|
GLOBAL CAP CTA DUOFIX 44*18
|
Facility
|
IP
|
$29,948.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,893.30 |
| Max. Negotiated Rate |
$28,750.56 |
| Rate for Payer: Aetna Commercial |
$23,060.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,359.83
|
| Rate for Payer: Cash Price |
$14,974.25
|
| Rate for Payer: Cigna Commercial |
$24,857.26
|
| Rate for Payer: First Health Commercial |
$28,451.08
|
| Rate for Payer: Humana Commercial |
$25,456.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,557.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,101.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,984.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,354.68
|
| Rate for Payer: Ohio Health Group HMO |
$22,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,989.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,893.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,284.04
|
| Rate for Payer: PHCS Commercial |
$28,750.56
|
| Rate for Payer: United Healthcare All Payer |
$26,354.68
|
|
|
GLOBAL CAP CTA DUOFIX 48*18
|
Facility
|
IP
|
$29,948.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,893.30 |
| Max. Negotiated Rate |
$28,750.56 |
| Rate for Payer: Aetna Commercial |
$23,060.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,359.83
|
| Rate for Payer: Cash Price |
$14,974.25
|
| Rate for Payer: Cigna Commercial |
$24,857.26
|
| Rate for Payer: First Health Commercial |
$28,451.08
|
| Rate for Payer: Humana Commercial |
$25,456.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,557.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,101.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,984.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,354.68
|
| Rate for Payer: Ohio Health Group HMO |
$22,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,989.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,893.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,284.04
|
| Rate for Payer: PHCS Commercial |
$28,750.56
|
| Rate for Payer: United Healthcare All Payer |
$26,354.68
|
|
|
GLOBAL CAP CTA DUOFIX 48*18
|
Facility
|
OP
|
$29,948.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,893.30 |
| Max. Negotiated Rate |
$28,750.56 |
| Rate for Payer: Aetna Commercial |
$23,060.34
|
| Rate for Payer: Anthem Medicaid |
$10,299.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,359.83
|
| Rate for Payer: Cash Price |
$14,974.25
|
| Rate for Payer: Cigna Commercial |
$24,857.26
|
| Rate for Payer: First Health Commercial |
$28,451.08
|
| Rate for Payer: Humana Commercial |
$25,456.22
|
| Rate for Payer: Humana KY Medicaid |
$10,299.29
|
| Rate for Payer: Kentucky WC Medicaid |
$10,404.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,557.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,101.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,984.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,505.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,354.68
|
| Rate for Payer: Ohio Health Group HMO |
$22,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,989.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,893.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,284.04
|
| Rate for Payer: PHCS Commercial |
$28,750.56
|
| Rate for Payer: United Healthcare All Payer |
$26,354.68
|
|
|
GLOBAL CAP CTA DUOFIX 48*21
|
Facility
|
IP
|
$29,948.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,893.30 |
| Max. Negotiated Rate |
$28,750.56 |
| Rate for Payer: Aetna Commercial |
$23,060.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,359.83
|
| Rate for Payer: Cash Price |
$14,974.25
|
| Rate for Payer: Cigna Commercial |
$24,857.26
|
| Rate for Payer: First Health Commercial |
$28,451.08
|
| Rate for Payer: Humana Commercial |
$25,456.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,557.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,101.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,984.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,354.68
|
| Rate for Payer: Ohio Health Group HMO |
$22,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,989.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,893.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,284.04
|
| Rate for Payer: PHCS Commercial |
$28,750.56
|
| Rate for Payer: United Healthcare All Payer |
$26,354.68
|
|
|
GLOBAL CAP CTA DUOFIX 48*21
|
Facility
|
OP
|
$29,948.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,893.30 |
| Max. Negotiated Rate |
$28,750.56 |
| Rate for Payer: Aetna Commercial |
$23,060.34
|
| Rate for Payer: Anthem Medicaid |
$10,299.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,359.83
|
| Rate for Payer: Cash Price |
$14,974.25
|
| Rate for Payer: Cigna Commercial |
$24,857.26
|
| Rate for Payer: First Health Commercial |
$28,451.08
|
| Rate for Payer: Humana Commercial |
$25,456.22
|
| Rate for Payer: Humana KY Medicaid |
$10,299.29
|
| Rate for Payer: Kentucky WC Medicaid |
$10,404.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,557.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,101.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,984.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,505.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,354.68
|
| Rate for Payer: Ohio Health Group HMO |
$22,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,989.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,893.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,284.04
|
| Rate for Payer: PHCS Commercial |
$28,750.56
|
| Rate for Payer: United Healthcare All Payer |
$26,354.68
|
|
|
GLOBAL CAP CTA DUOFIX 52*18
|
Facility
|
OP
|
$29,948.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,893.30 |
| Max. Negotiated Rate |
$28,750.56 |
| Rate for Payer: Aetna Commercial |
$23,060.34
|
| Rate for Payer: Anthem Medicaid |
$10,299.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,359.83
|
| Rate for Payer: Cash Price |
$14,974.25
|
| Rate for Payer: Cigna Commercial |
$24,857.26
|
| Rate for Payer: First Health Commercial |
$28,451.08
|
| Rate for Payer: Humana Commercial |
$25,456.22
|
| Rate for Payer: Humana KY Medicaid |
$10,299.29
|
| Rate for Payer: Kentucky WC Medicaid |
$10,404.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,557.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,101.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,984.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,505.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,354.68
|
| Rate for Payer: Ohio Health Group HMO |
$22,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,989.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,893.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,284.04
|
| Rate for Payer: PHCS Commercial |
$28,750.56
|
| Rate for Payer: United Healthcare All Payer |
$26,354.68
|
|
|
GLOBAL CAP CTA DUOFIX 52*18
|
Facility
|
IP
|
$29,948.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,893.30 |
| Max. Negotiated Rate |
$28,750.56 |
| Rate for Payer: Aetna Commercial |
$23,060.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,359.83
|
| Rate for Payer: Cash Price |
$14,974.25
|
| Rate for Payer: Cigna Commercial |
$24,857.26
|
| Rate for Payer: First Health Commercial |
$28,451.08
|
| Rate for Payer: Humana Commercial |
$25,456.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,557.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,101.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,984.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,354.68
|
| Rate for Payer: Ohio Health Group HMO |
$22,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,989.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,893.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,284.04
|
| Rate for Payer: PHCS Commercial |
$28,750.56
|
| Rate for Payer: United Healthcare All Payer |
$26,354.68
|
|
|
GLOBAL CAP CTA DUOFIX 52*21
|
Facility
|
IP
|
$29,948.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,893.30 |
| Max. Negotiated Rate |
$28,750.56 |
| Rate for Payer: Aetna Commercial |
$23,060.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,359.83
|
| Rate for Payer: Cash Price |
$14,974.25
|
| Rate for Payer: Cigna Commercial |
$24,857.26
|
| Rate for Payer: First Health Commercial |
$28,451.08
|
| Rate for Payer: Humana Commercial |
$25,456.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,557.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,101.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,984.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,354.68
|
| Rate for Payer: Ohio Health Group HMO |
$22,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,989.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,893.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,284.04
|
| Rate for Payer: PHCS Commercial |
$28,750.56
|
| Rate for Payer: United Healthcare All Payer |
$26,354.68
|
|
|
GLOBAL CAP CTA DUOFIX 52*21
|
Facility
|
OP
|
$29,948.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,893.30 |
| Max. Negotiated Rate |
$28,750.56 |
| Rate for Payer: Aetna Commercial |
$23,060.34
|
| Rate for Payer: Anthem Medicaid |
$10,299.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,359.83
|
| Rate for Payer: Cash Price |
$14,974.25
|
| Rate for Payer: Cigna Commercial |
$24,857.26
|
| Rate for Payer: First Health Commercial |
$28,451.08
|
| Rate for Payer: Humana Commercial |
$25,456.22
|
| Rate for Payer: Humana KY Medicaid |
$10,299.29
|
| Rate for Payer: Kentucky WC Medicaid |
$10,404.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,557.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,101.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,984.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,505.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,354.68
|
| Rate for Payer: Ohio Health Group HMO |
$22,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,989.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,893.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,284.04
|
| Rate for Payer: PHCS Commercial |
$28,750.56
|
| Rate for Payer: United Healthcare All Payer |
$26,354.68
|
|
|
GLOBAL CAP CTA DUOFIX 56*18
|
Facility
|
OP
|
$29,948.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,893.30 |
| Max. Negotiated Rate |
$28,750.56 |
| Rate for Payer: Aetna Commercial |
$23,060.34
|
| Rate for Payer: Anthem Medicaid |
$10,299.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,359.83
|
| Rate for Payer: Cash Price |
$14,974.25
|
| Rate for Payer: Cigna Commercial |
$24,857.26
|
| Rate for Payer: First Health Commercial |
$28,451.08
|
| Rate for Payer: Humana Commercial |
$25,456.22
|
| Rate for Payer: Humana KY Medicaid |
$10,299.29
|
| Rate for Payer: Kentucky WC Medicaid |
$10,404.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,557.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,101.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,984.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,505.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,354.68
|
| Rate for Payer: Ohio Health Group HMO |
$22,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,989.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,893.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,284.04
|
| Rate for Payer: PHCS Commercial |
$28,750.56
|
| Rate for Payer: United Healthcare All Payer |
$26,354.68
|
|
|
GLOBAL CAP CTA DUOFIX 56*18
|
Facility
|
IP
|
$29,948.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,893.30 |
| Max. Negotiated Rate |
$28,750.56 |
| Rate for Payer: Aetna Commercial |
$23,060.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,359.83
|
| Rate for Payer: Cash Price |
$14,974.25
|
| Rate for Payer: Cigna Commercial |
$24,857.26
|
| Rate for Payer: First Health Commercial |
$28,451.08
|
| Rate for Payer: Humana Commercial |
$25,456.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,557.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,101.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,984.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,354.68
|
| Rate for Payer: Ohio Health Group HMO |
$22,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,989.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,893.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,284.04
|
| Rate for Payer: PHCS Commercial |
$28,750.56
|
| Rate for Payer: United Healthcare All Payer |
$26,354.68
|
|
|
GLOBAL CAP CTA DUOFIX 56*21
|
Facility
|
OP
|
$29,948.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,893.30 |
| Max. Negotiated Rate |
$28,750.56 |
| Rate for Payer: Aetna Commercial |
$23,060.34
|
| Rate for Payer: Anthem Medicaid |
$10,299.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,359.83
|
| Rate for Payer: Cash Price |
$14,974.25
|
| Rate for Payer: Cigna Commercial |
$24,857.26
|
| Rate for Payer: First Health Commercial |
$28,451.08
|
| Rate for Payer: Humana Commercial |
$25,456.22
|
| Rate for Payer: Humana KY Medicaid |
$10,299.29
|
| Rate for Payer: Kentucky WC Medicaid |
$10,404.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,557.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,101.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,984.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,505.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,354.68
|
| Rate for Payer: Ohio Health Group HMO |
$22,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,989.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,893.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,284.04
|
| Rate for Payer: PHCS Commercial |
$28,750.56
|
| Rate for Payer: United Healthcare All Payer |
$26,354.68
|
|
|
GLOBAL CAP CTA DUOFIX 56*21
|
Facility
|
IP
|
$29,948.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,893.30 |
| Max. Negotiated Rate |
$28,750.56 |
| Rate for Payer: Aetna Commercial |
$23,060.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,359.83
|
| Rate for Payer: Cash Price |
$14,974.25
|
| Rate for Payer: Cigna Commercial |
$24,857.26
|
| Rate for Payer: First Health Commercial |
$28,451.08
|
| Rate for Payer: Humana Commercial |
$25,456.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,557.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,101.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,984.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,354.68
|
| Rate for Payer: Ohio Health Group HMO |
$22,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,989.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,893.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,284.04
|
| Rate for Payer: PHCS Commercial |
$28,750.56
|
| Rate for Payer: United Healthcare All Payer |
$26,354.68
|
|
|
GLOBAL CAP HD 40X15
|
Facility
|
IP
|
$24,108.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,134.10 |
| Max. Negotiated Rate |
$23,144.16 |
| Rate for Payer: Aetna Commercial |
$18,563.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,804.63
|
| Rate for Payer: Cash Price |
$12,054.25
|
| Rate for Payer: Cigna Commercial |
$20,010.06
|
| Rate for Payer: First Health Commercial |
$22,903.08
|
| Rate for Payer: Humana Commercial |
$20,492.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,768.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,792.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,232.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,215.48
|
| Rate for Payer: Ohio Health Group HMO |
$18,081.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,821.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,134.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,473.64
|
| Rate for Payer: PHCS Commercial |
$23,144.16
|
| Rate for Payer: United Healthcare All Payer |
$21,215.48
|
|
|
GLOBAL CAP HD 40X15
|
Facility
|
OP
|
$24,108.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,134.10 |
| Max. Negotiated Rate |
$23,144.16 |
| Rate for Payer: Aetna Commercial |
$18,563.54
|
| Rate for Payer: Anthem Medicaid |
$8,290.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,804.63
|
| Rate for Payer: Cash Price |
$12,054.25
|
| Rate for Payer: Cigna Commercial |
$20,010.06
|
| Rate for Payer: First Health Commercial |
$22,903.08
|
| Rate for Payer: Humana Commercial |
$20,492.22
|
| Rate for Payer: Humana KY Medicaid |
$8,290.91
|
| Rate for Payer: Kentucky WC Medicaid |
$8,375.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,768.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,792.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,232.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,457.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,215.48
|
| Rate for Payer: Ohio Health Group HMO |
$18,081.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,821.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,134.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,473.64
|
| Rate for Payer: PHCS Commercial |
$23,144.16
|
| Rate for Payer: United Healthcare All Payer |
$21,215.48
|
|
|
GLOBAL CAP HD 40X18
|
Facility
|
IP
|
$24,108.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,134.10 |
| Max. Negotiated Rate |
$23,144.16 |
| Rate for Payer: Aetna Commercial |
$18,563.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,804.63
|
| Rate for Payer: Cash Price |
$12,054.25
|
| Rate for Payer: Cigna Commercial |
$20,010.06
|
| Rate for Payer: First Health Commercial |
$22,903.08
|
| Rate for Payer: Humana Commercial |
$20,492.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,768.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,792.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,232.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,215.48
|
| Rate for Payer: Ohio Health Group HMO |
$18,081.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,821.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,134.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,473.64
|
| Rate for Payer: PHCS Commercial |
$23,144.16
|
| Rate for Payer: United Healthcare All Payer |
$21,215.48
|
|
|
GLOBAL CAP HD 40X18
|
Facility
|
OP
|
$24,108.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,134.10 |
| Max. Negotiated Rate |
$23,144.16 |
| Rate for Payer: Aetna Commercial |
$18,563.54
|
| Rate for Payer: Anthem Medicaid |
$8,290.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,804.63
|
| Rate for Payer: Cash Price |
$12,054.25
|
| Rate for Payer: Cigna Commercial |
$20,010.06
|
| Rate for Payer: First Health Commercial |
$22,903.08
|
| Rate for Payer: Humana Commercial |
$20,492.22
|
| Rate for Payer: Humana KY Medicaid |
$8,290.91
|
| Rate for Payer: Kentucky WC Medicaid |
$8,375.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,768.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,792.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,232.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,457.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,215.48
|
| Rate for Payer: Ohio Health Group HMO |
$18,081.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,821.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,134.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,473.64
|
| Rate for Payer: PHCS Commercial |
$23,144.16
|
| Rate for Payer: United Healthcare All Payer |
$21,215.48
|
|
|
GLOBAL CAP HD 44X`15
|
Facility
|
IP
|
$24,108.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,134.10 |
| Max. Negotiated Rate |
$23,144.16 |
| Rate for Payer: Aetna Commercial |
$18,563.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,804.63
|
| Rate for Payer: Cash Price |
$12,054.25
|
| Rate for Payer: Cigna Commercial |
$20,010.06
|
| Rate for Payer: First Health Commercial |
$22,903.08
|
| Rate for Payer: Humana Commercial |
$20,492.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,768.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,792.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,232.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,215.48
|
| Rate for Payer: Ohio Health Group HMO |
$18,081.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,821.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,134.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,473.64
|
| Rate for Payer: PHCS Commercial |
$23,144.16
|
| Rate for Payer: United Healthcare All Payer |
$21,215.48
|
|
|
GLOBAL CAP HD 44X`15
|
Facility
|
OP
|
$24,108.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,134.10 |
| Max. Negotiated Rate |
$23,144.16 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,804.63
|
| Rate for Payer: Aetna Commercial |
$18,563.54
|
| Rate for Payer: Anthem Medicaid |
$8,290.91
|
| Rate for Payer: Cash Price |
$12,054.25
|
| Rate for Payer: Cigna Commercial |
$20,010.06
|
| Rate for Payer: First Health Commercial |
$22,903.08
|
| Rate for Payer: Humana Commercial |
$20,492.22
|
| Rate for Payer: Humana KY Medicaid |
$8,290.91
|
| Rate for Payer: Kentucky WC Medicaid |
$8,375.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,768.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,792.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,232.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,457.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,215.48
|
| Rate for Payer: Ohio Health Group HMO |
$18,081.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,821.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,134.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,473.64
|
| Rate for Payer: PHCS Commercial |
$23,144.16
|
| Rate for Payer: United Healthcare All Payer |
$21,215.48
|
|
|
GLOBAL CAP HD 44X18
|
Facility
|
OP
|
$28,714.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,732.92 |
| Max. Negotiated Rate |
$27,566.21 |
| Rate for Payer: Aetna Commercial |
$22,110.40
|
| Rate for Payer: Anthem Medicaid |
$9,875.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,397.54
|
| Rate for Payer: Cash Price |
$14,357.40
|
| Rate for Payer: Cigna Commercial |
$23,833.28
|
| Rate for Payer: First Health Commercial |
$27,279.06
|
| Rate for Payer: Humana Commercial |
$24,407.58
|
| Rate for Payer: Humana KY Medicaid |
$9,875.02
|
| Rate for Payer: Kentucky WC Medicaid |
$9,975.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,546.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,191.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,614.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,073.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,269.02
|
| Rate for Payer: Ohio Health Group HMO |
$21,536.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,742.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,732.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,901.59
|
| Rate for Payer: PHCS Commercial |
$27,566.21
|
| Rate for Payer: United Healthcare All Payer |
$25,269.02
|
|
|
GLOBAL CAP HD 44X18
|
Facility
|
IP
|
$28,714.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,732.92 |
| Max. Negotiated Rate |
$27,566.21 |
| Rate for Payer: Aetna Commercial |
$22,110.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,397.54
|
| Rate for Payer: Cash Price |
$14,357.40
|
| Rate for Payer: Cigna Commercial |
$23,833.28
|
| Rate for Payer: First Health Commercial |
$27,279.06
|
| Rate for Payer: Humana Commercial |
$24,407.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,546.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,191.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,614.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,269.02
|
| Rate for Payer: Ohio Health Group HMO |
$21,536.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,742.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,732.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,901.59
|
| Rate for Payer: PHCS Commercial |
$27,566.21
|
| Rate for Payer: United Healthcare All Payer |
$25,269.02
|
|
|
GLOBAL CAP HD 48X18
|
Facility
|
OP
|
$26,702.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,471.31 |
| Max. Negotiated Rate |
$25,634.31 |
| Rate for Payer: Aetna Commercial |
$20,560.86
|
| Rate for Payer: Anthem Medicaid |
$9,182.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,827.88
|
| Rate for Payer: Cash Price |
$13,351.20
|
| Rate for Payer: Cigna Commercial |
$22,163.00
|
| Rate for Payer: First Health Commercial |
$25,367.29
|
| Rate for Payer: Humana Commercial |
$22,697.05
|
| Rate for Payer: Humana KY Medicaid |
$9,182.96
|
| Rate for Payer: Kentucky WC Medicaid |
$9,276.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,895.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,706.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,010.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,367.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,498.12
|
| Rate for Payer: Ohio Health Group HMO |
$20,026.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,340.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,471.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,277.75
|
| Rate for Payer: PHCS Commercial |
$25,634.31
|
| Rate for Payer: United Healthcare All Payer |
$23,498.12
|
|
|
GLOBAL CAP HD 48X18
|
Facility
|
IP
|
$26,702.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,471.31 |
| Max. Negotiated Rate |
$25,634.31 |
| Rate for Payer: Aetna Commercial |
$20,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,827.88
|
| Rate for Payer: Cash Price |
$13,351.20
|
| Rate for Payer: Cigna Commercial |
$22,163.00
|
| Rate for Payer: First Health Commercial |
$25,367.29
|
| Rate for Payer: Humana Commercial |
$22,697.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,895.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,706.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,010.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,498.12
|
| Rate for Payer: Ohio Health Group HMO |
$20,026.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,340.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,471.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,277.75
|
| Rate for Payer: PHCS Commercial |
$25,634.31
|
| Rate for Payer: United Healthcare All Payer |
$23,498.12
|
|
|
GLOBAL CAP HD 52X18
|
Facility
|
OP
|
$24,108.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,134.10 |
| Max. Negotiated Rate |
$23,144.16 |
| Rate for Payer: Aetna Commercial |
$18,563.54
|
| Rate for Payer: Anthem Medicaid |
$8,290.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,804.63
|
| Rate for Payer: Cash Price |
$12,054.25
|
| Rate for Payer: Cigna Commercial |
$20,010.06
|
| Rate for Payer: First Health Commercial |
$22,903.08
|
| Rate for Payer: Humana Commercial |
$20,492.22
|
| Rate for Payer: Humana KY Medicaid |
$8,290.91
|
| Rate for Payer: Kentucky WC Medicaid |
$8,375.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,768.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,792.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,232.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,457.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,215.48
|
| Rate for Payer: Ohio Health Group HMO |
$18,081.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,821.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,134.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,473.64
|
| Rate for Payer: PHCS Commercial |
$23,144.16
|
| Rate for Payer: United Healthcare All Payer |
$21,215.48
|
|
|
GLOBAL CAP HD 52X18
|
Facility
|
IP
|
$24,108.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,134.10 |
| Max. Negotiated Rate |
$23,144.16 |
| Rate for Payer: Aetna Commercial |
$18,563.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,804.63
|
| Rate for Payer: Cash Price |
$12,054.25
|
| Rate for Payer: Cigna Commercial |
$20,010.06
|
| Rate for Payer: First Health Commercial |
$22,903.08
|
| Rate for Payer: Humana Commercial |
$20,492.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,768.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,792.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,232.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,215.48
|
| Rate for Payer: Ohio Health Group HMO |
$18,081.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,821.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,134.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,473.64
|
| Rate for Payer: PHCS Commercial |
$23,144.16
|
| Rate for Payer: United Healthcare All Payer |
$21,215.48
|
|
