|
GLOBAL CAP HD 52X21
|
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 52X21
|
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 56X18
|
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 56X18
|
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 56X21
|
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 56X21
|
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 HE 48X21
|
Facility
|
IP
|
$25,462.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,310.14 |
| Max. Negotiated Rate |
$24,444.14 |
| Rate for Payer: Aetna Commercial |
$19,606.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,860.87
|
| Rate for Payer: Cash Price |
$12,731.33
|
| Rate for Payer: Cigna Commercial |
$21,134.00
|
| Rate for Payer: First Health Commercial |
$24,189.52
|
| Rate for Payer: Humana Commercial |
$21,643.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,879.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,791.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,638.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,407.13
|
| Rate for Payer: Ohio Health Group HMO |
$19,096.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,092.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,310.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,893.42
|
| Rate for Payer: PHCS Commercial |
$24,444.14
|
| Rate for Payer: United Healthcare All Payer |
$22,407.13
|
|
|
GLOBAL CAP HE 48X21
|
Facility
|
OP
|
$25,462.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,310.14 |
| Max. Negotiated Rate |
$24,444.14 |
| Rate for Payer: Aetna Commercial |
$19,606.24
|
| Rate for Payer: Anthem Medicaid |
$8,756.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,860.87
|
| Rate for Payer: Cash Price |
$12,731.33
|
| Rate for Payer: Cigna Commercial |
$21,134.00
|
| Rate for Payer: First Health Commercial |
$24,189.52
|
| Rate for Payer: Humana Commercial |
$21,643.25
|
| Rate for Payer: Humana KY Medicaid |
$8,756.61
|
| Rate for Payer: Kentucky WC Medicaid |
$8,845.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,879.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,791.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,638.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,932.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,407.13
|
| Rate for Payer: Ohio Health Group HMO |
$19,096.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,092.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,310.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,893.42
|
| Rate for Payer: PHCS Commercial |
$24,444.14
|
| Rate for Payer: United Healthcare All Payer |
$22,407.13
|
|
|
GLOBAL FX STEM 10MM
|
Facility
|
OP
|
$14,031.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,824.03 |
| Max. Negotiated Rate |
$13,469.76 |
| Rate for Payer: Aetna Commercial |
$10,803.87
|
| Rate for Payer: Anthem Medicaid |
$4,825.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,944.18
|
| Rate for Payer: Cash Price |
$7,015.50
|
| Rate for Payer: Cigna Commercial |
$11,645.73
|
| Rate for Payer: First Health Commercial |
$13,329.45
|
| Rate for Payer: Humana Commercial |
$11,926.35
|
| Rate for Payer: Humana KY Medicaid |
$4,825.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,874.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,505.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,354.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,209.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,922.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,347.28
|
| Rate for Payer: Ohio Health Group HMO |
$10,523.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,806.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,824.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,349.61
|
| Rate for Payer: PHCS Commercial |
$13,469.76
|
| Rate for Payer: United Healthcare All Payer |
$12,347.28
|
|
|
GLOBAL FX STEM 10MM
|
Facility
|
IP
|
$14,031.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,824.03 |
| Max. Negotiated Rate |
$13,469.76 |
| Rate for Payer: Aetna Commercial |
$10,803.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,944.18
|
| Rate for Payer: Cash Price |
$7,015.50
|
| Rate for Payer: Cigna Commercial |
$11,645.73
|
| Rate for Payer: First Health Commercial |
$13,329.45
|
| Rate for Payer: Humana Commercial |
$11,926.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,505.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,354.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,209.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,347.28
|
| Rate for Payer: Ohio Health Group HMO |
$10,523.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,806.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,824.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,349.61
|
| Rate for Payer: PHCS Commercial |
$13,469.76
|
| Rate for Payer: United Healthcare All Payer |
$12,347.28
|
|
|
GLOBAL FX STEM 10MM LONG
|
Facility
|
IP
|
$20,586.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,676.21 |
| Max. Negotiated Rate |
$19,762.80 |
| Rate for Payer: Aetna Commercial |
$15,851.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,057.28
|
| Rate for Payer: Cash Price |
$10,293.12
|
| Rate for Payer: Cigna Commercial |
$17,086.59
|
| Rate for Payer: First Health Commercial |
$19,556.94
|
| Rate for Payer: Humana Commercial |
$17,498.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,880.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,192.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,175.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,115.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,439.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,117.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,381.74
|
| Rate for Payer: PHCS Commercial |
$19,762.80
|
| Rate for Payer: United Healthcare All Payer |
$18,115.90
|
|
|
GLOBAL FX STEM 10MM LONG
|
Facility
|
OP
|
$20,586.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,676.21 |
| Max. Negotiated Rate |
$19,762.80 |
| Rate for Payer: Aetna Commercial |
$15,851.41
|
| Rate for Payer: Anthem Medicaid |
$7,079.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,057.28
|
| Rate for Payer: Cash Price |
$10,293.12
|
| Rate for Payer: Cigna Commercial |
$17,086.59
|
| Rate for Payer: First Health Commercial |
$19,556.94
|
| Rate for Payer: Humana Commercial |
$17,498.31
|
| Rate for Payer: Humana KY Medicaid |
$7,079.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,151.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,880.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,192.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,175.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,221.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,115.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,439.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,117.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,381.74
|
| Rate for Payer: PHCS Commercial |
$19,762.80
|
| Rate for Payer: United Healthcare All Payer |
$18,115.90
|
|
|
GLOBAL FX STEM 12MM
|
Facility
|
IP
|
$14,031.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,824.03 |
| Max. Negotiated Rate |
$13,469.76 |
| Rate for Payer: Aetna Commercial |
$10,803.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,944.18
|
| Rate for Payer: Cash Price |
$7,015.50
|
| Rate for Payer: Cigna Commercial |
$11,645.73
|
| Rate for Payer: First Health Commercial |
$13,329.45
|
| Rate for Payer: Humana Commercial |
$11,926.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,505.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,354.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,209.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,347.28
|
| Rate for Payer: Ohio Health Group HMO |
$10,523.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,806.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,824.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,349.61
|
| Rate for Payer: PHCS Commercial |
$13,469.76
|
| Rate for Payer: United Healthcare All Payer |
$12,347.28
|
|
|
GLOBAL FX STEM 12MM
|
Facility
|
OP
|
$14,031.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,824.03 |
| Max. Negotiated Rate |
$13,469.76 |
| Rate for Payer: Aetna Commercial |
$10,803.87
|
| Rate for Payer: Anthem Medicaid |
$4,825.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,944.18
|
| Rate for Payer: Cash Price |
$7,015.50
|
| Rate for Payer: Cigna Commercial |
$11,645.73
|
| Rate for Payer: First Health Commercial |
$13,329.45
|
| Rate for Payer: Humana Commercial |
$11,926.35
|
| Rate for Payer: Humana KY Medicaid |
$4,825.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,874.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,505.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,354.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,209.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,922.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,347.28
|
| Rate for Payer: Ohio Health Group HMO |
$10,523.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,806.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,824.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,349.61
|
| Rate for Payer: PHCS Commercial |
$13,469.76
|
| Rate for Payer: United Healthcare All Payer |
$12,347.28
|
|
|
GLOBAL FX STEM 12MM LONG
|
Facility
|
IP
|
$20,586.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,676.21 |
| Max. Negotiated Rate |
$19,762.80 |
| Rate for Payer: Aetna Commercial |
$15,851.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,057.28
|
| Rate for Payer: Cash Price |
$10,293.12
|
| Rate for Payer: Cigna Commercial |
$17,086.59
|
| Rate for Payer: First Health Commercial |
$19,556.94
|
| Rate for Payer: Humana Commercial |
$17,498.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,880.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,192.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,175.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,115.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,439.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,117.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,381.74
|
| Rate for Payer: PHCS Commercial |
$19,762.80
|
| Rate for Payer: United Healthcare All Payer |
$18,115.90
|
|
|
GLOBAL FX STEM 12MM LONG
|
Facility
|
OP
|
$20,586.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,676.21 |
| Max. Negotiated Rate |
$19,762.80 |
| Rate for Payer: Aetna Commercial |
$15,851.41
|
| Rate for Payer: Anthem Medicaid |
$7,079.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,057.28
|
| Rate for Payer: Cash Price |
$10,293.12
|
| Rate for Payer: Cigna Commercial |
$17,086.59
|
| Rate for Payer: First Health Commercial |
$19,556.94
|
| Rate for Payer: Humana Commercial |
$17,498.31
|
| Rate for Payer: Humana KY Medicaid |
$7,079.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,151.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,880.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,192.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,175.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,221.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,115.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,439.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,117.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,381.74
|
| Rate for Payer: PHCS Commercial |
$19,762.80
|
| Rate for Payer: United Healthcare All Payer |
$18,115.90
|
|
|
GLOBAL FX STEM 6MM
|
Facility
|
IP
|
$14,031.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,824.03 |
| Max. Negotiated Rate |
$13,469.76 |
| Rate for Payer: Aetna Commercial |
$10,803.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,944.18
|
| Rate for Payer: Cash Price |
$7,015.50
|
| Rate for Payer: Cigna Commercial |
$11,645.73
|
| Rate for Payer: First Health Commercial |
$13,329.45
|
| Rate for Payer: Humana Commercial |
$11,926.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,505.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,354.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,209.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,347.28
|
| Rate for Payer: Ohio Health Group HMO |
$10,523.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,806.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,824.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,349.61
|
| Rate for Payer: PHCS Commercial |
$13,469.76
|
| Rate for Payer: United Healthcare All Payer |
$12,347.28
|
|
|
GLOBAL FX STEM 6MM
|
Facility
|
OP
|
$14,031.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,824.03 |
| Max. Negotiated Rate |
$13,469.76 |
| Rate for Payer: Aetna Commercial |
$10,803.87
|
| Rate for Payer: Anthem Medicaid |
$4,825.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,944.18
|
| Rate for Payer: Cash Price |
$7,015.50
|
| Rate for Payer: Cigna Commercial |
$11,645.73
|
| Rate for Payer: First Health Commercial |
$13,329.45
|
| Rate for Payer: Humana Commercial |
$11,926.35
|
| Rate for Payer: Humana KY Medicaid |
$4,825.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,874.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,505.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,354.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,209.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,922.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,347.28
|
| Rate for Payer: Ohio Health Group HMO |
$10,523.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,806.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,824.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,349.61
|
| Rate for Payer: PHCS Commercial |
$13,469.76
|
| Rate for Payer: United Healthcare All Payer |
$12,347.28
|
|
|
GLOBAL FX STEM 6MM LONG
|
Facility
|
OP
|
$20,586.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,676.21 |
| Max. Negotiated Rate |
$19,762.80 |
| Rate for Payer: Aetna Commercial |
$15,851.41
|
| Rate for Payer: Anthem Medicaid |
$7,079.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,057.28
|
| Rate for Payer: Cash Price |
$10,293.12
|
| Rate for Payer: Cigna Commercial |
$17,086.59
|
| Rate for Payer: First Health Commercial |
$19,556.94
|
| Rate for Payer: Humana Commercial |
$17,498.31
|
| Rate for Payer: Humana KY Medicaid |
$7,079.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,151.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,880.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,192.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,175.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,221.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,115.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,439.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,117.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,381.74
|
| Rate for Payer: PHCS Commercial |
$19,762.80
|
| Rate for Payer: United Healthcare All Payer |
$18,115.90
|
|
|
GLOBAL FX STEM 6MM LONG
|
Facility
|
IP
|
$20,586.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,676.21 |
| Max. Negotiated Rate |
$19,762.80 |
| Rate for Payer: Aetna Commercial |
$15,851.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,057.28
|
| Rate for Payer: Cash Price |
$10,293.12
|
| Rate for Payer: Cigna Commercial |
$17,086.59
|
| Rate for Payer: First Health Commercial |
$19,556.94
|
| Rate for Payer: Humana Commercial |
$17,498.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,880.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,192.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,175.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,115.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,439.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,117.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,381.74
|
| Rate for Payer: PHCS Commercial |
$19,762.80
|
| Rate for Payer: United Healthcare All Payer |
$18,115.90
|
|
|
GLOBAL FX STEM 8MM
|
Facility
|
OP
|
$14,031.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,824.03 |
| Max. Negotiated Rate |
$13,469.76 |
| Rate for Payer: Aetna Commercial |
$10,803.87
|
| Rate for Payer: Anthem Medicaid |
$4,825.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,944.18
|
| Rate for Payer: Cash Price |
$7,015.50
|
| Rate for Payer: Cigna Commercial |
$11,645.73
|
| Rate for Payer: First Health Commercial |
$13,329.45
|
| Rate for Payer: Humana Commercial |
$11,926.35
|
| Rate for Payer: Humana KY Medicaid |
$4,825.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,874.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,505.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,354.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,209.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,922.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,347.28
|
| Rate for Payer: Ohio Health Group HMO |
$10,523.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,806.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,824.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,349.61
|
| Rate for Payer: PHCS Commercial |
$13,469.76
|
| Rate for Payer: United Healthcare All Payer |
$12,347.28
|
|
|
GLOBAL FX STEM 8MM
|
Facility
|
IP
|
$14,031.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,824.03 |
| Max. Negotiated Rate |
$13,469.76 |
| Rate for Payer: Aetna Commercial |
$10,803.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,944.18
|
| Rate for Payer: Cash Price |
$7,015.50
|
| Rate for Payer: Cigna Commercial |
$11,645.73
|
| Rate for Payer: First Health Commercial |
$13,329.45
|
| Rate for Payer: Humana Commercial |
$11,926.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,505.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,354.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,209.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,347.28
|
| Rate for Payer: Ohio Health Group HMO |
$10,523.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,806.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,824.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,349.61
|
| Rate for Payer: PHCS Commercial |
$13,469.76
|
| Rate for Payer: United Healthcare All Payer |
$12,347.28
|
|
|
GLOBAL FX STEM 8MM LONG
|
Facility
|
IP
|
$20,586.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,676.21 |
| Max. Negotiated Rate |
$19,762.80 |
| Rate for Payer: Aetna Commercial |
$15,851.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,057.28
|
| Rate for Payer: Cash Price |
$10,293.12
|
| Rate for Payer: Cigna Commercial |
$17,086.59
|
| Rate for Payer: First Health Commercial |
$19,556.94
|
| Rate for Payer: Humana Commercial |
$17,498.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,880.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,192.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,175.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,115.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,439.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,117.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,381.74
|
| Rate for Payer: PHCS Commercial |
$19,762.80
|
| Rate for Payer: United Healthcare All Payer |
$18,115.90
|
|
|
GLOBAL FX STEM 8MM LONG
|
Facility
|
OP
|
$20,586.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,676.21 |
| Max. Negotiated Rate |
$19,762.80 |
| Rate for Payer: Aetna Commercial |
$15,851.41
|
| Rate for Payer: Anthem Medicaid |
$7,079.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,057.28
|
| Rate for Payer: Cash Price |
$10,293.12
|
| Rate for Payer: Cigna Commercial |
$17,086.59
|
| Rate for Payer: First Health Commercial |
$19,556.94
|
| Rate for Payer: Humana Commercial |
$17,498.31
|
| Rate for Payer: Humana KY Medicaid |
$7,079.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,151.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,880.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,192.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,175.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,221.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,115.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,439.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,117.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,381.74
|
| Rate for Payer: PHCS Commercial |
$19,762.80
|
| Rate for Payer: United Healthcare All Payer |
$18,115.90
|
|
|
GLOBAL SHLDR GLENOD PEG SZ44
|
Facility
|
IP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
