer: Anthem Medicaid |
$4,879.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,066.60
|
| Rate for Payer: Cash Price |
$7,093.98
|
| Rate for Payer: Cigna Commercial |
$11,776.00
|
| Rate for Payer: First Health Commercial |
$13,478.55
|
| Rate for Payer: Humana Commercial |
$12,059.76
|
| Rate for Payer: Humana KY Medicaid |
$4,879.24
|
| Rate for Payer: Kentucky WC Medicaid |
$4,928.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,634.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,470.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,256.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,977.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,485.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,640.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,837.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,844.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,398.26
|
| Rate for Payer: PHCS Commercial |
$13,620.43
|
| Rate for Payer: United Healthcare All Payer |
$12,485.40
|
|
|
GLOBAL ADVANTAGE HUM HD 40*21
|
Facility
|
OP
|
$13,563.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,763.29 |
| Max. Negotiated Rate |
$13,021.25 |
| Rate for Payer: Aetna Commercial |
$10,444.13
|
| Rate for Payer: Anthem Medicaid |
$4,664.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,579.76
|
| Rate for Payer: Cash Price |
$6,781.90
|
| Rate for Payer: Cigna Commercial |
$11,257.95
|
| Rate for Payer: First Health Commercial |
$12,885.61
|
| Rate for Payer: Humana Commercial |
$11,529.23
|
| Rate for Payer: Humana KY Medicaid |
$4,664.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,712.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,122.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,010.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,069.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,758.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,936.14
|
| Rate for Payer: Ohio Health Group HMO |
$10,172.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,712.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,763.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,204.78
|
| Rate for Payer: PHCS Commercial |
$13,021.25
|
| Rate for Payer: United Healthcare All Payer |
$11,936.14
|
|
|
GLOBAL ADVANTAGE HUM HD 40*21
|
Facility
|
IP
|
$13,563.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,763.29 |
| Max. Negotiated Rate |
$13,021.25 |
| Rate for Payer: Aetna Commercial |
$10,444.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,579.76
|
| Rate for Payer: Cash Price |
$6,781.90
|
| Rate for Payer: Cigna Commercial |
$11,257.95
|
| Rate for Payer: First Health Commercial |
$12,885.61
|
| Rate for Payer: Humana Commercial |
$11,529.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,122.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,010.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,069.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,936.14
|
| Rate for Payer: Ohio Health Group HMO |
$10,172.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,712.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,763.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,204.78
|
| Rate for Payer: PHCS Commercial |
$13,021.25
|
| Rate for Payer: United Healthcare All Payer |
$11,936.14
|
|
|
GLOBAL ADVANTAGE HUM HD 44*15
|
Facility
|
OP
|
$9,625.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,251.32 |
| Max. Negotiated Rate |
$9,240.48 |
| Rate for Payer: Aetna Commercial |
$7,411.64
|
| Rate for Payer: Anthem Medicaid |
$3,310.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,507.89
|
| Rate for Payer: Cash Price |
$4,812.75
|
| Rate for Payer: Cigna Commercial |
$7,989.16
|
| Rate for Payer: First Health Commercial |
$9,144.22
|
| Rate for Payer: Humana Commercial |
$8,181.68
|
| Rate for Payer: Humana KY Medicaid |
$3,310.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3,343.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,892.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,103.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,887.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,376.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,470.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,219.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,925.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,251.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,983.90
|
| Rate for Payer: PHCS Commercial |
$9,240.48
|
| Rate for Payer: United Healthcare All Payer |
$8,470.44
|
|
|
GLOBAL ADVANTAGE HUM HD 44*15
|
Facility
|
IP
|
$9,625.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,251.32 |
| Max. Negotiated Rate |
$9,240.48 |
| Rate for Payer: Aetna Commercial |
$7,411.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,507.89
|
| Rate for Payer: Cash Price |
$4,812.75
|
| Rate for Payer: Cigna Commercial |
$7,989.16
|
| Rate for Payer: First Health Commercial |
$9,144.22
|
| Rate for Payer: Humana Commercial |
$8,181.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,892.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,103.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,887.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,470.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,219.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,925.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,251.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,983.90
|
| Rate for Payer: PHCS Commercial |
$9,240.48
|
| Rate for Payer: United Healthcare All Payer |
$8,470.44
|
|
|
GLOBAL ADVANTAGE HUM HD 44*18
|
Facility
|
OP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem Medicaid |
$2,588.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Humana KY Medicaid |
$2,588.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,614.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,640.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
GLOBAL ADVANTAGE HUM HD 44*18
|
Facility
|
IP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
GLOBAL ADVANTAGE HUM HD 44*21
|
Facility
|
IP
|
$9,625.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,251.32 |
| Max. Negotiated Rate |
$9,240.48 |
| Rate for Payer: Aetna Commercial |
$7,411.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,507.89
|
| Rate for Payer: Cash Price |
$4,812.75
|
| Rate for Payer: Cigna Commercial |
$7,989.16
|
| Rate for Payer: First Health Commercial |
$9,144.22
|
| Rate for Payer: Humana Commercial |
$8,181.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,892.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,103.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,887.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,470.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,219.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,925.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,251.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,983.90
|
| Rate for Payer: PHCS Commercial |
$9,240.48
|
| Rate for Payer: United Healthcare All Payer |
$8,470.44
|
|
|
GLOBAL ADVANTAGE HUM HD 44*21
|
Facility
|
OP
|
$9,625.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,251.32 |
| Max. Negotiated Rate |
$9,240.48 |
| Rate for Payer: Aetna Commercial |
$7,411.64
|
| Rate for Payer: Anthem Medicaid |
$3,310.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,507.89
|
| Rate for Payer: Cash Price |
$4,812.75
|
| Rate for Payer: Cigna Commercial |
$7,989.16
|
| Rate for Payer: First Health Commercial |
$9,144.22
|
| Rate for Payer: Humana Commercial |
$8,181.68
|
| Rate for Payer: Humana KY Medicaid |
$3,310.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3,343.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,892.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,103.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,887.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,376.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,470.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,219.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,925.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,251.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,983.90
|
| Rate for Payer: PHCS Commercial |
$9,240.48
|
| Rate for Payer: United Healthcare All Payer |
$8,470.44
|
|
|
GLOBAL ADVANTAGE HUM HD 48*15
|
Facility
|
IP
|
$6,538.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$850.01 |
| Max. Negotiated Rate |
$6,276.97 |
| Rate for Payer: Aetna Commercial |
$5,034.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,100.04
|
| Rate for Payer: Cash Price |
$3,269.26
|
| Rate for Payer: Cigna Commercial |
$5,426.96
|
| Rate for Payer: First Health Commercial |
$6,211.58
|
| Rate for Payer: Humana Commercial |
$5,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,361.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,825.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,961.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,753.89
|
| Rate for Payer: Ohio Health Group HMO |
$4,903.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$850.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.94
|
| Rate for Payer: PHCS Commercial |
$6,276.97
|
| Rate for Payer: United Healthcare All Payer |
$5,753.89
|
|
|
GLOBAL ADVANTAGE HUM HD 48*15
|
Facility
|
OP
|
$6,538.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$850.01 |
| Max. Negotiated Rate |
$6,276.97 |
| Rate for Payer: Aetna Commercial |
$5,034.65
|
| Rate for Payer: Anthem Medicaid |
$2,248.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,100.04
|
| Rate for Payer: Cash Price |
$3,269.26
|
| Rate for Payer: Cigna Commercial |
$5,426.96
|
| Rate for Payer: First Health Commercial |
$6,211.58
|
| Rate for Payer: Humana Commercial |
$5,557.73
|
| Rate for Payer: Humana KY Medicaid |
$2,248.59
|
| Rate for Payer: Kentucky WC Medicaid |
$2,271.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,361.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,825.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,961.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,293.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,753.89
|
| Rate for Payer: Ohio Health Group HMO |
$4,903.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$850.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.94
|
| Rate for Payer: PHCS Commercial |
$6,276.97
|
| Rate for Payer: United Healthcare All Payer |
$5,753.89
|
|
|
GLOBAL ADVANTAGE HUM HD 48*18
|
Facility
|
IP
|
$10,037.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.93 |
| Max. Negotiated Rate |
$9,636.43 |
| Rate for Payer: Aetna Commercial |
$7,729.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,829.60
|
| Rate for Payer: Cash Price |
$5,018.98
|
| Rate for Payer: Cigna Commercial |
$8,331.50
|
| Rate for Payer: First Health Commercial |
$9,536.05
|
| Rate for Payer: Humana Commercial |
$8,532.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,231.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,408.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,011.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,833.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,528.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,007.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,111.76
|
| Rate for Payer: PHCS Commercial |
$9,636.43
|
| Rate for Payer: United Healthcare All Payer |
$8,833.40
|
|
