|
GMRS CEM STR 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 STR 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 STR 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 STR 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 STR 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 STR 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 STR 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 STR 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 STR 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 STR STEM W/O BODY 11M
|
Facility
|
IP
|
$16,147.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,099.15 |
| Max. Negotiated Rate |
$15,501.43 |
| Rate for Payer: Aetna Commercial |
$12,433.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,594.91
|
| Rate for Payer: Cash Price |
$8,073.66
|
| Rate for Payer: Cigna Commercial |
$13,402.28
|
| Rate for Payer: First Health Commercial |
$15,339.95
|
| Rate for Payer: Humana Commercial |
$13,725.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,240.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,916.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,844.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,209.64
|
| Rate for Payer: Ohio Health Group HMO |
$12,110.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,229.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,099.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,005.67
|
| Rate for Payer: PHCS Commercial |
$15,501.43
|
| Rate for Payer: United Healthcare All Payer |
$14,209.64
|
|
|
GMRS CEM STR STEM W/O BODY 11M
|
Facility
|
OP
|
$16,147.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,099.15 |
| Max. Negotiated Rate |
$15,501.43 |
| Rate for Payer: Aetna Commercial |
$12,433.44
|
| Rate for Payer: Anthem Medicaid |
$5,553.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,594.91
|
| Rate for Payer: Cash Price |
$8,073.66
|
| Rate for Payer: Cigna Commercial |
$13,402.28
|
| Rate for Payer: First Health Commercial |
$15,339.95
|
| Rate for Payer: Humana Commercial |
$13,725.22
|
| Rate for Payer: Humana KY Medicaid |
$5,553.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,609.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,240.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,916.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,844.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,664.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,209.64
|
| Rate for Payer: Ohio Health Group HMO |
$12,110.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,229.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,099.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,005.67
|
| Rate for Payer: PHCS Commercial |
$15,501.43
|
| Rate for Payer: United Healthcare All Payer |
$14,209.64
|
|
|
GMRS CEM STR STEM WO BODY 13MM
|
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 STR STEM WO BODY 13MM
|
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 STR 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 STR 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 STR 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 STR 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 STR 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 STR 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 STR 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 STR 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 CONNECTION PCE 90MM RT
|
Facility
|
IP
|
$22,409.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,913.18 |
| Max. Negotiated Rate |
$21,512.70 |
| Rate for Payer: Aetna Commercial |
$17,254.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,479.07
|
| Rate for Payer: Cash Price |
$11,204.53
|
| Rate for Payer: Cigna Commercial |
$18,599.52
|
| Rate for Payer: First Health Commercial |
$21,288.61
|
| Rate for Payer: Humana Commercial |
$19,047.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,375.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,537.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,722.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,719.97
|
| Rate for Payer: Ohio Health Group HMO |
$16,806.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,481.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,913.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,946.81
|
| Rate for Payer: PHCS Commercial |
$21,512.70
|
| Rate for Payer: United Healthcare All Payer |
$19,719.97
|
|
|
GMRS CONNECTION PCE 90MM RT
|
Facility
|
OP
|
$22,409.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,913.18 |
| Max. Negotiated Rate |
$21,512.70 |
| Rate for Payer: Aetna Commercial |
$17,254.98
|
| Rate for Payer: Anthem Medicaid |
$7,706.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,479.07
|
| Rate for Payer: Cash Price |
$11,204.53
|
| Rate for Payer: Cigna Commercial |
$18,599.52
|
| Rate for Payer: First Health Commercial |
$21,288.61
|
| Rate for Payer: Humana Commercial |
$19,047.70
|
| Rate for Payer: Humana KY Medicaid |
$7,706.48
|
| Rate for Payer: Kentucky WC Medicaid |
$7,784.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,375.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,537.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,722.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,861.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,719.97
|
| Rate for Payer: Ohio Health Group HMO |
$16,806.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,481.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,913.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,946.81
|
| Rate for Payer: PHCS Commercial |
$21,512.70
|
| Rate for Payer: United Healthcare All Payer |
$19,719.97
|
|
|
GMRS DIS FEM STD LEFT 65MM
|
Facility
|
OP
|
$27,733.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,605.38 |
| Max. Negotiated Rate |
$26,624.33 |
| Rate for Payer: Aetna Commercial |
$21,354.93
|
| Rate for Payer: Anthem Medicaid |
$9,537.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,632.27
|
| Rate for Payer: Cash Price |
$13,866.84
|
| Rate for Payer: Cigna Commercial |
$23,018.95
|
| Rate for Payer: First Health Commercial |
$26,347.00
|
| Rate for Payer: Humana Commercial |
$23,573.63
|
| Rate for Payer: Humana KY Medicaid |
$9,537.61
|
| Rate for Payer: Kentucky WC Medicaid |
$9,634.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,741.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,467.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,320.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,728.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,405.64
|
| Rate for Payer: Ohio Health Group HMO |
$20,800.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,546.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,605.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,597.44
|
| Rate for Payer: PHCS Commercial |
$26,624.33
|
| Rate for Payer: United Healthcare All Payer |
$24,405.64
|
|
|
GMRS DIS FEM STD LEFT 65MM
|
Facility
|
IP
|
$27,733.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,605.38 |
| Max. Negotiated Rate |
$26,624.33 |
| Rate for Payer: Aetna Commercial |
$21,354.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,632.27
|
| Rate for Payer: Cash Price |
$13,866.84
|
| Rate for Payer: Cigna Commercial |
$23,018.95
|
| Rate for Payer: First Health Commercial |
$26,347.00
|
| Rate for Payer: Humana Commercial |
$23,573.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,741.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,467.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,320.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,405.64
|
| Rate for Payer: Ohio Health Group HMO |
$20,800.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,546.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,605.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,597.44
|
| Rate for Payer: PHCS Commercial |
$26,624.33
|
| Rate for Payer: United Healthcare All Payer |
$24,405.64
|
|
