|
GLYCERIN PEDIATRIC SUPP. 1EA
|
Facility
|
IP
|
$4.29
|
|
|
Service Code
|
NDC 46122022263
|
| Hospital Charge Code |
25000732
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.56
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
GLYCINE IRRIGATION 3000ML
|
Facility
|
OP
|
$88.44
|
|
|
Service Code
|
NDC 990797408
|
| Hospital Charge Code |
25003085
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$84.90 |
| Rate for Payer: Aetna Commercial |
$68.10
|
| Rate for Payer: Anthem Medicaid |
$30.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.98
|
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Cigna Commercial |
$73.41
|
| Rate for Payer: First Health Commercial |
$84.02
|
| Rate for Payer: Humana Commercial |
$75.17
|
| Rate for Payer: Humana KY Medicaid |
$30.41
|
| Rate for Payer: Kentucky WC Medicaid |
$30.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.83
|
| Rate for Payer: Ohio Health Group HMO |
$66.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.42
|
| Rate for Payer: PHCS Commercial |
$84.90
|
| Rate for Payer: United Healthcare All Payer |
$77.83
|
|
|
GLYCINE IRRIGATION 3000ML
|
Facility
|
IP
|
$88.44
|
|
|
Service Code
|
NDC 990797408
|
| Hospital Charge Code |
25003085
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$84.90 |
| Rate for Payer: Aetna Commercial |
$68.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.98
|
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Cigna Commercial |
$73.41
|
| Rate for Payer: First Health Commercial |
$84.02
|
| Rate for Payer: Humana Commercial |
$75.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.83
|
| Rate for Payer: Ohio Health Group HMO |
$66.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.42
|
| Rate for Payer: PHCS Commercial |
$84.90
|
| Rate for Payer: United Healthcare All Payer |
$77.83
|
|
|
GMRS AXLE SMALL
|
Facility
|
OP
|
$6,765.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$879.50 |
| Max. Negotiated Rate |
$6,494.75 |
| Rate for Payer: Aetna Commercial |
$5,209.33
|
| Rate for Payer: Anthem Medicaid |
$2,326.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,276.98
|
| Rate for Payer: Cash Price |
$3,382.68
|
| Rate for Payer: Cigna Commercial |
$5,615.25
|
| Rate for Payer: First Health Commercial |
$6,427.09
|
| Rate for Payer: Humana Commercial |
$5,750.56
|
| Rate for Payer: Humana KY Medicaid |
$2,326.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,350.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,547.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,992.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,029.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,373.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,953.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,074.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,353.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$879.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,097.26
|
| Rate for Payer: PHCS Commercial |
$6,494.75
|
| Rate for Payer: United Healthcare All Payer |
$5,953.52
|
|
|
GMRS AXLE SMALL
|
Facility
|
IP
|
$6,765.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$879.50 |
| Max. Negotiated Rate |
$6,494.75 |
| Rate for Payer: Aetna Commercial |
$5,209.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,276.98
|
| Rate for Payer: Cash Price |
$3,382.68
|
| Rate for Payer: Cigna Commercial |
$5,615.25
|
| Rate for Payer: First Health Commercial |
$6,427.09
|
| Rate for Payer: Humana Commercial |
$5,750.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,547.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,992.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,029.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,953.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,074.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,353.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$879.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,097.26
|
| Rate for Payer: PHCS Commercial |
$6,494.75
|
| Rate for Payer: United Healthcare All Payer |
$5,953.52
|
|
|
GMRS CEM CVD STEM 10MM
|
Facility
|
IP
|
$16,399.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.96 |
| Max. Negotiated Rate |
$15,743.69 |
| Rate for Payer: Aetna Commercial |
$12,627.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,791.75
|
| Rate for Payer: Cash Price |
$8,199.84
|
| Rate for Payer: Cigna Commercial |
$13,611.73
|
| Rate for Payer: First Health Commercial |
$15,579.70
|
| Rate for Payer: Humana Commercial |
$13,939.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,447.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,102.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,919.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,431.72
|
| Rate for Payer: Ohio Health Group HMO |
$12,299.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,279.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,131.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,083.90
|
| Rate for Payer: PHCS Commercial |
$15,743.69
|
| Rate for Payer: United Healthcare All Payer |
$14,431.72
|
|
|
GMRS CEM CVD STEM 10MM
|
Facility
|
OP
|
$16,399.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.96 |
| Max. Negotiated Rate |
$15,743.69 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,791.75
|
| Rate for Payer: Aetna Commercial |
$12,627.75
|
| Rate for Payer: Anthem Medicaid |
$5,639.85
|
| Rate for Payer: Cash Price |
$8,199.84
|
| Rate for Payer: Cigna Commercial |
$13,611.73
|
| Rate for Payer: First Health Commercial |
$15,579.70
|
| Rate for Payer: Humana Commercial |
$13,939.73
|
| Rate for Payer: Humana KY Medicaid |
$5,639.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,697.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,447.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,102.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,919.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,753.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,431.72
|
| Rate for Payer: Ohio Health Group HMO |
$12,299.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,279.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,131.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,083.90
|
| Rate for Payer: PHCS Commercial |
$15,743.69
|
| Rate for Payer: United Healthcare All Payer |
$14,431.72
|
|
|
GMRS CEM CVD STEM 11MM
|
Facility
|
IP
|
$16,399.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.96 |
| Max. Negotiated Rate |
$15,743.69 |
| Rate for Payer: Aetna Commercial |
$12,627.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,791.75
|
| Rate for Payer: Cash Price |
$8,199.84
|
| Rate for Payer: Cigna Commercial |
$13,611.73
|
| Rate for Payer: First Health Commercial |
$15,579.70
|
| Rate for Payer: Humana Commercial |
$13,939.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,447.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,102.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,919.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,431.72
|
| Rate for Payer: Ohio Health Group HMO |
$12,299.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,279.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,131.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,083.90
|
| Rate for Payer: PHCS Commercial |
$15,743.69
|
| Rate for Payer: United Healthcare All Payer |
$14,431.72
|
|
|
GMRS CEM CVD STEM 11MM
|
Facility
|
OP
|
$16,399.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.96 |
| Max. Negotiated Rate |
$15,743.69 |
| Rate for Payer: Aetna Commercial |
$12,627.75
|
| Rate for Payer: Anthem Medicaid |
$5,639.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,791.75
|
| Rate for Payer: Cash Price |
$8,199.84
|
| Rate for Payer: Cigna Commercial |
$13,611.73
|
| Rate for Payer: First Health Commercial |
$15,579.70
|
| Rate for Payer: Humana Commercial |
$13,939.73
|
| Rate for Payer: Humana KY Medicaid |
$5,639.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,697.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,447.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,102.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,919.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,753.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,431.72
|
| Rate for Payer: Ohio Health Group HMO |
$12,299.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,279.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,131.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,083.90
|
| Rate for Payer: PHCS Commercial |
$15,743.69
|
| Rate for Payer: United Healthcare All Payer |
$14,431.72
|
|
|
GMRS CEM CVD STEM 13MM
|
Facility
|
OP
|
$19,689.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,559.58 |
| Max. Negotiated Rate |
$18,901.52 |
| Rate for Payer: Aetna Commercial |
$15,160.59
|
| Rate for Payer: Anthem Medicaid |
$6,771.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,357.48
|
| Rate for Payer: Cash Price |
$9,844.54
|
| Rate for Payer: Cigna Commercial |
$16,341.94
|
| Rate for Payer: First Health Commercial |
$18,704.63
|
| Rate for Payer: Humana Commercial |
$16,735.72
|
| Rate for Payer: Humana KY Medicaid |
$6,771.07
|
| Rate for Payer: Kentucky WC Medicaid |
$6,839.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,145.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,530.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,906.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,906.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,326.39
|
| Rate for Payer: Ohio Health Group HMO |
$14,766.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,937.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,559.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,103.61
|
| Rate for Payer: PHCS Commercial |
$18,901.52
|
| Rate for Payer: United Healthcare All Payer |
$17,326.39
|
|
|
GMRS CEM CVD STEM 13MM
|
Facility
|
IP
|
$19,689.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,559.58 |
| Max. Negotiated Rate |
$18,901.52 |
| Rate for Payer: Aetna Commercial |
$15,160.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,357.48
|
| Rate for Payer: Cash Price |
$9,844.54
|
| Rate for Payer: Cigna Commercial |
$16,341.94
|
| Rate for Payer: First Health Commercial |
$18,704.63
|
| Rate for Payer: Humana Commercial |
$16,735.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,145.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,530.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,906.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,326.39
|
| Rate for Payer: Ohio Health Group HMO |
$14,766.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,937.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,559.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,103.61
|
| Rate for Payer: PHCS Commercial |
$18,901.52
|
| Rate for Payer: United Healthcare All Payer |
$17,326.39
|
|
|
GMRS CEM CVD STEM 15MM
|
Facility
|
IP
|
$16,399.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.96 |
| Max. Negotiated Rate |
$15,743.69 |
| Rate for Payer: Aetna Commercial |
$12,627.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,791.75
|
| Rate for Payer: Cash Price |
$8,199.84
|
| Rate for Payer: Cigna Commercial |
$13,611.73
|
| Rate for Payer: First Health Commercial |
$15,579.70
|
| Rate for Payer: Humana Commercial |
$13,939.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,447.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,102.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,919.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,431.72
|
| Rate for Payer: Ohio Health Group HMO |
$12,299.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,279.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,131.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,083.90
|
| Rate for Payer: PHCS Commercial |
$15,743.69
|
| Rate for Payer: United Healthcare All Payer |
$14,431.72
|
|
|
GMRS CEM CVD STEM 15MM
|
Facility
|
OP
|
$16,399.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.96 |
| Max. Negotiated Rate |
$15,743.69 |
| Rate for Payer: Aetna Commercial |
$12,627.75
|
| Rate for Payer: Anthem Medicaid |
$5,639.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,791.75
|
| Rate for Payer: Cash Price |
$8,199.84
|
| Rate for Payer: Cigna Commercial |
$13,611.73
|
| Rate for Payer: First Health Commercial |
$15,579.70
|
| Rate for Payer: Humana Commercial |
$13,939.73
|
| Rate for Payer: Humana KY Medicaid |
$5,639.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,697.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,447.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,102.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,919.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,753.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,431.72
|
| Rate for Payer: Ohio Health Group HMO |
$12,299.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,279.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,131.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,083.90
|
| Rate for Payer: PHCS Commercial |
$15,743.69
|
| Rate for Payer: United Healthcare All Payer |
$14,431.72
|
|
|
GMRS CEM CVD STEM 17MM
|
Facility
|
OP
|
$16,399.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.96 |
| Max. Negotiated Rate |
$15,743.69 |
| Rate for Payer: Aetna Commercial |
$12,627.75
|
| Rate for Payer: Anthem Medicaid |
$5,639.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,791.75
|
| Rate for Payer: Cash Price |
$8,199.84
|
| Rate for Payer: Cigna Commercial |
$13,611.73
|
| Rate for Payer: First Health Commercial |
$15,579.70
|
| Rate for Payer: Humana Commercial |
$13,939.73
|
| Rate for Payer: Humana KY Medicaid |
$5,639.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,697.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,447.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,102.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,919.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,753.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,431.72
|
| Rate for Payer: Ohio Health Group HMO |
$12,299.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,279.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,131.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,083.90
|
| Rate for Payer: PHCS Commercial |
$15,743.69
|
| Rate for Payer: United Healthcare All Payer |
$14,431.72
|
|
|
GMRS CEM CVD STEM 17MM
|
Facility
|
IP
|
$16,399.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.96 |
| Max. Negotiated Rate |
$15,743.69 |
| Rate for Payer: Aetna Commercial |
$12,627.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,791.75
|
| Rate for Payer: Cash Price |
$8,199.84
|
| Rate for Payer: Cigna Commercial |
$13,611.73
|
| Rate for Payer: First Health Commercial |
$15,579.70
|
| Rate for Payer: Humana Commercial |
$13,939.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,447.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,102.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,919.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,431.72
|
| Rate for Payer: Ohio Health Group HMO |
$12,299.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,279.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,131.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,083.90
|
| Rate for Payer: PHCS Commercial |
$15,743.69
|
| Rate for Payer: United Healthcare All Payer |
$14,431.72
|
|
|
GMRS CEM CVD STEM 8MM
|
Facility
|
IP
|
$16,399.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.96 |
| Max. Negotiated Rate |
$15,743.69 |
| Rate for Payer: Aetna Commercial |
$12,627.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,791.75
|
| Rate for Payer: Cash Price |
$8,199.84
|
| Rate for Payer: Cigna Commercial |
$13,611.73
|
| Rate for Payer: First Health Commercial |
$15,579.70
|
| Rate for Payer: Humana Commercial |
$13,939.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,447.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,102.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,919.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,431.72
|
| Rate for Payer: Ohio Health Group HMO |
$12,299.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,279.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,131.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,083.90
|
| Rate for Payer: PHCS Commercial |
$15,743.69
|
| Rate for Payer: United Healthcare All Payer |
$14,431.72
|
|
|
GMRS CEM CVD STEM 8MM
|
Facility
|
OP
|
$16,399.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.96 |
| Max. Negotiated Rate |
$15,743.69 |
| Rate for Payer: Aetna Commercial |
$12,627.75
|
| Rate for Payer: Anthem Medicaid |
$5,639.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,791.75
|
| Rate for Payer: Cash Price |
$8,199.84
|
| Rate for Payer: Cigna Commercial |
$13,611.73
|
| Rate for Payer: First Health Commercial |
$15,579.70
|
| Rate for Payer: Humana Commercial |
$13,939.73
|
| Rate for Payer: Humana KY Medicaid |
$5,639.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,697.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,447.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,102.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,919.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,753.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,431.72
|
| Rate for Payer: Ohio Health Group HMO |
$12,299.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,279.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,131.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,083.90
|
| Rate for Payer: PHCS Commercial |
$15,743.69
|
| Rate for Payer: United Healthcare All Payer |
$14,431.72
|
|
|
GMRS CEM CVD STEM 9MM
|
Facility
|
OP
|
$16,399.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.96 |
| Max. Negotiated Rate |
$15,743.69 |
| Rate for Payer: Aetna Commercial |
$12,627.75
|
| Rate for Payer: Anthem Medicaid |
$5,639.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,791.75
|
| Rate for Payer: Cash Price |
$8,199.84
|
| Rate for Payer: Cigna Commercial |
$13,611.73
|
| Rate for Payer: First Health Commercial |
$15,579.70
|
| Rate for Payer: Humana Commercial |
$13,939.73
|
| Rate for Payer: Humana KY Medicaid |
$5,639.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,697.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,447.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,102.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,919.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,753.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,431.72
|
| Rate for Payer: Ohio Health Group HMO |
$12,299.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,279.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,131.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,083.90
|
| Rate for Payer: PHCS Commercial |
$15,743.69
|
| Rate for Payer: United Healthcare All Payer |
$14,431.72
|
|
|
GMRS CEM CVD STEM 9MM
|
Facility
|
IP
|
$16,399.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.96 |
| Max. Negotiated Rate |
$15,743.69 |
| Rate for Payer: Aetna Commercial |
$12,627.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,791.75
|
| Rate for Payer: Cash Price |
$8,199.84
|
| Rate for Payer: Cigna Commercial |
$13,611.73
|
| Rate for Payer: First Health Commercial |
$15,579.70
|
| Rate for Payer: Humana Commercial |
$13,939.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,447.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,102.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,919.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,431.72
|
| Rate for Payer: Ohio Health Group HMO |
$12,299.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,279.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,131.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,083.90
|
| Rate for Payer: PHCS Commercial |
$15,743.69
|
| Rate for Payer: United Healthcare All Payer |
$14,431.72
|
|
|
GMRS CEM CVD STEM WO BODY 10MM
|
Facility
|
IP
|
$12,261.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,593.99 |
| Max. Negotiated Rate |
$11,771.02 |
| Rate for Payer: Aetna Commercial |
$9,441.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,563.95
|
| Rate for Payer: Cash Price |
$6,130.74
|
| Rate for Payer: Cigna Commercial |
$10,177.03
|
| Rate for Payer: First Health Commercial |
$11,648.41
|
| Rate for Payer: Humana Commercial |
$10,422.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,054.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,048.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,678.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,790.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,196.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,452.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,593.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,801.06
|
| Rate for Payer: PHCS Commercial |
$11,771.02
|
| Rate for Payer: United Healthcare All Payer |
$10,790.10
|
|
|
GMRS CEM CVD STEM WO BODY 10MM
|
Facility
|
OP
|
$12,261.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,593.99 |
| Max. Negotiated Rate |
$11,771.02 |
| Rate for Payer: Aetna Commercial |
$9,441.34
|
| Rate for Payer: Anthem Medicaid |
$4,216.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,563.95
|
| Rate for Payer: Cash Price |
$6,130.74
|
| Rate for Payer: Cigna Commercial |
$10,177.03
|
| Rate for Payer: First Health Commercial |
$11,648.41
|
| Rate for Payer: Humana Commercial |
$10,422.26
|
| Rate for Payer: Humana KY Medicaid |
$4,216.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,259.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,054.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,048.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,678.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,301.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,790.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,196.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,452.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,593.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,801.06
|
| Rate for Payer: PHCS Commercial |
$11,771.02
|
| Rate for Payer: United Healthcare All Payer |
$10,790.10
|
|
|
GMRS CEM CVD STEM WO BODY 11MM
|
Facility
|
IP
|
$12,261.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,593.99 |
| Max. Negotiated Rate |
$11,771.02 |
| Rate for Payer: Aetna Commercial |
$9,441.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,563.95
|
| Rate for Payer: Cash Price |
$6,130.74
|
| Rate for Payer: Cigna Commercial |
$10,177.03
|
| Rate for Payer: First Health Commercial |
$11,648.41
|
| Rate for Payer: Humana Commercial |
$10,422.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,054.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,048.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,678.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,790.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,196.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,452.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,593.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,801.06
|
| Rate for Payer: PHCS Commercial |
$11,771.02
|
| Rate for Payer: United Healthcare All Payer |
$10,790.10
|
|
|
GMRS CEM CVD STEM WO BODY 11MM
|
Facility
|
OP
|
$12,261.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,593.99 |
| Max. Negotiated Rate |
$11,771.02 |
| Rate for Payer: Aetna Commercial |
$9,441.34
|
| Rate for Payer: Anthem Medicaid |
$4,216.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,563.95
|
| Rate for Payer: Cash Price |
$6,130.74
|
| Rate for Payer: Cigna Commercial |
$10,177.03
|
| Rate for Payer: First Health Commercial |
$11,648.41
|
| Rate for Payer: Humana Commercial |
$10,422.26
|
| Rate for Payer: Humana KY Medicaid |
$4,216.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,259.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,054.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,048.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,678.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,301.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,790.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,196.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,452.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,593.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,801.06
|
| Rate for Payer: PHCS Commercial |
$11,771.02
|
| Rate for Payer: United Healthcare All Payer |
$10,790.10
|
|
|
GMRS CEM CVD STEM WO BODY 13MM
|
Facility
|
OP
|
$13,271.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,725.33 |
| Max. Negotiated Rate |
$12,740.93 |
| Rate for Payer: Aetna Commercial |
$10,219.29
|
| Rate for Payer: Anthem Medicaid |
$4,564.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,352.00
|
| Rate for Payer: Cash Price |
$6,635.90
|
| Rate for Payer: Cigna Commercial |
$11,015.59
|
| Rate for Payer: First Health Commercial |
$12,608.21
|
| Rate for Payer: Humana Commercial |
$11,281.03
|
| Rate for Payer: Humana KY Medicaid |
$4,564.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,610.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,882.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,794.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,981.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,655.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,679.18
|
| Rate for Payer: Ohio Health Group HMO |
$9,953.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,654.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,725.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,114.26
|
| Rate for Payer: PHCS Commercial |
$12,740.93
|
| Rate for Payer: United Healthcare All Payer |
$11,679.18
|
|
|
GMRS CEM CVD STEM WO BODY 13MM
|
Facility
|
IP
|
$13,271.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,725.33 |
| Max. Negotiated Rate |
$12,740.93 |
| Rate for Payer: Aetna Commercial |
$10,219.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,352.00
|
| Rate for Payer: Cash Price |
$6,635.90
|
| Rate for Payer: Cigna Commercial |
$11,015.59
|
| Rate for Payer: First Health Commercial |
$12,608.21
|
| Rate for Payer: Humana Commercial |
$11,281.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,882.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,794.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,981.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,679.18
|
| Rate for Payer: Ohio Health Group HMO |
$9,953.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,654.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,725.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,114.26
|
| Rate for Payer: PHCS Commercial |
$12,740.93
|
| Rate for Payer: United Healthcare All Payer |
$11,679.18
|
|
