|
GLOBAL FX STEM 10MM
|
Facility
|
IP
|
$14,289.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,286.94 |
| Max. Negotiated Rate |
$13,718.21 |
| Rate for Payer: Aetna Commercial |
$11,003.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,146.04
|
| Rate for Payer: Cash Price |
$7,144.90
|
| Rate for Payer: Cigna Commercial |
$11,860.53
|
| Rate for Payer: First Health Commercial |
$13,575.31
|
| Rate for Payer: Humana Commercial |
$12,146.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,717.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,545.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,286.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,575.02
|
| Rate for Payer: Ohio Health Group HMO |
$10,717.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,431.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,432.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,859.96
|
| Rate for Payer: PHCS Commercial |
$13,718.21
|
| Rate for Payer: United Healthcare All Payer |
$12,575.02
|
|
|
GLOBAL FX STEM 10MM
|
Facility
|
OP
|
$14,289.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,286.94 |
| Max. Negotiated Rate |
$13,718.21 |
| Rate for Payer: Aetna Commercial |
$11,003.15
|
| Rate for Payer: Anthem Medicaid |
$4,914.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,146.04
|
| Rate for Payer: Cash Price |
$7,144.90
|
| Rate for Payer: Cigna Commercial |
$11,860.53
|
| Rate for Payer: First Health Commercial |
$13,575.31
|
| Rate for Payer: Humana Commercial |
$12,146.33
|
| Rate for Payer: Humana KY Medicaid |
$4,914.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,964.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,717.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,545.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,286.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,012.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,575.02
|
| Rate for Payer: Ohio Health Group HMO |
$10,717.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,431.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,432.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,859.96
|
| Rate for Payer: PHCS Commercial |
$13,718.21
|
| Rate for Payer: United Healthcare All Payer |
$12,575.02
|
|
|
GLOBAL FX STEM 10MM LONG
|
Facility
|
OP
|
$21,218.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,365.62 |
| Max. Negotiated Rate |
$20,370.00 |
| Rate for Payer: Aetna Commercial |
$16,338.44
|
| Rate for Payer: Anthem Medicaid |
$7,297.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,550.62
|
| Rate for Payer: Cash Price |
$10,609.38
|
| Rate for Payer: Cigna Commercial |
$17,611.56
|
| Rate for Payer: First Health Commercial |
$20,157.81
|
| Rate for Payer: Humana Commercial |
$18,035.94
|
| Rate for Payer: Humana KY Medicaid |
$7,297.13
|
| Rate for Payer: Kentucky WC Medicaid |
$7,371.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,399.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,659.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,443.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,672.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,914.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,975.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,460.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,640.94
|
| Rate for Payer: PHCS Commercial |
$20,370.00
|
| Rate for Payer: United Healthcare All Payer |
$18,672.50
|
|
|
GLOBAL FX STEM 10MM LONG
|
Facility
|
IP
|
$21,218.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,365.62 |
| Max. Negotiated Rate |
$20,370.00 |
| Rate for Payer: Aetna Commercial |
$16,338.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,550.62
|
| Rate for Payer: Cash Price |
$10,609.38
|
| Rate for Payer: Cigna Commercial |
$17,611.56
|
| Rate for Payer: First Health Commercial |
$20,157.81
|
| Rate for Payer: Humana Commercial |
$18,035.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,399.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,659.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,672.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,914.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,975.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,460.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,640.94
|
| Rate for Payer: PHCS Commercial |
$20,370.00
|
| Rate for Payer: United Healthcare All Payer |
$18,672.50
|
|
|
GLOBAL FX STEM 12MM
|
Facility
|
IP
|
$14,289.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,286.94 |
| Max. Negotiated Rate |
$13,718.21 |
| Rate for Payer: Aetna Commercial |
$11,003.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,146.04
|
| Rate for Payer: Cash Price |
$7,144.90
|
| Rate for Payer: Cigna Commercial |
$11,860.53
|
| Rate for Payer: First Health Commercial |
$13,575.31
|
| Rate for Payer: Humana Commercial |
$12,146.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,717.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,545.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,286.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,575.02
|
| Rate for Payer: Ohio Health Group HMO |
$10,717.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,431.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,432.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,859.96
|
| Rate for Payer: PHCS Commercial |
$13,718.21
|
| Rate for Payer: United Healthcare All Payer |
$12,575.02
|
|
|
GLOBAL FX STEM 12MM
|
Facility
|
OP
|
$14,289.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,286.94 |
| Max. Negotiated Rate |
$13,718.21 |
| Rate for Payer: Aetna Commercial |
$11,003.15
|
| Rate for Payer: Anthem Medicaid |
$4,914.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,146.04
|
| Rate for Payer: Cash Price |
$7,144.90
|
| Rate for Payer: Cigna Commercial |
$11,860.53
|
| Rate for Payer: First Health Commercial |
$13,575.31
|
| Rate for Payer: Humana Commercial |
$12,146.33
|
| Rate for Payer: Humana KY Medicaid |
$4,914.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,964.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,717.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,545.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,286.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,012.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,575.02
|
| Rate for Payer: Ohio Health Group HMO |
$10,717.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,431.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,432.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,859.96
|
| Rate for Payer: PHCS Commercial |
$13,718.21
|
| Rate for Payer: United Healthcare All Payer |
$12,575.02
|
|
|
GLOBAL FX STEM 12MM LONG
|
Facility
|
OP
|
$21,218.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,365.62 |
| Max. Negotiated Rate |
$20,370.00 |
| Rate for Payer: Aetna Commercial |
$16,338.44
|
| Rate for Payer: Anthem Medicaid |
$7,297.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,550.62
|
| Rate for Payer: Cash Price |
$10,609.38
|
| Rate for Payer: Cigna Commercial |
$17,611.56
|
| Rate for Payer: First Health Commercial |
$20,157.81
|
| Rate for Payer: Humana Commercial |
$18,035.94
|
| Rate for Payer: Humana KY Medicaid |
$7,297.13
|
| Rate for Payer: Kentucky WC Medicaid |
$7,371.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,399.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,659.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,443.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,672.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,914.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,975.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,460.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,640.94
|
| Rate for Payer: PHCS Commercial |
$20,370.00
|
| Rate for Payer: United Healthcare All Payer |
$18,672.50
|
|
|
GLOBAL FX STEM 12MM LONG
|
Facility
|
IP
|
$21,218.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,365.62 |
| Max. Negotiated Rate |
$20,370.00 |
| Rate for Payer: Aetna Commercial |
$16,338.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,550.62
|
| Rate for Payer: Cash Price |
$10,609.38
|
| Rate for Payer: Cigna Commercial |
$17,611.56
|
| Rate for Payer: First Health Commercial |
$20,157.81
|
| Rate for Payer: Humana Commercial |
$18,035.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,399.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,659.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,672.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,914.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,975.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,460.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,640.94
|
| Rate for Payer: PHCS Commercial |
$20,370.00
|
| Rate for Payer: United Healthcare All Payer |
$18,672.50
|
|
|
GLOBAL FX STEM 6MM
|
Facility
|
OP
|
$14,289.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,286.94 |
| Max. Negotiated Rate |
$13,718.21 |
| Rate for Payer: Aetna Commercial |
$11,003.15
|
| Rate for Payer: Anthem Medicaid |
$4,914.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,146.04
|
| Rate for Payer: Cash Price |
$7,144.90
|
| Rate for Payer: Cigna Commercial |
$11,860.53
|
| Rate for Payer: First Health Commercial |
$13,575.31
|
| Rate for Payer: Humana Commercial |
$12,146.33
|
| Rate for Payer: Humana KY Medicaid |
$4,914.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,964.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,717.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,545.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,286.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,012.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,575.02
|
| Rate for Payer: Ohio Health Group HMO |
$10,717.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,431.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,432.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,859.96
|
| Rate for Payer: PHCS Commercial |
$13,718.21
|
| Rate for Payer: United Healthcare All Payer |
$12,575.02
|
|
|
GLOBAL FX STEM 6MM
|
Facility
|
IP
|
$14,289.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,286.94 |
| Max. Negotiated Rate |
$13,718.21 |
| Rate for Payer: Aetna Commercial |
$11,003.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,146.04
|
| Rate for Payer: Cash Price |
$7,144.90
|
| Rate for Payer: Cigna Commercial |
$11,860.53
|
| Rate for Payer: First Health Commercial |
$13,575.31
|
| Rate for Payer: Humana Commercial |
$12,146.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,717.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,545.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,286.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,575.02
|
| Rate for Payer: Ohio Health Group HMO |
$10,717.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,431.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,432.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,859.96
|
| Rate for Payer: PHCS Commercial |
$13,718.21
|
| Rate for Payer: United Healthcare All Payer |
$12,575.02
|
|
|
GLOBAL FX STEM 6MM LONG
|
Facility
|
OP
|
$21,218.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,365.62 |
| Max. Negotiated Rate |
$20,370.00 |
| Rate for Payer: Aetna Commercial |
$16,338.44
|
| Rate for Payer: Anthem Medicaid |
$7,297.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,550.62
|
| Rate for Payer: Cash Price |
$10,609.38
|
| Rate for Payer: Cigna Commercial |
$17,611.56
|
| Rate for Payer: First Health Commercial |
$20,157.81
|
| Rate for Payer: Humana Commercial |
$18,035.94
|
| Rate for Payer: Humana KY Medicaid |
$7,297.13
|
| Rate for Payer: Kentucky WC Medicaid |
$7,371.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,399.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,659.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,443.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,672.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,914.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,975.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,460.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,640.94
|
| Rate for Payer: PHCS Commercial |
$20,370.00
|
| Rate for Payer: United Healthcare All Payer |
$18,672.50
|
|
|
GLOBAL FX STEM 6MM LONG
|
Facility
|
IP
|
$21,218.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,365.62 |
| Max. Negotiated Rate |
$20,370.00 |
| Rate for Payer: Aetna Commercial |
$16,338.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,550.62
|
| Rate for Payer: Cash Price |
$10,609.38
|
| Rate for Payer: Cigna Commercial |
$17,611.56
|
| Rate for Payer: First Health Commercial |
$20,157.81
|
| Rate for Payer: Humana Commercial |
$18,035.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,399.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,659.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,672.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,914.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,975.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,460.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,640.94
|
| Rate for Payer: PHCS Commercial |
$20,370.00
|
| Rate for Payer: United Healthcare All Payer |
$18,672.50
|
|
|
GLOBAL FX STEM 8MM
|
Facility
|
IP
|
$14,289.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,286.94 |
| Max. Negotiated Rate |
$13,718.21 |
| Rate for Payer: Aetna Commercial |
$11,003.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,146.04
|
| Rate for Payer: Cash Price |
$7,144.90
|
| Rate for Payer: Cigna Commercial |
$11,860.53
|
| Rate for Payer: First Health Commercial |
$13,575.31
|
| Rate for Payer: Humana Commercial |
$12,146.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,717.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,545.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,286.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,575.02
|
| Rate for Payer: Ohio Health Group HMO |
$10,717.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,431.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,432.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,859.96
|
| Rate for Payer: PHCS Commercial |
$13,718.21
|
| Rate for Payer: United Healthcare All Payer |
$12,575.02
|
|
|
GLOBAL FX STEM 8MM
|
Facility
|
OP
|
$14,289.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,286.94 |
| Max. Negotiated Rate |
$13,718.21 |
| Rate for Payer: Aetna Commercial |
$11,003.15
|
| Rate for Payer: Anthem Medicaid |
$4,914.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,146.04
|
| Rate for Payer: Cash Price |
$7,144.90
|
| Rate for Payer: Cigna Commercial |
$11,860.53
|
| Rate for Payer: First Health Commercial |
$13,575.31
|
| Rate for Payer: Humana Commercial |
$12,146.33
|
| Rate for Payer: Humana KY Medicaid |
$4,914.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,964.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,717.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,545.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,286.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,012.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,575.02
|
| Rate for Payer: Ohio Health Group HMO |
$10,717.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,431.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,432.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,859.96
|
| Rate for Payer: PHCS Commercial |
$13,718.21
|
| Rate for Payer: United Healthcare All Payer |
$12,575.02
|
|
|
GLOBAL FX STEM 8MM LONG
|
Facility
|
OP
|
$21,218.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,365.62 |
| Max. Negotiated Rate |
$20,370.00 |
| Rate for Payer: Aetna Commercial |
$16,338.44
|
| Rate for Payer: Anthem Medicaid |
$7,297.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,550.62
|
| Rate for Payer: Cash Price |
$10,609.38
|
| Rate for Payer: Cigna Commercial |
$17,611.56
|
| Rate for Payer: First Health Commercial |
$20,157.81
|
| Rate for Payer: Humana Commercial |
$18,035.94
|
| Rate for Payer: Humana KY Medicaid |
$7,297.13
|
| Rate for Payer: Kentucky WC Medicaid |
$7,371.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,399.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,659.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,443.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,672.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,914.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,975.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,460.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,640.94
|
| Rate for Payer: PHCS Commercial |
$20,370.00
|
| Rate for Payer: United Healthcare All Payer |
$18,672.50
|
|
|
GLOBAL FX STEM 8MM LONG
|
Facility
|
IP
|
$21,218.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,365.62 |
| Max. Negotiated Rate |
$20,370.00 |
| Rate for Payer: Aetna Commercial |
$16,338.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,550.62
|
| Rate for Payer: Cash Price |
$10,609.38
|
| Rate for Payer: Cigna Commercial |
$17,611.56
|
| Rate for Payer: First Health Commercial |
$20,157.81
|
| Rate for Payer: Humana Commercial |
$18,035.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,399.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,659.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,672.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,914.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,975.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,460.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,640.94
|
| Rate for Payer: PHCS Commercial |
$20,370.00
|
| Rate for Payer: United Healthcare All Payer |
$18,672.50
|
|
|
GLOBAL SHLDR GLENOD PEG SZ44
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
GLOBAL SHLDR GLENOD PEG SZ44
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
GLOSSECTOMY
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 41120
|
| Hospital Charge Code |
76101660
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.46 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
GLOSSECTOMY
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 41120
|
| Hospital Charge Code |
76101660
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$475.75 |
| Max. Negotiated Rate |
$1,478.21 |
| Rate for Payer: Aetna Commercial |
$1,470.72
|
| Rate for Payer: Ambetter Exchange |
$971.66
|
| Rate for Payer: Anthem Medicaid |
$475.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$971.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$971.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,165.99
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,478.21
|
| Rate for Payer: Healthspan PPO |
$1,240.29
|
| Rate for Payer: Humana Medicaid |
$475.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,337.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$971.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$971.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$485.26
|
| Rate for Payer: Molina Healthcare Passport |
$475.75
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,263.16
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$480.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$971.66
|
|
|
GLOSSECTOMY
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 41120
|
| Hospital Charge Code |
76101660
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
GLOSSECTOMY(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 41120
|
| Hospital Charge Code |
761P1660
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$475.75 |
| Max. Negotiated Rate |
$1,478.21 |
| Rate for Payer: Aetna Commercial |
$1,470.72
|
| Rate for Payer: Ambetter Exchange |
$971.66
|
| Rate for Payer: Anthem Medicaid |
$475.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$971.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$971.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,165.99
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,478.21
|
| Rate for Payer: Healthspan PPO |
$1,240.29
|
| Rate for Payer: Humana Medicaid |
$475.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,337.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$971.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$971.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$485.26
|
| Rate for Payer: Molina Healthcare Passport |
$475.75
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,263.16
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$480.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$971.66
|
|
|
GLOW FOWARD
|
Facility
|
OP
|
$85.00
|
|
| Hospital Charge Code |
22200138
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem Medicaid |
$29.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.30
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Humana KY Medicaid |
$29.23
|
| Rate for Payer: Kentucky WC Medicaid |
$29.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.65
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
GLOW FOWARD
|
Professional
|
Both
|
$85.00
|
|
| Hospital Charge Code |
22200138
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Multiplan PHCS |
$51.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.50
|
| Rate for Payer: UHCCP Medicaid |
$29.75
|
|
|
GLOW FOWARD
|
Facility
|
IP
|
$85.00
|
|
| Hospital Charge Code |
22200138
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.30
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.65
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
