|
GLOBAL CAP CTA DUOFIX 52*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 56*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 56*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 56*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 56*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 HD 40X15
|
Facility
|
OP
|
$24,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,451.25 |
| Max. Negotiated Rate |
$23,844.00 |
| Rate for Payer: Aetna Commercial |
$19,124.88
|
| Rate for Payer: Anthem Medicaid |
$8,541.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,373.25
|
| Rate for Payer: Cash Price |
$12,418.75
|
| Rate for Payer: Cigna Commercial |
$20,615.12
|
| Rate for Payer: First Health Commercial |
$23,595.62
|
| Rate for Payer: Humana Commercial |
$21,111.88
|
| Rate for Payer: Humana KY Medicaid |
$8,541.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8,628.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,366.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,330.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,451.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,713.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,857.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,628.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,608.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,137.88
|
| Rate for Payer: PHCS Commercial |
$23,844.00
|
| Rate for Payer: United Healthcare All Payer |
$21,857.00
|
|
|
GLOBAL CAP HD 40X15
|
Facility
|
IP
|
$24,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,451.25 |
| Max. Negotiated Rate |
$23,844.00 |
| Rate for Payer: Aetna Commercial |
$19,124.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,373.25
|
| Rate for Payer: Cash Price |
$12,418.75
|
| Rate for Payer: Cigna Commercial |
$20,615.12
|
| Rate for Payer: First Health Commercial |
$23,595.62
|
| Rate for Payer: Humana Commercial |
$21,111.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,366.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,330.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,451.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,857.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,628.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,608.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,137.88
|
| Rate for Payer: PHCS Commercial |
$23,844.00
|
| Rate for Payer: United Healthcare All Payer |
$21,857.00
|
|
|
GLOBAL CAP HD 40X18
|
Facility
|
OP
|
$24,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,451.25 |
| Max. Negotiated Rate |
$23,844.00 |
| Rate for Payer: Aetna Commercial |
$19,124.88
|
| Rate for Payer: Anthem Medicaid |
$8,541.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,373.25
|
| Rate for Payer: Cash Price |
$12,418.75
|
| Rate for Payer: Cigna Commercial |
$20,615.12
|
| Rate for Payer: First Health Commercial |
$23,595.62
|
| Rate for Payer: Humana Commercial |
$21,111.88
|
| Rate for Payer: Humana KY Medicaid |
$8,541.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8,628.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,366.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,330.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,451.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,713.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,857.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,628.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,608.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,137.88
|
| Rate for Payer: PHCS Commercial |
$23,844.00
|
| Rate for Payer: United Healthcare All Payer |
$21,857.00
|
|
|
GLOBAL CAP HD 40X18
|
Facility
|
IP
|
$24,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,451.25 |
| Max. Negotiated Rate |
$23,844.00 |
| Rate for Payer: Aetna Commercial |
$19,124.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,373.25
|
| Rate for Payer: Cash Price |
$12,418.75
|
| Rate for Payer: Cigna Commercial |
$20,615.12
|
| Rate for Payer: First Health Commercial |
$23,595.62
|
| Rate for Payer: Humana Commercial |
$21,111.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,366.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,330.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,451.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,857.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,628.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,608.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,137.88
|
| Rate for Payer: PHCS Commercial |
$23,844.00
|
| Rate for Payer: United Healthcare All Payer |
$21,857.00
|
|
|
GLOBAL CAP HD 44X`15
|
Facility
|
IP
|
$24,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,451.25 |
| Max. Negotiated Rate |
$23,844.00 |
| Rate for Payer: Aetna Commercial |
$19,124.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,373.25
|
| Rate for Payer: Cash Price |
$12,418.75
|
| Rate for Payer: Cigna Commercial |
$20,615.12
|
| Rate for Payer: First Health Commercial |
$23,595.62
|
| Rate for Payer: Humana Commercial |
$21,111.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,366.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,330.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,451.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,857.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,628.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,608.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,137.88
|
| Rate for Payer: PHCS Commercial |
$23,844.00
|
| Rate for Payer: United Healthcare All Payer |
$21,857.00
|
|
|
GLOBAL CAP HD 44X`15
|
Facility
|
OP
|
$24,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,451.25 |
| Max. Negotiated Rate |
$23,844.00 |
| Rate for Payer: Aetna Commercial |
$19,124.88
|
| Rate for Payer: Anthem Medicaid |
$8,541.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,373.25
|
| Rate for Payer: Cash Price |
$12,418.75
|
| Rate for Payer: Cigna Commercial |
$20,615.12
|
| Rate for Payer: First Health Commercial |
$23,595.62
|
| Rate for Payer: Humana Commercial |
$21,111.88
|
| Rate for Payer: Humana KY Medicaid |
$8,541.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8,628.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,366.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,330.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,451.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,713.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,857.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,628.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,608.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,137.88
|
| Rate for Payer: PHCS Commercial |
$23,844.00
|
| Rate for Payer: United Healthcare All Payer |
$21,857.00
|
|
|
GLOBAL CAP HD 44X18
|
Facility
|
IP
|
$29,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,871.00 |
| Max. Negotiated Rate |
$28,387.20 |
| Rate for Payer: Aetna Commercial |
$22,768.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,064.60
|
| Rate for Payer: Cash Price |
$14,785.00
|
| Rate for Payer: Cigna Commercial |
$24,543.10
|
| Rate for Payer: First Health Commercial |
$28,091.50
|
| Rate for Payer: Humana Commercial |
$25,134.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,247.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,822.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,871.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,021.60
|
| Rate for Payer: Ohio Health Group HMO |
$22,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,725.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,403.30
|
| Rate for Payer: PHCS Commercial |
$28,387.20
|
| Rate for Payer: United Healthcare All Payer |
$26,021.60
|
|
|
GLOBAL CAP HD 44X18
|
Facility
|
OP
|
$29,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,871.00 |
| Max. Negotiated Rate |
$28,387.20 |
| Rate for Payer: Aetna Commercial |
$22,768.90
|
| Rate for Payer: Anthem Medicaid |
$10,169.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,064.60
|
| Rate for Payer: Cash Price |
$14,785.00
|
| Rate for Payer: Cigna Commercial |
$24,543.10
|
| Rate for Payer: First Health Commercial |
$28,091.50
|
| Rate for Payer: Humana Commercial |
$25,134.50
|
| Rate for Payer: Humana KY Medicaid |
$10,169.12
|
| Rate for Payer: Kentucky WC Medicaid |
$10,272.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,247.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,822.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,871.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,373.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,021.60
|
| Rate for Payer: Ohio Health Group HMO |
$22,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,725.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,403.30
|
| Rate for Payer: PHCS Commercial |
$28,387.20
|
| Rate for Payer: United Healthcare All Payer |
$26,021.60
|
|
|
GLOBAL CAP HD 48X18
|
Facility
|
IP
|
$27,502.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,250.74 |
| Max. Negotiated Rate |
$26,402.37 |
| Rate for Payer: Aetna Commercial |
$21,176.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,451.93
|
| Rate for Payer: Cash Price |
$13,751.24
|
| Rate for Payer: Cigna Commercial |
$22,827.05
|
| Rate for Payer: First Health Commercial |
$26,127.35
|
| Rate for Payer: Humana Commercial |
$23,377.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,552.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,296.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,250.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,202.17
|
| Rate for Payer: Ohio Health Group HMO |
$20,626.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,001.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,927.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,976.70
|
| Rate for Payer: PHCS Commercial |
$26,402.37
|
| Rate for Payer: United Healthcare All Payer |
$24,202.17
|
|
|
GLOBAL CAP HD 48X18
|
Facility
|
OP
|
$27,502.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,250.74 |
| Max. Negotiated Rate |
$26,402.37 |
| Rate for Payer: Aetna Commercial |
$21,176.90
|
| Rate for Payer: Anthem Medicaid |
$9,458.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,451.93
|
| Rate for Payer: Cash Price |
$13,751.24
|
| Rate for Payer: Cigna Commercial |
$22,827.05
|
| Rate for Payer: First Health Commercial |
$26,127.35
|
| Rate for Payer: Humana Commercial |
$23,377.10
|
| Rate for Payer: Humana KY Medicaid |
$9,458.10
|
| Rate for Payer: Kentucky WC Medicaid |
$9,554.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,552.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,296.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,250.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,647.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,202.17
|
| Rate for Payer: Ohio Health Group HMO |
$20,626.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,001.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,927.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,976.70
|
| Rate for Payer: PHCS Commercial |
$26,402.37
|
| Rate for Payer: United Healthcare All Payer |
$24,202.17
|
|
|
GLOBAL CAP HD 52X18
|
Facility
|
IP
|
$24,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,451.25 |
| Max. Negotiated Rate |
$23,844.00 |
| Rate for Payer: Aetna Commercial |
$19,124.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,373.25
|
| Rate for Payer: Cash Price |
$12,418.75
|
| Rate for Payer: Cigna Commercial |
$20,615.12
|
| Rate for Payer: First Health Commercial |
$23,595.62
|
| Rate for Payer: Humana Commercial |
$21,111.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,366.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,330.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,451.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,857.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,628.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,608.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,137.88
|
| Rate for Payer: PHCS Commercial |
$23,844.00
|
| Rate for Payer: United Healthcare All Payer |
$21,857.00
|
|
|
GLOBAL CAP HD 52X18
|
Facility
|
OP
|
$24,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,451.25 |
| Max. Negotiated Rate |
$23,844.00 |
| Rate for Payer: Aetna Commercial |
$19,124.88
|
| Rate for Payer: Anthem Medicaid |
$8,541.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,373.25
|
| Rate for Payer: Cash Price |
$12,418.75
|
| Rate for Payer: Cigna Commercial |
$20,615.12
|
| Rate for Payer: First Health Commercial |
$23,595.62
|
| Rate for Payer: Humana Commercial |
$21,111.88
|
| Rate for Payer: Humana KY Medicaid |
$8,541.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8,628.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,366.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,330.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,451.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,713.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,857.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,628.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,608.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,137.88
|
| Rate for Payer: PHCS Commercial |
$23,844.00
|
| Rate for Payer: United Healthcare All Payer |
$21,857.00
|
|
|
GLOBAL CAP HD 52X21
|
Facility
|
OP
|
$24,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,451.25 |
| Max. Negotiated Rate |
$23,844.00 |
| Rate for Payer: Aetna Commercial |
$19,124.88
|
| Rate for Payer: Anthem Medicaid |
$8,541.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,373.25
|
| Rate for Payer: Cash Price |
$12,418.75
|
| Rate for Payer: Cigna Commercial |
$20,615.12
|
| Rate for Payer: First Health Commercial |
$23,595.62
|
| Rate for Payer: Humana Commercial |
$21,111.88
|
| Rate for Payer: Humana KY Medicaid |
$8,541.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8,628.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,366.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,330.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,451.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,713.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,857.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,628.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,608.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,137.88
|
| Rate for Payer: PHCS Commercial |
$23,844.00
|
| Rate for Payer: United Healthcare All Payer |
$21,857.00
|
|
|
GLOBAL CAP HD 52X21
|
Facility
|
IP
|
$24,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,451.25 |
| Max. Negotiated Rate |
$23,844.00 |
| Rate for Payer: Aetna Commercial |
$19,124.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,373.25
|
| Rate for Payer: Cash Price |
$12,418.75
|
| Rate for Payer: Cigna Commercial |
$20,615.12
|
| Rate for Payer: First Health Commercial |
$23,595.62
|
| Rate for Payer: Humana Commercial |
$21,111.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,366.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,330.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,451.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,857.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,628.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,608.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,137.88
|
| Rate for Payer: PHCS Commercial |
$23,844.00
|
| Rate for Payer: United Healthcare All Payer |
$21,857.00
|
|
|
GLOBAL CAP HD 56X18
|
Facility
|
IP
|
$24,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,451.25 |
| Max. Negotiated Rate |
$23,844.00 |
| Rate for Payer: Aetna Commercial |
$19,124.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,373.25
|
| Rate for Payer: Cash Price |
$12,418.75
|
| Rate for Payer: Cigna Commercial |
$20,615.12
|
| Rate for Payer: First Health Commercial |
$23,595.62
|
| Rate for Payer: Humana Commercial |
$21,111.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,366.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,330.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,451.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,857.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,628.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,608.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,137.88
|
| Rate for Payer: PHCS Commercial |
$23,844.00
|
| Rate for Payer: United Healthcare All Payer |
$21,857.00
|
|
|
GLOBAL CAP HD 56X18
|
Facility
|
OP
|
$24,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,451.25 |
| Max. Negotiated Rate |
$23,844.00 |
| Rate for Payer: Aetna Commercial |
$19,124.88
|
| Rate for Payer: Anthem Medicaid |
$8,541.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,373.25
|
| Rate for Payer: Cash Price |
$12,418.75
|
| Rate for Payer: Cigna Commercial |
$20,615.12
|
| Rate for Payer: First Health Commercial |
$23,595.62
|
| Rate for Payer: Humana Commercial |
$21,111.88
|
| Rate for Payer: Humana KY Medicaid |
$8,541.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8,628.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,366.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,330.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,451.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,713.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,857.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,628.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,608.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,137.88
|
| Rate for Payer: PHCS Commercial |
$23,844.00
|
| Rate for Payer: United Healthcare All Payer |
$21,857.00
|
|
|
GLOBAL CAP HD 56X21
|
Facility
|
OP
|
$27,502.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,250.74 |
| Max. Negotiated Rate |
$26,402.37 |
| Rate for Payer: Aetna Commercial |
$21,176.90
|
| Rate for Payer: Anthem Medicaid |
$9,458.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,451.93
|
| Rate for Payer: Cash Price |
$13,751.24
|
| Rate for Payer: Cigna Commercial |
$22,827.05
|
| Rate for Payer: First Health Commercial |
$26,127.35
|
| Rate for Payer: Humana Commercial |
$23,377.10
|
| Rate for Payer: Humana KY Medicaid |
$9,458.10
|
| Rate for Payer: Kentucky WC Medicaid |
$9,554.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,552.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,296.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,250.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,647.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,202.17
|
| Rate for Payer: Ohio Health Group HMO |
$20,626.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,001.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,927.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,976.70
|
| Rate for Payer: PHCS Commercial |
$26,402.37
|
| Rate for Payer: United Healthcare All Payer |
$24,202.17
|
|
|
GLOBAL CAP HD 56X21
|
Facility
|
IP
|
$27,502.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,250.74 |
| Max. Negotiated Rate |
$26,402.37 |
| Rate for Payer: Aetna Commercial |
$21,176.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,451.93
|
| Rate for Payer: Cash Price |
$13,751.24
|
| Rate for Payer: Cigna Commercial |
$22,827.05
|
| Rate for Payer: First Health Commercial |
$26,127.35
|
| Rate for Payer: Humana Commercial |
$23,377.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,552.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,296.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,250.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,202.17
|
| Rate for Payer: Ohio Health Group HMO |
$20,626.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,001.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,927.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,976.70
|
| Rate for Payer: PHCS Commercial |
$26,402.37
|
| Rate for Payer: United Healthcare All Payer |
$24,202.17
|
|
|
GLOBAL CAP HE 48X21
|
Facility
|
OP
|
$26,228.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,868.62 |
| Max. Negotiated Rate |
$25,179.60 |
| Rate for Payer: Aetna Commercial |
$20,196.14
|
| Rate for Payer: Anthem Medicaid |
$9,020.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,458.42
|
| Rate for Payer: Cash Price |
$13,114.38
|
| Rate for Payer: Cigna Commercial |
$21,769.86
|
| Rate for Payer: First Health Commercial |
$24,917.31
|
| Rate for Payer: Humana Commercial |
$22,294.44
|
| Rate for Payer: Humana KY Medicaid |
$9,020.07
|
| Rate for Payer: Kentucky WC Medicaid |
$9,111.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,507.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,356.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,868.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,201.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,081.30
|
| Rate for Payer: Ohio Health Group HMO |
$19,671.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,983.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,819.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,097.84
|
| Rate for Payer: PHCS Commercial |
$25,179.60
|
| Rate for Payer: United Healthcare All Payer |
$23,081.30
|
|
|
GLOBAL CAP HE 48X21
|
Facility
|
IP
|
$26,228.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,868.62 |
| Max. Negotiated Rate |
$25,179.60 |
| Rate for Payer: Aetna Commercial |
$20,196.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,458.42
|
| Rate for Payer: Cash Price |
$13,114.38
|
| Rate for Payer: Cigna Commercial |
$21,769.86
|
| Rate for Payer: First Health Commercial |
$24,917.31
|
| Rate for Payer: Humana Commercial |
$22,294.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,507.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,356.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,868.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,081.30
|
| Rate for Payer: Ohio Health Group HMO |
$19,671.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,983.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,819.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,097.84
|
| Rate for Payer: PHCS Commercial |
$25,179.60
|
| Rate for Payer: United Healthcare All Payer |
$23,081.30
|
|
