|
GLOBAL ADVANTAGE STEM 8MM
|
Facility
|
IP
|
$25,730.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,719.00 |
| Max. Negotiated Rate |
$24,700.80 |
| Rate for Payer: Aetna Commercial |
$19,812.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,069.40
|
| Rate for Payer: Cash Price |
$12,865.00
|
| Rate for Payer: Cigna Commercial |
$21,355.90
|
| Rate for Payer: First Health Commercial |
$24,443.50
|
| Rate for Payer: Humana Commercial |
$21,870.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,098.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,988.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,719.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,642.40
|
| Rate for Payer: Ohio Health Group HMO |
$19,297.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,584.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,385.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,753.70
|
| Rate for Payer: PHCS Commercial |
$24,700.80
|
| Rate for Payer: United Healthcare All Payer |
$22,642.40
|
|
|
GLOBAL ADVANTAGE STEM 8MM
|
Facility
|
OP
|
$25,730.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,719.00 |
| Max. Negotiated Rate |
$24,700.80 |
| Rate for Payer: Aetna Commercial |
$19,812.10
|
| Rate for Payer: Anthem Medicaid |
$8,848.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,069.40
|
| Rate for Payer: Cash Price |
$12,865.00
|
| Rate for Payer: Cigna Commercial |
$21,355.90
|
| Rate for Payer: First Health Commercial |
$24,443.50
|
| Rate for Payer: Humana Commercial |
$21,870.50
|
| Rate for Payer: Humana KY Medicaid |
$8,848.55
|
| Rate for Payer: Kentucky WC Medicaid |
$8,938.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,098.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,988.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,719.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,026.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,642.40
|
| Rate for Payer: Ohio Health Group HMO |
$19,297.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,584.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,385.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,753.70
|
| Rate for Payer: PHCS Commercial |
$24,700.80
|
| Rate for Payer: United Healthcare All Payer |
$22,642.40
|
|
|
GLOBAL ADVANTAGE STEM P/C 12MM
|
Facility
|
OP
|
$31,227.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,368.25 |
| Max. Negotiated Rate |
$29,978.40 |
| Rate for Payer: Aetna Commercial |
$24,045.17
|
| Rate for Payer: Anthem Medicaid |
$10,739.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,357.45
|
| Rate for Payer: Cash Price |
$15,613.75
|
| Rate for Payer: Cigna Commercial |
$25,918.83
|
| Rate for Payer: First Health Commercial |
$29,666.12
|
| Rate for Payer: Humana Commercial |
$26,543.38
|
| Rate for Payer: Humana KY Medicaid |
$10,739.14
|
| Rate for Payer: Kentucky WC Medicaid |
$10,848.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,606.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,045.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,368.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,954.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,480.20
|
| Rate for Payer: Ohio Health Group HMO |
$23,420.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,982.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,167.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,546.97
|
| Rate for Payer: PHCS Commercial |
$29,978.40
|
| Rate for Payer: United Healthcare All Payer |
$27,480.20
|
|
|
GLOBAL ADVANTAGE STEM P/C 12MM
|
Facility
|
IP
|
$31,227.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,368.25 |
| Max. Negotiated Rate |
$29,978.40 |
| Rate for Payer: Aetna Commercial |
$24,045.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,357.45
|
| Rate for Payer: Cash Price |
$15,613.75
|
| Rate for Payer: Cigna Commercial |
$25,918.83
|
| Rate for Payer: First Health Commercial |
$29,666.12
|
| Rate for Payer: Humana Commercial |
$26,543.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,606.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,045.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,368.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,480.20
|
| Rate for Payer: Ohio Health Group HMO |
$23,420.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,982.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,167.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,546.97
|
| Rate for Payer: PHCS Commercial |
$29,978.40
|
| Rate for Payer: United Healthcare All Payer |
$27,480.20
|
|
|
GLOBAL ADVANTAGE STEM P/C 14MM
|
Facility
|
IP
|
$22,055.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,616.50 |
| Max. Negotiated Rate |
$21,172.80 |
| Rate for Payer: Aetna Commercial |
$16,982.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,202.90
|
| Rate for Payer: Cash Price |
$11,027.50
|
| Rate for Payer: Cigna Commercial |
$18,305.65
|
| Rate for Payer: First Health Commercial |
$20,952.25
|
| Rate for Payer: Humana Commercial |
$18,746.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,085.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,276.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,616.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,408.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,541.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,187.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,217.95
|
| Rate for Payer: PHCS Commercial |
$21,172.80
|
| Rate for Payer: United Healthcare All Payer |
$19,408.40
|
|
|
GLOBAL ADVANTAGE STEM P/C 14MM
|
Facility
|
OP
|
$22,055.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,616.50 |
| Max. Negotiated Rate |
$21,172.80 |
| Rate for Payer: Aetna Commercial |
$16,982.35
|
| Rate for Payer: Anthem Medicaid |
$7,584.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,202.90
|
| Rate for Payer: Cash Price |
$11,027.50
|
| Rate for Payer: Cigna Commercial |
$18,305.65
|
| Rate for Payer: First Health Commercial |
$20,952.25
|
| Rate for Payer: Humana Commercial |
$18,746.75
|
| Rate for Payer: Humana KY Medicaid |
$7,584.71
|
| Rate for Payer: Kentucky WC Medicaid |
$7,661.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,085.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,276.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,616.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,736.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,408.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,541.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,187.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,217.95
|
| Rate for Payer: PHCS Commercial |
$21,172.80
|
| Rate for Payer: United Healthcare All Payer |
$19,408.40
|
|
|
GLOBAL ADVANTAGE STEM P/C 8MM
|
Facility
|
IP
|
$29,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,916.00 |
| Max. Negotiated Rate |
$28,531.20 |
| Rate for Payer: Aetna Commercial |
$22,884.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,181.60
|
| Rate for Payer: Cash Price |
$14,860.00
|
| Rate for Payer: Cigna Commercial |
$24,667.60
|
| Rate for Payer: First Health Commercial |
$28,234.00
|
| Rate for Payer: Humana Commercial |
$25,262.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,370.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,933.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,916.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$22,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,856.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,506.80
|
| Rate for Payer: PHCS Commercial |
$28,531.20
|
| Rate for Payer: United Healthcare All Payer |
$26,153.60
|
|
|
GLOBAL ADVANTAGE STEM P/C 8MM
|
Facility
|
OP
|
$29,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,916.00 |
| Max. Negotiated Rate |
$28,531.20 |
| Rate for Payer: Aetna Commercial |
$22,884.40
|
| Rate for Payer: Anthem Medicaid |
$10,220.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,181.60
|
| Rate for Payer: Cash Price |
$14,860.00
|
| Rate for Payer: Cigna Commercial |
$24,667.60
|
| Rate for Payer: First Health Commercial |
$28,234.00
|
| Rate for Payer: Humana Commercial |
$25,262.00
|
| Rate for Payer: Humana KY Medicaid |
$10,220.71
|
| Rate for Payer: Kentucky WC Medicaid |
$10,324.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,370.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,933.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,916.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,425.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$22,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,856.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,506.80
|
| Rate for Payer: PHCS Commercial |
$28,531.20
|
| Rate for Payer: United Healthcare All Payer |
$26,153.60
|
|
|
GLOBAL ADV. HUM STEM P/C 16MM
|
Facility
|
IP
|
$20,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,281.25 |
| Max. Negotiated Rate |
$20,100.00 |
| Rate for Payer: Aetna Commercial |
$16,121.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,331.25
|
| Rate for Payer: Cash Price |
$10,468.75
|
| Rate for Payer: Cigna Commercial |
$17,378.12
|
| Rate for Payer: First Health Commercial |
$19,890.62
|
| Rate for Payer: Humana Commercial |
$17,796.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,168.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,451.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,281.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,425.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,703.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,750.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,215.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,446.88
|
| Rate for Payer: PHCS Commercial |
$20,100.00
|
| Rate for Payer: United Healthcare All Payer |
$18,425.00
|
|
|
GLOBAL ADV. HUM STEM P/C 16MM
|
Facility
|
OP
|
$20,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,281.25 |
| Max. Negotiated Rate |
$20,100.00 |
| Rate for Payer: Aetna Commercial |
$16,121.88
|
| Rate for Payer: Anthem Medicaid |
$7,200.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,331.25
|
| Rate for Payer: Cash Price |
$10,468.75
|
| Rate for Payer: Cigna Commercial |
$17,378.12
|
| Rate for Payer: First Health Commercial |
$19,890.62
|
| Rate for Payer: Humana Commercial |
$17,796.88
|
| Rate for Payer: Humana KY Medicaid |
$7,200.41
|
| Rate for Payer: Kentucky WC Medicaid |
$7,273.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,168.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,451.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,281.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,344.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,425.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,703.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,750.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,215.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,446.88
|
| Rate for Payer: PHCS Commercial |
$20,100.00
|
| Rate for Payer: United Healthcare All Payer |
$18,425.00
|
|
|
GLOBAL CAP CTA DUOFIX 40*15
|
Facility
|
OP
|
$30,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,251.25 |
| Max. Negotiated Rate |
$29,604.00 |
| Rate for Payer: Aetna Commercial |
$23,744.88
|
| Rate for Payer: Anthem Medicaid |
$10,605.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,053.25
|
| Rate for Payer: Cash Price |
$15,418.75
|
| Rate for Payer: Cigna Commercial |
$25,595.12
|
| Rate for Payer: First Health Commercial |
$29,295.62
|
| Rate for Payer: Humana Commercial |
$26,211.88
|
| Rate for Payer: Humana KY Medicaid |
$10,605.02
|
| Rate for Payer: Kentucky WC Medicaid |
$10,712.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,286.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,758.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,251.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,817.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,137.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,128.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,670.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,828.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,277.88
|
| Rate for Payer: PHCS Commercial |
$29,604.00
|
| Rate for Payer: United Healthcare All Payer |
$27,137.00
|
|
|
GLOBAL CAP CTA DUOFIX 40*15
|
Facility
|
IP
|
$30,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,251.25 |
| Max. Negotiated Rate |
$29,604.00 |
| Rate for Payer: Aetna Commercial |
$23,744.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,053.25
|
| Rate for Payer: Cash Price |
$15,418.75
|
| Rate for Payer: Cigna Commercial |
$25,595.12
|
| Rate for Payer: First Health Commercial |
$29,295.62
|
| Rate for Payer: Humana Commercial |
$26,211.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,286.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,758.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,251.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,137.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,128.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,670.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,828.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,277.88
|
| Rate for Payer: PHCS Commercial |
$29,604.00
|
| Rate for Payer: United Healthcare All Payer |
$27,137.00
|
|
|
GLOBAL CAP CTA DUOFIX 40*18
|
Facility
|
OP
|
$30,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,251.25 |
| Max. Negotiated Rate |
$29,604.00 |
| Rate for Payer: Aetna Commercial |
$23,744.88
|
| Rate for Payer: Anthem Medicaid |
$10,605.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,053.25
|
| Rate for Payer: Cash Price |
$15,418.75
|
| Rate for Payer: Cigna Commercial |
$25,595.12
|
| Rate for Payer: First Health Commercial |
$29,295.62
|
| Rate for Payer: Humana Commercial |
$26,211.88
|
| Rate for Payer: Humana KY Medicaid |
$10,605.02
|
| Rate for Payer: Kentucky WC Medicaid |
$10,712.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,286.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,758.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,251.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,817.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,137.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,128.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,670.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,828.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,277.88
|
| Rate for Payer: PHCS Commercial |
$29,604.00
|
| Rate for Payer: United Healthcare All Payer |
$27,137.00
|
|
|
GLOBAL CAP CTA DUOFIX 40*18
|
Facility
|
IP
|
$30,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,251.25 |
| Max. Negotiated Rate |
$29,604.00 |
| Rate for Payer: Aetna Commercial |
$23,744.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,053.25
|
| Rate for Payer: Cash Price |
$15,418.75
|
| Rate for Payer: Cigna Commercial |
$25,595.12
|
| Rate for Payer: First Health Commercial |
$29,295.62
|
| Rate for Payer: Humana Commercial |
$26,211.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,286.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,758.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,251.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,137.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,128.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,670.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,828.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,277.88
|
| Rate for Payer: PHCS Commercial |
$29,604.00
|
| Rate for Payer: United Healthcare All Payer |
$27,137.00
|
|
|
GLOBAL CAP CTA DUOFIX 44*15
|
Facility
|
OP
|
$30,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,251.25 |
| Max. Negotiated Rate |
$29,604.00 |
| Rate for Payer: Aetna Commercial |
$23,744.88
|
| Rate for Payer: Anthem Medicaid |
$10,605.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,053.25
|
| Rate for Payer: Cash Price |
$15,418.75
|
| Rate for Payer: Cigna Commercial |
$25,595.12
|
| Rate for Payer: First Health Commercial |
$29,295.62
|
| Rate for Payer: Humana Commercial |
$26,211.88
|
| Rate for Payer: Humana KY Medicaid |
$10,605.02
|
| Rate for Payer: Kentucky WC Medicaid |
$10,712.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,286.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,758.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,251.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,817.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,137.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,128.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,670.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,828.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,277.88
|
| Rate for Payer: PHCS Commercial |
$29,604.00
|
| Rate for Payer: United Healthcare All Payer |
$27,137.00
|
|
|
GLOBAL CAP CTA DUOFIX 44*15
|
Facility
|
IP
|
$30,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,251.25 |
| Max. Negotiated Rate |
$29,604.00 |
| Rate for Payer: Aetna Commercial |
$23,744.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,053.25
|
| Rate for Payer: Cash Price |
$15,418.75
|
| Rate for Payer: Cigna Commercial |
$25,595.12
|
| Rate for Payer: First Health Commercial |
$29,295.62
|
| Rate for Payer: Humana Commercial |
$26,211.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,286.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,758.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,251.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,137.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,128.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,670.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,828.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,277.88
|
| Rate for Payer: PHCS Commercial |
$29,604.00
|
| Rate for Payer: United Healthcare All Payer |
$27,137.00
|
|
|
GLOBAL CAP CTA DUOFIX 44*18
|
Facility
|
OP
|
$30,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,251.25 |
| Max. Negotiated Rate |
$29,604.00 |
| Rate for Payer: Aetna Commercial |
$23,744.88
|
| Rate for Payer: Anthem Medicaid |
$10,605.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,053.25
|
| Rate for Payer: Cash Price |
$15,418.75
|
| Rate for Payer: Cigna Commercial |
$25,595.12
|
| Rate for Payer: First Health Commercial |
$29,295.62
|
| Rate for Payer: Humana Commercial |
$26,211.88
|
| Rate for Payer: Humana KY Medicaid |
$10,605.02
|
| Rate for Payer: Kentucky WC Medicaid |
$10,712.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,286.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,758.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,251.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,817.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,137.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,128.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,670.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,828.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,277.88
|
| Rate for Payer: PHCS Commercial |
$29,604.00
|
| Rate for Payer: United Healthcare All Payer |
$27,137.00
|
|
|
GLOBAL CAP CTA DUOFIX 44*18
|
Facility
|
IP
|
$30,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,251.25 |
| Max. Negotiated Rate |
$29,604.00 |
| Rate for Payer: Aetna Commercial |
$23,744.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,053.25
|
| Rate for Payer: Cash Price |
$15,418.75
|
| Rate for Payer: Cigna Commercial |
$25,595.12
|
| Rate for Payer: First Health Commercial |
$29,295.62
|
| Rate for Payer: Humana Commercial |
$26,211.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,286.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,758.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,251.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,137.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,128.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,670.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,828.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,277.88
|
| Rate for Payer: PHCS Commercial |
$29,604.00
|
| Rate for Payer: United Healthcare All Payer |
$27,137.00
|
|
|
GLOBAL CAP CTA DUOFIX 48*18
|
Facility
|
OP
|
$30,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,251.25 |
| Max. Negotiated Rate |
$29,604.00 |
| Rate for Payer: Aetna Commercial |
$23,744.88
|
| Rate for Payer: Anthem Medicaid |
$10,605.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,053.25
|
| Rate for Payer: Cash Price |
$15,418.75
|
| Rate for Payer: Cigna Commercial |
$25,595.12
|
| Rate for Payer: First Health Commercial |
$29,295.62
|
| Rate for Payer: Humana Commercial |
$26,211.88
|
| Rate for Payer: Humana KY Medicaid |
$10,605.02
|
| Rate for Payer: Kentucky WC Medicaid |
$10,712.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,286.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,758.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,251.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,817.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,137.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,128.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,670.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,828.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,277.88
|
| Rate for Payer: PHCS Commercial |
$29,604.00
|
| Rate for Payer: United Healthcare All Payer |
$27,137.00
|
|
|
GLOBAL CAP CTA DUOFIX 48*18
|
Facility
|
IP
|
$30,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,251.25 |
| Max. Negotiated Rate |
$29,604.00 |
| Rate for Payer: Aetna Commercial |
$23,744.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,053.25
|
| Rate for Payer: Cash Price |
$15,418.75
|
| Rate for Payer: Cigna Commercial |
$25,595.12
|
| Rate for Payer: First Health Commercial |
$29,295.62
|
| Rate for Payer: Humana Commercial |
$26,211.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,286.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,758.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,251.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,137.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,128.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,670.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,828.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,277.88
|
| Rate for Payer: PHCS Commercial |
$29,604.00
|
| Rate for Payer: United Healthcare All Payer |
$27,137.00
|
|
|
GLOBAL CAP CTA DUOFIX 48*21
|
Facility
|
OP
|
$30,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,251.25 |
| Max. Negotiated Rate |
$29,604.00 |
| Rate for Payer: Aetna Commercial |
$23,744.88
|
| Rate for Payer: Anthem Medicaid |
$10,605.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,053.25
|
| Rate for Payer: Cash Price |
$15,418.75
|
| Rate for Payer: Cigna Commercial |
$25,595.12
|
| Rate for Payer: First Health Commercial |
$29,295.62
|
| Rate for Payer: Humana Commercial |
$26,211.88
|
| Rate for Payer: Humana KY Medicaid |
$10,605.02
|
| Rate for Payer: Kentucky WC Medicaid |
$10,712.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,286.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,758.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,251.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,817.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,137.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,128.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,670.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,828.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,277.88
|
| Rate for Payer: PHCS Commercial |
$29,604.00
|
| Rate for Payer: United Healthcare All Payer |
$27,137.00
|
|
|
GLOBAL CAP CTA DUOFIX 48*21
|
Facility
|
IP
|
$30,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,251.25 |
| Max. Negotiated Rate |
$29,604.00 |
| Rate for Payer: Aetna Commercial |
$23,744.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,053.25
|
| Rate for Payer: Cash Price |
$15,418.75
|
| Rate for Payer: Cigna Commercial |
$25,595.12
|
| Rate for Payer: First Health Commercial |
$29,295.62
|
| Rate for Payer: Humana Commercial |
$26,211.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,286.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,758.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,251.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,137.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,128.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,670.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,828.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,277.88
|
| Rate for Payer: PHCS Commercial |
$29,604.00
|
| Rate for Payer: United Healthcare All Payer |
$27,137.00
|
|
|
GLOBAL CAP CTA DUOFIX 52*18
|
Facility
|
IP
|
$30,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,251.25 |
| Max. Negotiated Rate |
$29,604.00 |
| Rate for Payer: Aetna Commercial |
$23,744.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,053.25
|
| Rate for Payer: Cash Price |
$15,418.75
|
| Rate for Payer: Cigna Commercial |
$25,595.12
|
| Rate for Payer: First Health Commercial |
$29,295.62
|
| Rate for Payer: Humana Commercial |
$26,211.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,286.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,758.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,251.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,137.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,128.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,670.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,828.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,277.88
|
| Rate for Payer: PHCS Commercial |
$29,604.00
|
| Rate for Payer: United Healthcare All Payer |
$27,137.00
|
|
|
GLOBAL CAP CTA DUOFIX 52*18
|
Facility
|
OP
|
$30,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,251.25 |
| Max. Negotiated Rate |
$29,604.00 |
| Rate for Payer: Aetna Commercial |
$23,744.88
|
| Rate for Payer: Anthem Medicaid |
$10,605.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,053.25
|
| Rate for Payer: Cash Price |
$15,418.75
|
| Rate for Payer: Cigna Commercial |
$25,595.12
|
| Rate for Payer: First Health Commercial |
$29,295.62
|
| Rate for Payer: Humana Commercial |
$26,211.88
|
| Rate for Payer: Humana KY Medicaid |
$10,605.02
|
| Rate for Payer: Kentucky WC Medicaid |
$10,712.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,286.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,758.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,251.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,817.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,137.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,128.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,670.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,828.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,277.88
|
| Rate for Payer: PHCS Commercial |
$29,604.00
|
| Rate for Payer: United Healthcare All Payer |
$27,137.00
|
|
|
GLOBAL CAP CTA DUOFIX 52*21
|
Facility
|
OP
|
$30,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,251.25 |
| Max. Negotiated Rate |
$29,604.00 |
| Rate for Payer: Aetna Commercial |
$23,744.88
|
| Rate for Payer: Anthem Medicaid |
$10,605.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,053.25
|
| Rate for Payer: Cash Price |
$15,418.75
|
| Rate for Payer: Cigna Commercial |
$25,595.12
|
| Rate for Payer: First Health Commercial |
$29,295.62
|
| Rate for Payer: Humana Commercial |
$26,211.88
|
| Rate for Payer: Humana KY Medicaid |
$10,605.02
|
| Rate for Payer: Kentucky WC Medicaid |
$10,712.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,286.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,758.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,251.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,817.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,137.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,128.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,670.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,828.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,277.88
|
| Rate for Payer: PHCS Commercial |
$29,604.00
|
| Rate for Payer: United Healthcare All Payer |
$27,137.00
|
|
