|
GMRS CEM LONG CVD STEM 17MM
|
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 17MM
|
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 STR STEM 10MM
|
Facility
|
OP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem Medicaid |
$5,825.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Humana KY Medicaid |
$5,825.17
|
| Rate for Payer: Kentucky WC Medicaid |
$5,884.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,942.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM STR STEM 10MM
|
Facility
|
IP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM STR STEM 11MM
|
Facility
|
IP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM STR STEM 11MM
|
Facility
|
OP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem Medicaid |
$5,825.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Humana KY Medicaid |
$5,825.17
|
| Rate for Payer: Kentucky WC Medicaid |
$5,884.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,942.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM STR STEM 15MM
|
Facility
|
OP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem Medicaid |
$5,825.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Humana KY Medicaid |
$5,825.17
|
| Rate for Payer: Kentucky WC Medicaid |
$5,884.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,942.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM STR STEM 15MM
|
Facility
|
IP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM STR STEM 17MM
|
Facility
|
IP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM STR STEM 17MM
|
Facility
|
OP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem Medicaid |
$5,825.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Humana KY Medicaid |
$5,825.17
|
| Rate for Payer: Kentucky WC Medicaid |
$5,884.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,942.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM STR STEM 8MM
|
Facility
|
IP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM STR STEM 8MM
|
Facility
|
OP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem Medicaid |
$5,825.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Humana KY Medicaid |
$5,825.17
|
| Rate for Payer: Kentucky WC Medicaid |
$5,884.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,942.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM STR 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 STR STEM WO BODY 10MM
|
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 STR STEM W/O BODY 11M
|
Facility
|
OP
|
$16,679.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,003.76 |
| Max. Negotiated Rate |
$16,012.02 |
| Rate for Payer: Aetna Commercial |
$12,842.98
|
| Rate for Payer: Anthem Medicaid |
$5,735.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,009.77
|
| Rate for Payer: Cash Price |
$8,339.59
|
| Rate for Payer: Cigna Commercial |
$13,843.73
|
| Rate for Payer: First Health Commercial |
$15,845.23
|
| Rate for Payer: Humana Commercial |
$14,177.31
|
| Rate for Payer: Humana KY Medicaid |
$5,735.97
|
| Rate for Payer: Kentucky WC Medicaid |
$5,794.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,676.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,309.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,003.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,851.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,677.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,509.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,343.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,510.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,508.64
|
| Rate for Payer: PHCS Commercial |
$16,012.02
|
| Rate for Payer: United Healthcare All Payer |
$14,677.69
|
|
|
GMRS CEM STR STEM W/O BODY 11M
|
Facility
|
IP
|
$16,679.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,003.76 |
| Max. Negotiated Rate |
$16,012.02 |
| Rate for Payer: Aetna Commercial |
$12,842.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,009.77
|
| Rate for Payer: Cash Price |
$8,339.59
|
| Rate for Payer: Cigna Commercial |
$13,843.73
|
| Rate for Payer: First Health Commercial |
$15,845.23
|
| Rate for Payer: Humana Commercial |
$14,177.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,676.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,309.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,003.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,677.69
|
| Rate for Payer: Ohio Health Group HMO |
$12,509.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,343.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,510.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,508.64
|
| Rate for Payer: PHCS Commercial |
$16,012.02
|
| Rate for Payer: United Healthcare All Payer |
$14,677.69
|
|
|
GMRS CEM STR STEM WO BODY 13MM
|
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 STR STEM WO BODY 13MM
|
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 STR 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 STR 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 STR 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 STR 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 STR 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 STR 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 STR 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
|
|
