|
GLOBAL ADVANTAGE CTA HD 48*18
|
Facility
|
OP
|
$18,595.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,578.64 |
| Max. Negotiated Rate |
$17,851.64 |
| Rate for Payer: Aetna Commercial |
$14,318.50
|
| Rate for Payer: Anthem Medicaid |
$6,394.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,504.46
|
| Rate for Payer: Cash Price |
$9,297.73
|
| Rate for Payer: Cigna Commercial |
$15,434.23
|
| Rate for Payer: First Health Commercial |
$17,665.69
|
| Rate for Payer: Humana Commercial |
$15,806.14
|
| Rate for Payer: Humana KY Medicaid |
$6,394.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,460.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,248.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,723.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,578.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,523.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,946.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,876.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,178.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,830.87
|
| Rate for Payer: PHCS Commercial |
$17,851.64
|
| Rate for Payer: United Healthcare All Payer |
$16,364.00
|
|
|
GLOBAL ADVANTAGE CTA HD 52*18
|
Facility
|
OP
|
$18,595.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,578.64 |
| Max. Negotiated Rate |
$17,851.64 |
| Rate for Payer: Aetna Commercial |
$14,318.50
|
| Rate for Payer: Anthem Medicaid |
$6,394.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,504.46
|
| Rate for Payer: Cash Price |
$9,297.73
|
| Rate for Payer: Cigna Commercial |
$15,434.23
|
| Rate for Payer: First Health Commercial |
$17,665.69
|
| Rate for Payer: Humana Commercial |
$15,806.14
|
| Rate for Payer: Humana KY Medicaid |
$6,394.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,460.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,248.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,723.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,578.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,523.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,946.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,876.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,178.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,830.87
|
| Rate for Payer: PHCS Commercial |
$17,851.64
|
| Rate for Payer: United Healthcare All Payer |
$16,364.00
|
|
|
GLOBAL ADVANTAGE CTA HD 52*18
|
Facility
|
IP
|
$18,595.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,578.64 |
| Max. Negotiated Rate |
$17,851.64 |
| Rate for Payer: Aetna Commercial |
$14,318.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,504.46
|
| Rate for Payer: Cash Price |
$9,297.73
|
| Rate for Payer: Cigna Commercial |
$15,434.23
|
| Rate for Payer: First Health Commercial |
$17,665.69
|
| Rate for Payer: Humana Commercial |
$15,806.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,248.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,723.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,578.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,946.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,876.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,178.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,830.87
|
| Rate for Payer: PHCS Commercial |
$17,851.64
|
| Rate for Payer: United Healthcare All Payer |
$16,364.00
|
|
|
GLOBAL ADVANTAGE CTA HD 52*23
|
Facility
|
OP
|
$21,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,427.50 |
| Max. Negotiated Rate |
$20,568.00 |
| Rate for Payer: Aetna Commercial |
$16,497.25
|
| Rate for Payer: Anthem Medicaid |
$7,368.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,711.50
|
| Rate for Payer: Cash Price |
$10,712.50
|
| Rate for Payer: Cigna Commercial |
$17,782.75
|
| Rate for Payer: First Health Commercial |
$20,353.75
|
| Rate for Payer: Humana Commercial |
$18,211.25
|
| Rate for Payer: Humana KY Medicaid |
$7,368.06
|
| Rate for Payer: Kentucky WC Medicaid |
$7,443.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,568.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,811.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,427.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,515.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,854.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,068.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,639.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,783.25
|
| Rate for Payer: PHCS Commercial |
$20,568.00
|
| Rate for Payer: United Healthcare All Payer |
$18,854.00
|
|
|
GLOBAL ADVANTAGE CTA HD 52*23
|
Facility
|
IP
|
$21,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,427.50 |
| Max. Negotiated Rate |
$20,568.00 |
| Rate for Payer: Aetna Commercial |
$16,497.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,711.50
|
| Rate for Payer: Cash Price |
$10,712.50
|
| Rate for Payer: Cigna Commercial |
$17,782.75
|
| Rate for Payer: First Health Commercial |
$20,353.75
|
| Rate for Payer: Humana Commercial |
$18,211.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,568.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,811.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,427.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,854.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,068.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,639.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,783.25
|
| Rate for Payer: PHCS Commercial |
$20,568.00
|
| Rate for Payer: United Healthcare All Payer |
$18,854.00
|
|
|
GLOBAL ADVANTAGE CTA HD 56*18
|
Facility
|
IP
|
$12,189.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,656.89 |
| Max. Negotiated Rate |
$11,702.05 |
| Rate for Payer: Aetna Commercial |
$9,386.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,507.92
|
| Rate for Payer: Cash Price |
$6,094.82
|
| Rate for Payer: Cigna Commercial |
$10,117.40
|
| Rate for Payer: First Health Commercial |
$11,580.16
|
| Rate for Payer: Humana Commercial |
$10,361.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,995.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,995.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,656.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,726.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,142.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,751.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,604.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,410.85
|
| Rate for Payer: PHCS Commercial |
$11,702.05
|
| Rate for Payer: United Healthcare All Payer |
$10,726.88
|
|
|
GLOBAL ADVANTAGE CTA HD 56*18
|
Facility
|
OP
|
$12,189.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,656.89 |
| Max. Negotiated Rate |
$11,702.05 |
| Rate for Payer: Aetna Commercial |
$9,386.02
|
| Rate for Payer: Anthem Medicaid |
$4,192.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,507.92
|
| Rate for Payer: Cash Price |
$6,094.82
|
| Rate for Payer: Cigna Commercial |
$10,117.40
|
| Rate for Payer: First Health Commercial |
$11,580.16
|
| Rate for Payer: Humana Commercial |
$10,361.19
|
| Rate for Payer: Humana KY Medicaid |
$4,192.02
|
| Rate for Payer: Kentucky WC Medicaid |
$4,234.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,995.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,995.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,656.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,276.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,726.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,142.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,751.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,604.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,410.85
|
| Rate for Payer: PHCS Commercial |
$11,702.05
|
| Rate for Payer: United Healthcare All Payer |
$10,726.88
|
|
|
GLOBAL ADVANTAGE CTA HD 56*23
|
Facility
|
OP
|
$18,595.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,578.64 |
| Max. Negotiated Rate |
$17,851.64 |
| Rate for Payer: Aetna Commercial |
$14,318.50
|
| Rate for Payer: Anthem Medicaid |
$6,394.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,504.46
|
| Rate for Payer: Cash Price |
$9,297.73
|
| Rate for Payer: Cigna Commercial |
$15,434.23
|
| Rate for Payer: First Health Commercial |
$17,665.69
|
| Rate for Payer: Humana Commercial |
$15,806.14
|
| Rate for Payer: Humana KY Medicaid |
$6,394.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,460.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,248.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,723.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,578.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,523.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,946.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,876.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,178.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,830.87
|
| Rate for Payer: PHCS Commercial |
$17,851.64
|
| Rate for Payer: United Healthcare All Payer |
$16,364.00
|
|
|
GLOBAL ADVANTAGE CTA HD 56*23
|
Facility
|
IP
|
$18,595.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,578.64 |
| Max. Negotiated Rate |
$17,851.64 |
| Rate for Payer: Aetna Commercial |
$14,318.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,504.46
|
| Rate for Payer: Cash Price |
$9,297.73
|
| Rate for Payer: Cigna Commercial |
$15,434.23
|
| Rate for Payer: First Health Commercial |
$17,665.69
|
| Rate for Payer: Humana Commercial |
$15,806.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,248.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,723.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,578.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,946.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,876.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,178.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,830.87
|
| Rate for Payer: PHCS Commercial |
$17,851.64
|
| Rate for Payer: United Healthcare All Payer |
$16,364.00
|
|
|
GLOBAL ADVANTAGE CTS HD 48*23
|
Facility
|
OP
|
$12,189.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,656.89 |
| Max. Negotiated Rate |
$11,702.05 |
| Rate for Payer: Aetna Commercial |
$9,386.02
|
| Rate for Payer: Anthem Medicaid |
$4,192.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,507.92
|
| Rate for Payer: Cash Price |
$6,094.82
|
| Rate for Payer: Cigna Commercial |
$10,117.40
|
| Rate for Payer: First Health Commercial |
$11,580.16
|
| Rate for Payer: Humana Commercial |
$10,361.19
|
| Rate for Payer: Humana KY Medicaid |
$4,192.02
|
| Rate for Payer: Kentucky WC Medicaid |
$4,234.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,995.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,995.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,656.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,276.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,726.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,142.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,751.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,604.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,410.85
|
| Rate for Payer: PHCS Commercial |
$11,702.05
|
| Rate for Payer: United Healthcare All Payer |
$10,726.88
|
|
|
GLOBAL ADVANTAGE CTS HD 48*23
|
Facility
|
IP
|
$12,189.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,656.89 |
| Max. Negotiated Rate |
$11,702.05 |
| Rate for Payer: Aetna Commercial |
$9,386.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,507.92
|
| Rate for Payer: Cash Price |
$6,094.82
|
| Rate for Payer: Cigna Commercial |
$10,117.40
|
| Rate for Payer: First Health Commercial |
$11,580.16
|
| Rate for Payer: Humana Commercial |
$10,361.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,995.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,995.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,656.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,726.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,142.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,751.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,604.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,410.85
|
| Rate for Payer: PHCS Commercial |
$11,702.05
|
| Rate for Payer: United Healthcare All Payer |
$10,726.88
|
|
|
GLOBAL ADVANTAGE ECC HD 44*18
|
Facility
|
OP
|
$16,547.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,964.13 |
| Max. Negotiated Rate |
$15,885.22 |
| Rate for Payer: Aetna Commercial |
$12,741.27
|
| Rate for Payer: Anthem Medicaid |
$5,690.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,906.74
|
| Rate for Payer: Cash Price |
$8,273.55
|
| Rate for Payer: Cigna Commercial |
$13,734.09
|
| Rate for Payer: First Health Commercial |
$15,719.75
|
| Rate for Payer: Humana Commercial |
$14,065.03
|
| Rate for Payer: Humana KY Medicaid |
$5,690.55
|
| Rate for Payer: Kentucky WC Medicaid |
$5,748.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,568.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,211.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,964.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,804.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,561.45
|
| Rate for Payer: Ohio Health Group HMO |
$12,410.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,237.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,395.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,417.50
|
| Rate for Payer: PHCS Commercial |
$15,885.22
|
| Rate for Payer: United Healthcare All Payer |
$14,561.45
|
|
|
GLOBAL ADVANTAGE ECC HD 44*18
|
Facility
|
IP
|
$16,547.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,964.13 |
| Max. Negotiated Rate |
$15,885.22 |
| Rate for Payer: Aetna Commercial |
$12,741.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,906.74
|
| Rate for Payer: Cash Price |
$8,273.55
|
| Rate for Payer: Cigna Commercial |
$13,734.09
|
| Rate for Payer: First Health Commercial |
$15,719.75
|
| Rate for Payer: Humana Commercial |
$14,065.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,568.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,211.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,964.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,561.45
|
| Rate for Payer: Ohio Health Group HMO |
$12,410.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,237.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,395.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,417.50
|
| Rate for Payer: PHCS Commercial |
$15,885.22
|
| Rate for Payer: United Healthcare All Payer |
$14,561.45
|
|
|
GLOBAL ADVANTAGE ECC HD 44*21
|
Facility
|
IP
|
$16,080.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,824.27 |
| Max. Negotiated Rate |
$15,437.66 |
| Rate for Payer: Aetna Commercial |
$12,382.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,543.10
|
| Rate for Payer: Cash Price |
$8,040.45
|
| Rate for Payer: Cigna Commercial |
$13,347.15
|
| Rate for Payer: First Health Commercial |
$15,276.85
|
| Rate for Payer: Humana Commercial |
$13,668.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,186.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,151.19
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,864.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,990.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,095.82
|
| Rate for Payer: PHCS Commercial |
$15,437.66
|
| Rate for Payer: United Healthcare All Payer |
$14,151.19
|
|
|
GLOBAL ADVANTAGE ECC HD 44*21
|
Facility
|
OP
|
$16,080.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,824.27 |
| Max. Negotiated Rate |
$15,437.66 |
| Rate for Payer: Aetna Commercial |
$12,382.29
|
| Rate for Payer: Anthem Medicaid |
$5,530.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,543.10
|
| Rate for Payer: Cash Price |
$8,040.45
|
| Rate for Payer: Cigna Commercial |
$13,347.15
|
| Rate for Payer: First Health Commercial |
$15,276.85
|
| Rate for Payer: Humana Commercial |
$13,668.76
|
| Rate for Payer: Humana KY Medicaid |
$5,530.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,186.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,641.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,151.19
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,864.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,990.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,095.82
|
| Rate for Payer: PHCS Commercial |
$15,437.66
|
| Rate for Payer: United Healthcare All Payer |
$14,151.19
|
|
|
GLOBAL ADVANTAGE ECC HD 48*18
|
Facility
|
OP
|
$16,909.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,072.91 |
| Max. Negotiated Rate |
$16,233.31 |
| Rate for Payer: Aetna Commercial |
$13,020.47
|
| Rate for Payer: Anthem Medicaid |
$5,815.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,189.57
|
| Rate for Payer: Cash Price |
$8,454.85
|
| Rate for Payer: Cigna Commercial |
$14,035.05
|
| Rate for Payer: First Health Commercial |
$16,064.22
|
| Rate for Payer: Humana Commercial |
$14,373.25
|
| Rate for Payer: Humana KY Medicaid |
$5,815.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,874.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,865.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,479.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,072.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,931.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,880.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,682.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,527.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,711.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,667.69
|
| Rate for Payer: PHCS Commercial |
$16,233.31
|
| Rate for Payer: United Healthcare All Payer |
$14,880.54
|
|
|
GLOBAL ADVANTAGE ECC HD 48*18
|
Facility
|
IP
|
$16,909.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,072.91 |
| Max. Negotiated Rate |
$16,233.31 |
| Rate for Payer: Aetna Commercial |
$13,020.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,189.57
|
| Rate for Payer: Cash Price |
$8,454.85
|
| Rate for Payer: Cigna Commercial |
$14,035.05
|
| Rate for Payer: First Health Commercial |
$16,064.22
|
| Rate for Payer: Humana Commercial |
$14,373.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,865.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,479.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,072.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,880.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,682.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,527.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,711.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,667.69
|
| Rate for Payer: PHCS Commercial |
$16,233.31
|
| Rate for Payer: United Healthcare All Payer |
$14,880.54
|
|
|
GLOBAL ADVANTAGE ECC HD 48*21
|
Facility
|
OP
|
$16,547.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,964.13 |
| Max. Negotiated Rate |
$15,885.22 |
| Rate for Payer: Aetna Commercial |
$12,741.27
|
| Rate for Payer: Anthem Medicaid |
$5,690.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,906.74
|
| Rate for Payer: Cash Price |
$8,273.55
|
| Rate for Payer: Cigna Commercial |
$13,734.09
|
| Rate for Payer: First Health Commercial |
$15,719.75
|
| Rate for Payer: Humana Commercial |
$14,065.03
|
| Rate for Payer: Humana KY Medicaid |
$5,690.55
|
| Rate for Payer: Kentucky WC Medicaid |
$5,748.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,568.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,211.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,964.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,804.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,561.45
|
| Rate for Payer: Ohio Health Group HMO |
$12,410.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,237.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,395.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,417.50
|
| Rate for Payer: PHCS Commercial |
$15,885.22
|
| Rate for Payer: United Healthcare All Payer |
$14,561.45
|
|
|
GLOBAL ADVANTAGE ECC HD 48*21
|
Facility
|
IP
|
$16,547.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,964.13 |
| Max. Negotiated Rate |
$15,885.22 |
| Rate for Payer: Aetna Commercial |
$12,741.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,906.74
|
| Rate for Payer: Cash Price |
$8,273.55
|
| Rate for Payer: Cigna Commercial |
$13,734.09
|
| Rate for Payer: First Health Commercial |
$15,719.75
|
| Rate for Payer: Humana Commercial |
$14,065.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,568.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,211.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,964.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,561.45
|
| Rate for Payer: Ohio Health Group HMO |
$12,410.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,237.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,395.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,417.50
|
| Rate for Payer: PHCS Commercial |
$15,885.22
|
| Rate for Payer: United Healthcare All Payer |
$14,561.45
|
|
|
GLOBAL ADVANTAGE ECC HD 52*18
|
Facility
|
IP
|
$11,207.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
GLOBAL ADVANTAGE ECC HD 52*18
|
Facility
|
OP
|
$11,207.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem Medicaid |
$3,854.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Humana KY Medicaid |
$3,854.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,893.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,931.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
GLOBAL ADVANTAGE ECC HD 52*21
|
Facility
|
OP
|
$14,256.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,277.03 |
| Max. Negotiated Rate |
$13,686.50 |
| Rate for Payer: Aetna Commercial |
$10,977.71
|
| Rate for Payer: Anthem Medicaid |
$4,902.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,120.28
|
| Rate for Payer: Cash Price |
$7,128.38
|
| Rate for Payer: Cigna Commercial |
$11,833.12
|
| Rate for Payer: First Health Commercial |
$13,543.93
|
| Rate for Payer: Humana Commercial |
$12,118.25
|
| Rate for Payer: Humana KY Medicaid |
$4,902.90
|
| Rate for Payer: Kentucky WC Medicaid |
$4,952.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,690.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,521.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,277.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,001.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,545.96
|
| Rate for Payer: Ohio Health Group HMO |
$10,692.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,405.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,403.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,837.17
|
| Rate for Payer: PHCS Commercial |
$13,686.50
|
| Rate for Payer: United Healthcare All Payer |
$12,545.96
|
|
|
GLOBAL ADVANTAGE ECC HD 52*21
|
Facility
|
IP
|
$14,256.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,277.03 |
| Max. Negotiated Rate |
$13,686.50 |
| Rate for Payer: Aetna Commercial |
$10,977.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,120.28
|
| Rate for Payer: Cash Price |
$7,128.38
|
| Rate for Payer: Cigna Commercial |
$11,833.12
|
| Rate for Payer: First Health Commercial |
$13,543.93
|
| Rate for Payer: Humana Commercial |
$12,118.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,690.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,521.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,277.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,545.96
|
| Rate for Payer: Ohio Health Group HMO |
$10,692.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,405.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,403.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,837.17
|
| Rate for Payer: PHCS Commercial |
$13,686.50
|
| Rate for Payer: United Healthcare All Payer |
$12,545.96
|
|
|
GLOBAL ADVANTAGE ECC HD 56*18
|
Facility
|
IP
|
$15,907.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,772.10 |
| Max. Negotiated Rate |
$15,270.72 |
| Rate for Payer: Aetna Commercial |
$12,248.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,407.46
|
| Rate for Payer: Cash Price |
$7,953.50
|
| Rate for Payer: Cigna Commercial |
$13,202.81
|
| Rate for Payer: First Health Commercial |
$15,111.65
|
| Rate for Payer: Humana Commercial |
$13,520.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,043.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,739.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,772.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,998.16
|
| Rate for Payer: Ohio Health Group HMO |
$11,930.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,725.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,839.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,975.83
|
| Rate for Payer: PHCS Commercial |
$15,270.72
|
| Rate for Payer: United Healthcare All Payer |
$13,998.16
|
|
|
GLOBAL ADVANTAGE ECC HD 56*18
|
Facility
|
OP
|
$15,907.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,772.10 |
| Max. Negotiated Rate |
$15,270.72 |
| Rate for Payer: Aetna Commercial |
$12,248.39
|
| Rate for Payer: Anthem Medicaid |
$5,470.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,407.46
|
| Rate for Payer: Cash Price |
$7,953.50
|
| Rate for Payer: Cigna Commercial |
$13,202.81
|
| Rate for Payer: First Health Commercial |
$15,111.65
|
| Rate for Payer: Humana Commercial |
$13,520.95
|
| Rate for Payer: Humana KY Medicaid |
$5,470.42
|
| Rate for Payer: Kentucky WC Medicaid |
$5,526.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,043.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,739.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,772.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,580.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,998.16
|
| Rate for Payer: Ohio Health Group HMO |
$11,930.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,725.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,839.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,975.83
|
| Rate for Payer: PHCS Commercial |
$15,270.72
|
| Rate for Payer: United Healthcare All Payer |
$13,998.16
|
|
