|
GMRS CEM CVD STEM WO BODY 10MM
|
Facility
|
OP
|
$12,510.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,753.17 |
| Max. Negotiated Rate |
$12,010.16 |
| Rate for Payer: Aetna Commercial |
$9,633.15
|
| Rate for Payer: Anthem Medicaid |
$4,302.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,758.25
|
| Rate for Payer: Cash Price |
$6,255.29
|
| Rate for Payer: Cigna Commercial |
$10,383.78
|
| Rate for Payer: First Health Commercial |
$11,885.05
|
| Rate for Payer: Humana Commercial |
$10,633.99
|
| Rate for Payer: Humana KY Medicaid |
$4,302.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,346.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,258.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,232.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,753.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,388.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,009.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,382.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,008.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,884.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,632.30
|
| Rate for Payer: PHCS Commercial |
$12,010.16
|
| Rate for Payer: United Healthcare All Payer |
$11,009.31
|
|
|
GMRS CEM CVD STEM WO BODY 11MM
|
Facility
|
OP
|
$12,510.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,753.17 |
| Max. Negotiated Rate |
$12,010.16 |
| Rate for Payer: Aetna Commercial |
$9,633.15
|
| Rate for Payer: Anthem Medicaid |
$4,302.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,758.25
|
| Rate for Payer: Cash Price |
$6,255.29
|
| Rate for Payer: Cigna Commercial |
$10,383.78
|
| Rate for Payer: First Health Commercial |
$11,885.05
|
| Rate for Payer: Humana Commercial |
$10,633.99
|
| Rate for Payer: Humana KY Medicaid |
$4,302.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,346.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,258.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,232.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,753.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,388.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,009.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,382.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,008.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,884.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,632.30
|
| Rate for Payer: PHCS Commercial |
$12,010.16
|
| Rate for Payer: United Healthcare All Payer |
$11,009.31
|
|
|
GMRS CEM CVD STEM WO BODY 11MM
|
Facility
|
IP
|
$12,510.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,753.17 |
| Max. Negotiated Rate |
$12,010.16 |
| Rate for Payer: Aetna Commercial |
$9,633.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,758.25
|
| Rate for Payer: Cash Price |
$6,255.29
|
| Rate for Payer: Cigna Commercial |
$10,383.78
|
| Rate for Payer: First Health Commercial |
$11,885.05
|
| Rate for Payer: Humana Commercial |
$10,633.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,258.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,232.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,753.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,009.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,382.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,008.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,884.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,632.30
|
| Rate for Payer: PHCS Commercial |
$12,010.16
|
| Rate for Payer: United Healthcare All Payer |
$11,009.31
|
|
|
GMRS CEM CVD STEM WO BODY 13MM
|
Facility
|
IP
|
$13,526.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,057.93 |
| Max. Negotiated Rate |
$12,985.38 |
| Rate for Payer: Aetna Commercial |
$10,415.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,550.62
|
| Rate for Payer: Cash Price |
$6,763.22
|
| Rate for Payer: Cigna Commercial |
$11,226.95
|
| Rate for Payer: First Health Commercial |
$12,850.12
|
| Rate for Payer: Humana Commercial |
$11,497.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,091.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,982.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,057.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,903.27
|
| Rate for Payer: Ohio Health Group HMO |
$10,144.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,821.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,768.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,333.24
|
| Rate for Payer: PHCS Commercial |
$12,985.38
|
| Rate for Payer: United Healthcare All Payer |
$11,903.27
|
|
|
GMRS CEM CVD STEM WO BODY 13MM
|
Facility
|
OP
|
$13,526.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,057.93 |
| Max. Negotiated Rate |
$12,985.38 |
| Rate for Payer: Aetna Commercial |
$10,415.36
|
| Rate for Payer: Anthem Medicaid |
$4,651.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,550.62
|
| Rate for Payer: Cash Price |
$6,763.22
|
| Rate for Payer: Cigna Commercial |
$11,226.95
|
| Rate for Payer: First Health Commercial |
$12,850.12
|
| Rate for Payer: Humana Commercial |
$11,497.47
|
| Rate for Payer: Humana KY Medicaid |
$4,651.74
|
| Rate for Payer: Kentucky WC Medicaid |
$4,699.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,091.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,982.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,057.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,745.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,903.27
|
| Rate for Payer: Ohio Health Group HMO |
$10,144.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,821.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,768.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,333.24
|
| Rate for Payer: PHCS Commercial |
$12,985.38
|
| Rate for Payer: United Healthcare All Payer |
$11,903.27
|
|
|
GMRS CEM CVD STEM WO BODY 15MM
|
Facility
|
IP
|
$12,510.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,753.17 |
| Max. Negotiated Rate |
$12,010.16 |
| Rate for Payer: Aetna Commercial |
$9,633.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,758.25
|
| Rate for Payer: Cash Price |
$6,255.29
|
| Rate for Payer: Cigna Commercial |
$10,383.78
|
| Rate for Payer: First Health Commercial |
$11,885.05
|
| Rate for Payer: Humana Commercial |
$10,633.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,258.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,232.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,753.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,009.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,382.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,008.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,884.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,632.30
|
| Rate for Payer: PHCS Commercial |
$12,010.16
|
| Rate for Payer: United Healthcare All Payer |
$11,009.31
|
|
|
GMRS CEM CVD STEM WO BODY 15MM
|
Facility
|
OP
|
$12,510.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,753.17 |
| Max. Negotiated Rate |
$12,010.16 |
| Rate for Payer: Aetna Commercial |
$9,633.15
|
| Rate for Payer: Anthem Medicaid |
$4,302.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,758.25
|
| Rate for Payer: Cash Price |
$6,255.29
|
| Rate for Payer: Cigna Commercial |
$10,383.78
|
| Rate for Payer: First Health Commercial |
$11,885.05
|
| Rate for Payer: Humana Commercial |
$10,633.99
|
| Rate for Payer: Humana KY Medicaid |
$4,302.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,346.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,258.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,232.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,753.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,388.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,009.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,382.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,008.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,884.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,632.30
|
| Rate for Payer: PHCS Commercial |
$12,010.16
|
| Rate for Payer: United Healthcare All Payer |
$11,009.31
|
|
|
GMRS CEM CVD STEM WO BODY 17MM
|
Facility
|
OP
|
$12,510.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,753.17 |
| Max. Negotiated Rate |
$12,010.16 |
| Rate for Payer: Aetna Commercial |
$9,633.15
|
| Rate for Payer: Anthem Medicaid |
$4,302.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,758.25
|
| Rate for Payer: Cash Price |
$6,255.29
|
| Rate for Payer: Cigna Commercial |
$10,383.78
|
| Rate for Payer: First Health Commercial |
$11,885.05
|
| Rate for Payer: Humana Commercial |
$10,633.99
|
| Rate for Payer: Humana KY Medicaid |
$4,302.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,346.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,258.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,232.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,753.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,388.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,009.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,382.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,008.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,884.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,632.30
|
| Rate for Payer: PHCS Commercial |
$12,010.16
|
| Rate for Payer: United Healthcare All Payer |
$11,009.31
|
|
|
GMRS CEM CVD STEM WO BODY 17MM
|
Facility
|
IP
|
$12,510.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,753.17 |
| Max. Negotiated Rate |
$12,010.16 |
| Rate for Payer: Aetna Commercial |
$9,633.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,758.25
|
| Rate for Payer: Cash Price |
$6,255.29
|
| Rate for Payer: Cigna Commercial |
$10,383.78
|
| Rate for Payer: First Health Commercial |
$11,885.05
|
| Rate for Payer: Humana Commercial |
$10,633.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,258.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,232.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,753.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,009.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,382.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,008.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,884.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,632.30
|
| Rate for Payer: PHCS Commercial |
$12,010.16
|
| Rate for Payer: United Healthcare All Payer |
$11,009.31
|
|
|
GMRS CEM CVD STEM W/O BODY 8MM
|
Facility
|
OP
|
$12,510.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,753.17 |
| Max. Negotiated Rate |
$12,010.16 |
| Rate for Payer: Aetna Commercial |
$9,633.15
|
| Rate for Payer: Anthem Medicaid |
$4,302.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,758.25
|
| Rate for Payer: Cash Price |
$6,255.29
|
| Rate for Payer: Cigna Commercial |
$10,383.78
|
| Rate for Payer: First Health Commercial |
$11,885.05
|
| Rate for Payer: Humana Commercial |
$10,633.99
|
| Rate for Payer: Humana KY Medicaid |
$4,302.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,346.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,258.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,232.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,753.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,388.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,009.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,382.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,008.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,884.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,632.30
|
| Rate for Payer: PHCS Commercial |
$12,010.16
|
| Rate for Payer: United Healthcare All Payer |
$11,009.31
|
|
|
GMRS CEM CVD STEM W/O BODY 8MM
|
Facility
|
IP
|
$12,510.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,753.17 |
| Max. Negotiated Rate |
$12,010.16 |
| Rate for Payer: Aetna Commercial |
$9,633.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,758.25
|
| Rate for Payer: Cash Price |
$6,255.29
|
| Rate for Payer: Cigna Commercial |
$10,383.78
|
| Rate for Payer: First Health Commercial |
$11,885.05
|
| Rate for Payer: Humana Commercial |
$10,633.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,258.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,232.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,753.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,009.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,382.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,008.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,884.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,632.30
|
| Rate for Payer: PHCS Commercial |
$12,010.16
|
| Rate for Payer: United Healthcare All Payer |
$11,009.31
|
|
|
GMRS CEM CVD STEM W/O BODY 9MM
|
Facility
|
OP
|
$12,510.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,753.17 |
| Max. Negotiated Rate |
$12,010.16 |
| Rate for Payer: Aetna Commercial |
$9,633.15
|
| Rate for Payer: Anthem Medicaid |
$4,302.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,758.25
|
| Rate for Payer: Cash Price |
$6,255.29
|
| Rate for Payer: Cigna Commercial |
$10,383.78
|
| Rate for Payer: First Health Commercial |
$11,885.05
|
| Rate for Payer: Humana Commercial |
$10,633.99
|
| Rate for Payer: Humana KY Medicaid |
$4,302.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,346.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,258.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,232.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,753.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,388.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,009.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,382.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,008.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,884.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,632.30
|
| Rate for Payer: PHCS Commercial |
$12,010.16
|
| Rate for Payer: United Healthcare All Payer |
$11,009.31
|
|
|
GMRS CEM CVD STEM W/O BODY 9MM
|
Facility
|
IP
|
$12,510.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,753.17 |
| Max. Negotiated Rate |
$12,010.16 |
| Rate for Payer: Aetna Commercial |
$9,633.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,758.25
|
| Rate for Payer: Cash Price |
$6,255.29
|
| Rate for Payer: Cigna Commercial |
$10,383.78
|
| Rate for Payer: First Health Commercial |
$11,885.05
|
| Rate for Payer: Humana Commercial |
$10,633.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,258.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,232.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,753.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,009.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,382.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,008.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,884.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,632.30
|
| Rate for Payer: PHCS Commercial |
$12,010.16
|
| Rate for Payer: United Healthcare All Payer |
$11,009.31
|
|
|
GMRS CEM LGCVD STEM WO BDY 11M
|
Facility
|
IP
|
$17,154.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,146.39 |
| Max. Negotiated Rate |
$16,468.45 |
| Rate for Payer: Aetna Commercial |
$13,209.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,380.62
|
| Rate for Payer: Cash Price |
$8,577.32
|
| Rate for Payer: Cigna Commercial |
$14,238.35
|
| Rate for Payer: First Health Commercial |
$16,296.91
|
| Rate for Payer: Humana Commercial |
$14,581.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,066.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,660.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,146.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,096.08
|
| Rate for Payer: Ohio Health Group HMO |
$12,865.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,723.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,924.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,836.70
|
| Rate for Payer: PHCS Commercial |
$16,468.45
|
| Rate for Payer: United Healthcare All Payer |
$15,096.08
|
|
|
GMRS CEM LGCVD STEM WO BDY 11M
|
Facility
|
OP
|
$17,154.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,146.39 |
| Max. Negotiated Rate |
$16,468.45 |
| Rate for Payer: Aetna Commercial |
$13,209.07
|
| Rate for Payer: Anthem Medicaid |
$5,899.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,380.62
|
| Rate for Payer: Cash Price |
$8,577.32
|
| Rate for Payer: Cigna Commercial |
$14,238.35
|
| Rate for Payer: First Health Commercial |
$16,296.91
|
| Rate for Payer: Humana Commercial |
$14,581.44
|
| Rate for Payer: Humana KY Medicaid |
$5,899.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,959.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,066.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,660.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,146.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,017.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,096.08
|
| Rate for Payer: Ohio Health Group HMO |
$12,865.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,723.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,924.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,836.70
|
| Rate for Payer: PHCS Commercial |
$16,468.45
|
| Rate for Payer: United Healthcare All Payer |
$15,096.08
|
|
|
GMRS CEM LGCVD STEM WO BDY 13M
|
Facility
|
IP
|
$20,558.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,167.40 |
| Max. Negotiated Rate |
$19,735.68 |
| Rate for Payer: Aetna Commercial |
$15,829.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,035.24
|
| Rate for Payer: Cash Price |
$10,279.00
|
| Rate for Payer: Cigna Commercial |
$17,063.14
|
| Rate for Payer: First Health Commercial |
$19,530.10
|
| Rate for Payer: Humana Commercial |
$17,474.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,857.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,171.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,167.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,091.04
|
| Rate for Payer: Ohio Health Group HMO |
$15,418.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,446.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,885.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,185.02
|
| Rate for Payer: PHCS Commercial |
$19,735.68
|
| Rate for Payer: United Healthcare All Payer |
$18,091.04
|
|
|
GMRS CEM LGCVD STEM WO BDY 13M
|
Facility
|
OP
|
$20,558.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,167.40 |
| Max. Negotiated Rate |
$19,735.68 |
| Rate for Payer: Aetna Commercial |
$15,829.66
|
| Rate for Payer: Anthem Medicaid |
$7,069.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,035.24
|
| Rate for Payer: Cash Price |
$10,279.00
|
| Rate for Payer: Cigna Commercial |
$17,063.14
|
| Rate for Payer: First Health Commercial |
$19,530.10
|
| Rate for Payer: Humana Commercial |
$17,474.30
|
| Rate for Payer: Humana KY Medicaid |
$7,069.90
|
| Rate for Payer: Kentucky WC Medicaid |
$7,141.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,857.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,171.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,167.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,211.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,091.04
|
| Rate for Payer: Ohio Health Group HMO |
$15,418.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,446.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,885.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,185.02
|
| Rate for Payer: PHCS Commercial |
$19,735.68
|
| Rate for Payer: United Healthcare All Payer |
$18,091.04
|
|
|
GMRS CEM LGCVD STEM WO BDY 15M
|
Facility
|
IP
|
$17,154.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,146.39 |
| Max. Negotiated Rate |
$16,468.45 |
| Rate for Payer: Aetna Commercial |
$13,209.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,380.62
|
| Rate for Payer: Cash Price |
$8,577.32
|
| Rate for Payer: Cigna Commercial |
$14,238.35
|
| Rate for Payer: First Health Commercial |
$16,296.91
|
| Rate for Payer: Humana Commercial |
$14,581.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,066.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,660.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,146.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,096.08
|
| Rate for Payer: Ohio Health Group HMO |
$12,865.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,723.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,924.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,836.70
|
| Rate for Payer: PHCS Commercial |
$16,468.45
|
| Rate for Payer: United Healthcare All Payer |
$15,096.08
|
|
|
GMRS CEM LGCVD STEM WO BDY 15M
|
Facility
|
OP
|
$17,154.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,146.39 |
| Max. Negotiated Rate |
$16,468.45 |
| Rate for Payer: Aetna Commercial |
$13,209.07
|
| Rate for Payer: Anthem Medicaid |
$5,899.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,380.62
|
| Rate for Payer: Cash Price |
$8,577.32
|
| Rate for Payer: Cigna Commercial |
$14,238.35
|
| Rate for Payer: First Health Commercial |
$16,296.91
|
| Rate for Payer: Humana Commercial |
$14,581.44
|
| Rate for Payer: Humana KY Medicaid |
$5,899.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,959.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,066.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,660.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,146.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,017.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,096.08
|
| Rate for Payer: Ohio Health Group HMO |
$12,865.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,723.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,924.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,836.70
|
| Rate for Payer: PHCS Commercial |
$16,468.45
|
| Rate for Payer: United Healthcare All Payer |
$15,096.08
|
|
|
GMRS CEM LONG CVD STEM 11MM
|
Facility
|
OP
|
$21,617.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,485.10 |
| Max. Negotiated Rate |
$20,752.32 |
| Rate for Payer: Aetna Commercial |
$16,645.09
|
| Rate for Payer: Anthem Medicaid |
$7,434.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,861.26
|
| Rate for Payer: Cash Price |
$10,808.50
|
| Rate for Payer: Cigna Commercial |
$17,942.11
|
| Rate for Payer: First Health Commercial |
$20,536.15
|
| Rate for Payer: Humana Commercial |
$18,374.45
|
| Rate for Payer: Humana KY Medicaid |
$7,434.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,509.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,725.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,953.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,485.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,583.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,022.96
|
| Rate for Payer: Ohio Health Group HMO |
$16,212.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,293.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,806.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,915.73
|
| Rate for Payer: PHCS Commercial |
$20,752.32
|
| Rate for Payer: United Healthcare All Payer |
$19,022.96
|
|
|
GMRS CEM LONG CVD STEM 11MM
|
Facility
|
IP
|
$21,617.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,485.10 |
| Max. Negotiated Rate |
$20,752.32 |
| Rate for Payer: Aetna Commercial |
$16,645.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,861.26
|
| Rate for Payer: Cash Price |
$10,808.50
|
| Rate for Payer: Cigna Commercial |
$17,942.11
|
| Rate for Payer: First Health Commercial |
$20,536.15
|
| Rate for Payer: Humana Commercial |
$18,374.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,725.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,953.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,485.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,022.96
|
| Rate for Payer: Ohio Health Group HMO |
$16,212.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,293.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,806.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,915.73
|
| Rate for Payer: PHCS Commercial |
$20,752.32
|
| Rate for Payer: United Healthcare All Payer |
$19,022.96
|
|
|
GMRS CEM LONG CVD STEM 13MM
|
Facility
|
IP
|
$21,617.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,485.10 |
| Max. Negotiated Rate |
$20,752.32 |
| Rate for Payer: Aetna Commercial |
$16,645.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,861.26
|
| Rate for Payer: Cash Price |
$10,808.50
|
| Rate for Payer: Cigna Commercial |
$17,942.11
|
| Rate for Payer: First Health Commercial |
$20,536.15
|
| Rate for Payer: Humana Commercial |
$18,374.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,725.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,953.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,485.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,022.96
|
| Rate for Payer: Ohio Health Group HMO |
$16,212.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,293.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,806.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,915.73
|
| Rate for Payer: PHCS Commercial |
$20,752.32
|
| Rate for Payer: United Healthcare All Payer |
$19,022.96
|
|
|
GMRS CEM LONG CVD STEM 13MM
|
Facility
|
OP
|
$21,617.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,485.10 |
| Max. Negotiated Rate |
$20,752.32 |
| Rate for Payer: Aetna Commercial |
$16,645.09
|
| Rate for Payer: Anthem Medicaid |
$7,434.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,861.26
|
| Rate for Payer: Cash Price |
$10,808.50
|
| Rate for Payer: Cigna Commercial |
$17,942.11
|
| Rate for Payer: First Health Commercial |
$20,536.15
|
| Rate for Payer: Humana Commercial |
$18,374.45
|
| Rate for Payer: Humana KY Medicaid |
$7,434.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,509.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,725.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,953.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,485.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,583.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,022.96
|
| Rate for Payer: Ohio Health Group HMO |
$16,212.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,293.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,806.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,915.73
|
| Rate for Payer: PHCS Commercial |
$20,752.32
|
| Rate for Payer: United Healthcare All Payer |
$19,022.96
|
|
|
GMRS CEM LONG CVD STEM 15MM
|
Facility
|
OP
|
$21,617.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,485.10 |
| Max. Negotiated Rate |
$20,752.32 |
| Rate for Payer: Aetna Commercial |
$16,645.09
|
| Rate for Payer: Anthem Medicaid |
$7,434.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,861.26
|
| Rate for Payer: Cash Price |
$10,808.50
|
| Rate for Payer: Cigna Commercial |
$17,942.11
|
| Rate for Payer: First Health Commercial |
$20,536.15
|
| Rate for Payer: Humana Commercial |
$18,374.45
|
| Rate for Payer: Humana KY Medicaid |
$7,434.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,509.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,725.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,953.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,485.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,583.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,022.96
|
| Rate for Payer: Ohio Health Group HMO |
$16,212.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,293.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,806.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,915.73
|
| Rate for Payer: PHCS Commercial |
$20,752.32
|
| Rate for Payer: United Healthcare All Payer |
$19,022.96
|
|
|
GMRS CEM LONG CVD STEM 15MM
|
Facility
|
IP
|
$21,617.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,485.10 |
| Max. Negotiated Rate |
$20,752.32 |
| Rate for Payer: Aetna Commercial |
$16,645.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,861.26
|
| Rate for Payer: Cash Price |
$10,808.50
|
| Rate for Payer: Cigna Commercial |
$17,942.11
|
| Rate for Payer: First Health Commercial |
$20,536.15
|
| Rate for Payer: Humana Commercial |
$18,374.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,725.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,953.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,485.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,022.96
|
| Rate for Payer: Ohio Health Group HMO |
$16,212.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,293.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,806.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,915.73
|
| Rate for Payer: PHCS Commercial |
$20,752.32
|
| Rate for Payer: United Healthcare All Payer |
$19,022.96
|
|
