|
GMRS CEM CVD STEM WO BODY 15MM
|
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 15MM
|
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 17MM
|
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 17MM
|
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 W/O BODY 8MM
|
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 W/O BODY 8MM
|
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 W/O BODY 9MM
|
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 W/O BODY 9MM
|
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 LGCVD STEM WO BDY 11M
|
Facility
|
IP
|
$16,609.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,159.29 |
| Max. Negotiated Rate |
$15,945.52 |
| Rate for Payer: Aetna Commercial |
$12,789.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.74
|
| Rate for Payer: Cash Price |
$8,304.96
|
| Rate for Payer: Cigna Commercial |
$13,786.23
|
| Rate for Payer: First Health Commercial |
$15,779.42
|
| Rate for Payer: Humana Commercial |
$14,118.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,982.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.73
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,321.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,159.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,149.08
|
| Rate for Payer: PHCS Commercial |
$15,945.52
|
| Rate for Payer: United Healthcare All Payer |
$14,616.73
|
|
|
GMRS CEM LGCVD STEM WO BDY 11M
|
Facility
|
OP
|
$16,609.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,159.29 |
| Max. Negotiated Rate |
$15,945.52 |
| Rate for Payer: Aetna Commercial |
$12,789.64
|
| Rate for Payer: Anthem Medicaid |
$5,712.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.74
|
| Rate for Payer: Cash Price |
$8,304.96
|
| Rate for Payer: Cigna Commercial |
$13,786.23
|
| Rate for Payer: First Health Commercial |
$15,779.42
|
| Rate for Payer: Humana Commercial |
$14,118.43
|
| Rate for Payer: Humana KY Medicaid |
$5,712.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,982.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.73
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,321.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,159.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,149.08
|
| Rate for Payer: PHCS Commercial |
$15,945.52
|
| Rate for Payer: United Healthcare All Payer |
$14,616.73
|
|
|
GMRS CEM LGCVD STEM WO BDY 13M
|
Facility
|
IP
|
$19,943.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,592.61 |
| Max. Negotiated Rate |
$19,145.40 |
| Rate for Payer: Aetna Commercial |
$15,356.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,555.63
|
| Rate for Payer: Cash Price |
$9,971.56
|
| Rate for Payer: Cigna Commercial |
$16,552.79
|
| Rate for Payer: First Health Commercial |
$18,945.96
|
| Rate for Payer: Humana Commercial |
$16,951.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,353.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,718.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,982.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,549.95
|
| Rate for Payer: Ohio Health Group HMO |
$14,957.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,988.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,592.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,182.37
|
| Rate for Payer: PHCS Commercial |
$19,145.40
|
| Rate for Payer: United Healthcare All Payer |
$17,549.95
|
|
|
GMRS CEM LGCVD STEM WO BDY 13M
|
Facility
|
OP
|
$19,943.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,592.61 |
| Max. Negotiated Rate |
$19,145.40 |
| Rate for Payer: Aetna Commercial |
$15,356.20
|
| Rate for Payer: Anthem Medicaid |
$6,858.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,555.63
|
| Rate for Payer: Cash Price |
$9,971.56
|
| Rate for Payer: Cigna Commercial |
$16,552.79
|
| Rate for Payer: First Health Commercial |
$18,945.96
|
| Rate for Payer: Humana Commercial |
$16,951.65
|
| Rate for Payer: Humana KY Medicaid |
$6,858.44
|
| Rate for Payer: Kentucky WC Medicaid |
$6,928.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,353.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,718.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,982.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,996.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,549.95
|
| Rate for Payer: Ohio Health Group HMO |
$14,957.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,988.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,592.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,182.37
|
| Rate for Payer: PHCS Commercial |
$19,145.40
|
| Rate for Payer: United Healthcare All Payer |
$17,549.95
|
|
|
GMRS CEM LGCVD STEM WO BDY 15M
|
Facility
|
OP
|
$16,609.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,159.29 |
| Max. Negotiated Rate |
$15,945.52 |
| Rate for Payer: Aetna Commercial |
$12,789.64
|
| Rate for Payer: Anthem Medicaid |
$5,712.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.74
|
| Rate for Payer: Cash Price |
$8,304.96
|
| Rate for Payer: Cigna Commercial |
$13,786.23
|
| Rate for Payer: First Health Commercial |
$15,779.42
|
| Rate for Payer: Humana Commercial |
$14,118.43
|
| Rate for Payer: Humana KY Medicaid |
$5,712.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,982.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.73
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,321.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,159.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,149.08
|
| Rate for Payer: PHCS Commercial |
$15,945.52
|
| Rate for Payer: United Healthcare All Payer |
$14,616.73
|
|
|
GMRS CEM LGCVD STEM WO BDY 15M
|
Facility
|
IP
|
$16,609.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,159.29 |
| Max. Negotiated Rate |
$15,945.52 |
| Rate for Payer: Aetna Commercial |
$12,789.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.74
|
| Rate for Payer: Cash Price |
$8,304.96
|
| Rate for Payer: Cigna Commercial |
$13,786.23
|
| Rate for Payer: First Health Commercial |
$15,779.42
|
| Rate for Payer: Humana Commercial |
$14,118.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,982.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.73
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,321.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,159.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,149.08
|
| Rate for Payer: PHCS Commercial |
$15,945.52
|
| Rate for Payer: United Healthcare All Payer |
$14,616.73
|
|
|
GMRS CEM LONG CVD STEM 11MM
|
Facility
|
IP
|
$20,973.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,726.60 |
| Max. Negotiated Rate |
$20,134.92 |
| Rate for Payer: Aetna Commercial |
$16,149.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,359.63
|
| Rate for Payer: Cash Price |
$10,486.94
|
| Rate for Payer: Cigna Commercial |
$17,408.32
|
| Rate for Payer: First Health Commercial |
$19,925.19
|
| Rate for Payer: Humana Commercial |
$17,827.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,198.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,478.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,292.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,457.01
|
| Rate for Payer: Ohio Health Group HMO |
$15,730.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,194.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,726.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,501.90
|
| Rate for Payer: PHCS Commercial |
$20,134.92
|
| Rate for Payer: United Healthcare All Payer |
$18,457.01
|
|
|
GMRS CEM LONG CVD STEM 11MM
|
Facility
|
OP
|
$20,973.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,726.60 |
| Max. Negotiated Rate |
$20,134.92 |
| Rate for Payer: Aetna Commercial |
$16,149.89
|
| Rate for Payer: Anthem Medicaid |
$7,212.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,359.63
|
| Rate for Payer: Cash Price |
$10,486.94
|
| Rate for Payer: Cigna Commercial |
$17,408.32
|
| Rate for Payer: First Health Commercial |
$19,925.19
|
| Rate for Payer: Humana Commercial |
$17,827.80
|
| Rate for Payer: Humana KY Medicaid |
$7,212.92
|
| Rate for Payer: Kentucky WC Medicaid |
$7,286.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,198.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,478.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,292.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,357.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,457.01
|
| Rate for Payer: Ohio Health Group HMO |
$15,730.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,194.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,726.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,501.90
|
| Rate for Payer: PHCS Commercial |
$20,134.92
|
| Rate for Payer: United Healthcare All Payer |
$18,457.01
|
|
|
GMRS CEM LONG CVD STEM 13MM
|
Facility
|
OP
|
$20,973.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,726.60 |
| Max. Negotiated Rate |
$20,134.92 |
| Rate for Payer: Aetna Commercial |
$16,149.89
|
| Rate for Payer: Anthem Medicaid |
$7,212.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,359.63
|
| Rate for Payer: Cash Price |
$10,486.94
|
| Rate for Payer: Cigna Commercial |
$17,408.32
|
| Rate for Payer: First Health Commercial |
$19,925.19
|
| Rate for Payer: Humana Commercial |
$17,827.80
|
| Rate for Payer: Humana KY Medicaid |
$7,212.92
|
| Rate for Payer: Kentucky WC Medicaid |
$7,286.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,198.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,478.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,292.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,357.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,457.01
|
| Rate for Payer: Ohio Health Group HMO |
$15,730.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,194.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,726.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,501.90
|
| Rate for Payer: PHCS Commercial |
$20,134.92
|
| Rate for Payer: United Healthcare All Payer |
$18,457.01
|
|
|
GMRS CEM LONG CVD STEM 13MM
|
Facility
|
IP
|
$20,973.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,726.60 |
| Max. Negotiated Rate |
$20,134.92 |
| Rate for Payer: Aetna Commercial |
$16,149.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,359.63
|
| Rate for Payer: Cash Price |
$10,486.94
|
| Rate for Payer: Cigna Commercial |
$17,408.32
|
| Rate for Payer: First Health Commercial |
$19,925.19
|
| Rate for Payer: Humana Commercial |
$17,827.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,198.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,478.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,292.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,457.01
|
| Rate for Payer: Ohio Health Group HMO |
$15,730.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,194.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,726.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,501.90
|
| Rate for Payer: PHCS Commercial |
$20,134.92
|
| Rate for Payer: United Healthcare All Payer |
$18,457.01
|
|
|
GMRS CEM LONG CVD STEM 15MM
|
Facility
|
OP
|
$20,973.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,726.60 |
| Max. Negotiated Rate |
$20,134.92 |
| Rate for Payer: Aetna Commercial |
$16,149.89
|
| Rate for Payer: Anthem Medicaid |
$7,212.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,359.63
|
| Rate for Payer: Cash Price |
$10,486.94
|
| Rate for Payer: Cigna Commercial |
$17,408.32
|
| Rate for Payer: First Health Commercial |
$19,925.19
|
| Rate for Payer: Humana Commercial |
$17,827.80
|
| Rate for Payer: Humana KY Medicaid |
$7,212.92
|
| Rate for Payer: Kentucky WC Medicaid |
$7,286.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,198.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,478.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,292.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,357.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,457.01
|
| Rate for Payer: Ohio Health Group HMO |
$15,730.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,194.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,726.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,501.90
|
| Rate for Payer: PHCS Commercial |
$20,134.92
|
| Rate for Payer: United Healthcare All Payer |
$18,457.01
|
|
|
GMRS CEM LONG CVD STEM 15MM
|
Facility
|
IP
|
$20,973.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,726.60 |
| Max. Negotiated Rate |
$20,134.92 |
| Rate for Payer: Aetna Commercial |
$16,149.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,359.63
|
| Rate for Payer: Cash Price |
$10,486.94
|
| Rate for Payer: Cigna Commercial |
$17,408.32
|
| Rate for Payer: First Health Commercial |
$19,925.19
|
| Rate for Payer: Humana Commercial |
$17,827.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,198.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,478.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,292.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,457.01
|
| Rate for Payer: Ohio Health Group HMO |
$15,730.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,194.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,726.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,501.90
|
| Rate for Payer: PHCS Commercial |
$20,134.92
|
| Rate for Payer: United Healthcare All Payer |
$18,457.01
|
|
|
GMRS CEM LONG CVD STEM 17MM
|
Facility
|
OP
|
$20,973.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,726.60 |
| Max. Negotiated Rate |
$20,134.92 |
| Rate for Payer: Aetna Commercial |
$16,149.89
|
| Rate for Payer: Anthem Medicaid |
$7,212.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,359.63
|
| Rate for Payer: Cash Price |
$10,486.94
|
| Rate for Payer: Cigna Commercial |
$17,408.32
|
| Rate for Payer: First Health Commercial |
$19,925.19
|
| Rate for Payer: Humana Commercial |
$17,827.80
|
| Rate for Payer: Humana KY Medicaid |
$7,212.92
|
| Rate for Payer: Kentucky WC Medicaid |
$7,286.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,198.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,478.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,292.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,357.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,457.01
|
| Rate for Payer: Ohio Health Group HMO |
$15,730.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,194.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,726.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,501.90
|
| Rate for Payer: PHCS Commercial |
$20,134.92
|
| Rate for Payer: United Healthcare All Payer |
$18,457.01
|
|
|
GMRS CEM LONG CVD STEM 17MM
|
Facility
|
IP
|
$20,973.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,726.60 |
| Max. Negotiated Rate |
$20,134.92 |
| Rate for Payer: Aetna Commercial |
$16,149.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,359.63
|
| Rate for Payer: Cash Price |
$10,486.94
|
| Rate for Payer: Cigna Commercial |
$17,408.32
|
| Rate for Payer: First Health Commercial |
$19,925.19
|
| Rate for Payer: Humana Commercial |
$17,827.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,198.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,478.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,292.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,457.01
|
| Rate for Payer: Ohio Health Group HMO |
$15,730.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,194.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,726.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,501.90
|
| Rate for Payer: PHCS Commercial |
$20,134.92
|
| Rate for Payer: United Healthcare All Payer |
$18,457.01
|
|
|
GMRS CEM STR 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 STR 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: 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 STR 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
|
|
