|
GMRS CEM STR 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 CONNECTION PCE 90MM RT
|
Facility
|
OP
|
$23,091.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,927.45 |
| Max. Negotiated Rate |
$22,167.84 |
| Rate for Payer: Aetna Commercial |
$17,780.46
|
| Rate for Payer: Anthem Medicaid |
$7,941.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,011.37
|
| Rate for Payer: Cash Price |
$11,545.75
|
| Rate for Payer: Cigna Commercial |
$19,165.94
|
| Rate for Payer: First Health Commercial |
$21,936.92
|
| Rate for Payer: Humana Commercial |
$19,627.78
|
| Rate for Payer: Humana KY Medicaid |
$7,941.17
|
| Rate for Payer: Kentucky WC Medicaid |
$8,021.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,935.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,041.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,927.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,100.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,320.52
|
| Rate for Payer: Ohio Health Group HMO |
$17,318.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,473.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,089.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,933.14
|
| Rate for Payer: PHCS Commercial |
$22,167.84
|
| Rate for Payer: United Healthcare All Payer |
$20,320.52
|
|
|
GMRS CONNECTION PCE 90MM RT
|
Facility
|
IP
|
$23,091.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,927.45 |
| Max. Negotiated Rate |
$22,167.84 |
| Rate for Payer: Aetna Commercial |
$17,780.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,011.37
|
| Rate for Payer: Cash Price |
$11,545.75
|
| Rate for Payer: Cigna Commercial |
$19,165.94
|
| Rate for Payer: First Health Commercial |
$21,936.92
|
| Rate for Payer: Humana Commercial |
$19,627.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,935.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,041.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,927.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,320.52
|
| Rate for Payer: Ohio Health Group HMO |
$17,318.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,473.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,089.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,933.14
|
| Rate for Payer: PHCS Commercial |
$22,167.84
|
| Rate for Payer: United Healthcare All Payer |
$20,320.52
|
|
|
GMRS DIS FEM STD LEFT 65MM
|
Facility
|
IP
|
$28,562.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,568.60 |
| Max. Negotiated Rate |
$27,419.52 |
| Rate for Payer: Aetna Commercial |
$21,992.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,278.36
|
| Rate for Payer: Cash Price |
$14,281.00
|
| Rate for Payer: Cigna Commercial |
$23,706.46
|
| Rate for Payer: First Health Commercial |
$27,133.90
|
| Rate for Payer: Humana Commercial |
$24,277.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,420.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,078.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,568.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,134.56
|
| Rate for Payer: Ohio Health Group HMO |
$21,421.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,849.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,848.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,707.78
|
| Rate for Payer: PHCS Commercial |
$27,419.52
|
| Rate for Payer: United Healthcare All Payer |
$25,134.56
|
|
|
GMRS DIS FEM STD LEFT 65MM
|
Facility
|
OP
|
$28,562.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,568.60 |
| Max. Negotiated Rate |
$27,419.52 |
| Rate for Payer: Aetna Commercial |
$21,992.74
|
| Rate for Payer: Anthem Medicaid |
$9,822.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,278.36
|
| Rate for Payer: Cash Price |
$14,281.00
|
| Rate for Payer: Cigna Commercial |
$23,706.46
|
| Rate for Payer: First Health Commercial |
$27,133.90
|
| Rate for Payer: Humana Commercial |
$24,277.70
|
| Rate for Payer: Humana KY Medicaid |
$9,822.47
|
| Rate for Payer: Kentucky WC Medicaid |
$9,922.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,420.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,078.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,568.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,019.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,134.56
|
| Rate for Payer: Ohio Health Group HMO |
$21,421.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,849.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,848.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,707.78
|
| Rate for Payer: PHCS Commercial |
$27,419.52
|
| Rate for Payer: United Healthcare All Payer |
$25,134.56
|
|
|
GMRS EXTENSION PIECE 30MM
|
Facility
|
OP
|
$12,713.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,813.95 |
| Max. Negotiated Rate |
$12,204.64 |
| Rate for Payer: Aetna Commercial |
$9,789.14
|
| Rate for Payer: Anthem Medicaid |
$4,372.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,916.27
|
| Rate for Payer: Cash Price |
$6,356.58
|
| Rate for Payer: Cigna Commercial |
$10,551.93
|
| Rate for Payer: First Health Commercial |
$12,077.51
|
| Rate for Payer: Humana Commercial |
$10,806.19
|
| Rate for Payer: Humana KY Medicaid |
$4,372.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,416.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,424.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,382.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,813.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,459.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,187.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,534.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,170.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,060.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,772.09
|
| Rate for Payer: PHCS Commercial |
$12,204.64
|
| Rate for Payer: United Healthcare All Payer |
$11,187.59
|
|
|
GMRS EXTENSION PIECE 30MM
|
Facility
|
IP
|
$12,713.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,813.95 |
| Max. Negotiated Rate |
$12,204.64 |
| Rate for Payer: Aetna Commercial |
$9,789.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,916.27
|
| Rate for Payer: Cash Price |
$6,356.58
|
| Rate for Payer: Cigna Commercial |
$10,551.93
|
| Rate for Payer: First Health Commercial |
$12,077.51
|
| Rate for Payer: Humana Commercial |
$10,806.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,424.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,382.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,813.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,187.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,534.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,170.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,060.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,772.09
|
| Rate for Payer: PHCS Commercial |
$12,204.64
|
| Rate for Payer: United Healthcare All Payer |
$11,187.59
|
|
|
GMRS FLUTD STEM EXT 10MM*155MM
|
Facility
|
OP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem Medicaid |
$1,717.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Humana KY Medicaid |
$1,717.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,734.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,751.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
|
GMRS FLUTD STEM EXT 10MM*155MM
|
Facility
|
IP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
|
GMRS FLUTD STEM EXT 11MM*155MM
|
Facility
|
IP
|
$5,294.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,588.20 |
| Max. Negotiated Rate |
$5,082.24 |
| Rate for Payer: Aetna Commercial |
$4,076.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,129.32
|
| Rate for Payer: Cash Price |
$2,647.00
|
| Rate for Payer: Cigna Commercial |
$4,394.02
|
| Rate for Payer: First Health Commercial |
$5,029.30
|
| Rate for Payer: Humana Commercial |
$4,499.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,341.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,906.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,588.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,658.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,970.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,235.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,605.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,652.86
|
| Rate for Payer: PHCS Commercial |
$5,082.24
|
| Rate for Payer: United Healthcare All Payer |
$4,658.72
|
|
|
GMRS FLUTD STEM EXT 11MM*155MM
|
Facility
|
OP
|
$5,294.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,588.20 |
| Max. Negotiated Rate |
$5,082.24 |
| Rate for Payer: Aetna Commercial |
$4,076.38
|
| Rate for Payer: Anthem Medicaid |
$1,820.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,129.32
|
| Rate for Payer: Cash Price |
$2,647.00
|
| Rate for Payer: Cigna Commercial |
$4,394.02
|
| Rate for Payer: First Health Commercial |
$5,029.30
|
| Rate for Payer: Humana Commercial |
$4,499.90
|
| Rate for Payer: Humana KY Medicaid |
$1,820.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,839.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,341.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,906.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,588.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,857.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,658.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,970.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,235.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,605.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,652.86
|
| Rate for Payer: PHCS Commercial |
$5,082.24
|
| Rate for Payer: United Healthcare All Payer |
$4,658.72
|
|
|
GMRS FLUTD STEM EXT 12MM*155MM
|
Facility
|
IP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
|
GMRS FLUTD STEM EXT 12MM*155MM
|
Facility
|
OP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem Medicaid |
$1,717.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Humana KY Medicaid |
$1,717.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,734.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,751.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
|
GMRS FLUTD STEM EXT 13MM*155MM
|
Facility
|
OP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem Medicaid |
$1,717.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Humana KY Medicaid |
$1,717.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,734.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,751.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
|
GMRS FLUTD STEM EXT 13MM*155MM
|
Facility
|
IP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
|
GMRS FLUTD STEM EXT 14MM*155MM
|
Facility
|
IP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
|
GMRS FLUTD STEM EXT 14MM*155MM
|
Facility
|
OP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem Medicaid |
$1,717.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Humana KY Medicaid |
$1,717.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,734.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,751.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
|
GMRS FLUTD STEM EXT 15MM*155MM
|
Facility
|
IP
|
$6,705.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.64 |
| Max. Negotiated Rate |
$6,437.26 |
| Rate for Payer: Aetna Commercial |
$5,163.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.27
|
| Rate for Payer: Cash Price |
$3,352.74
|
| Rate for Payer: Cigna Commercial |
$5,565.55
|
| Rate for Payer: First Health Commercial |
$6,370.21
|
| Rate for Payer: Humana Commercial |
$5,699.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,364.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.78
|
| Rate for Payer: PHCS Commercial |
$6,437.26
|
| Rate for Payer: United Healthcare All Payer |
$5,900.82
|
|
|
GMRS FLUTD STEM EXT 15MM*155MM
|
Facility
|
OP
|
$6,705.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.64 |
| Max. Negotiated Rate |
$6,437.26 |
| Rate for Payer: Aetna Commercial |
$5,163.22
|
| Rate for Payer: Anthem Medicaid |
$2,306.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.27
|
| Rate for Payer: Cash Price |
$3,352.74
|
| Rate for Payer: Cigna Commercial |
$5,565.55
|
| Rate for Payer: First Health Commercial |
$6,370.21
|
| Rate for Payer: Humana Commercial |
$5,699.66
|
| Rate for Payer: Humana KY Medicaid |
$2,306.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,364.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.78
|
| Rate for Payer: PHCS Commercial |
$6,437.26
|
| Rate for Payer: United Healthcare All Payer |
$5,900.82
|
|
|
GMRS FLUTD STEM EXT 16MM*155MM
|
Facility
|
IP
|
$6,705.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.64 |
| Max. Negotiated Rate |
$6,437.26 |
| Rate for Payer: Aetna Commercial |
$5,163.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.27
|
| Rate for Payer: Cash Price |
$3,352.74
|
| Rate for Payer: Cigna Commercial |
$5,565.55
|
| Rate for Payer: First Health Commercial |
$6,370.21
|
| Rate for Payer: Humana Commercial |
$5,699.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,364.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.78
|
| Rate for Payer: PHCS Commercial |
$6,437.26
|
| Rate for Payer: United Healthcare All Payer |
$5,900.82
|
|
|
GMRS FLUTD STEM EXT 16MM*155MM
|
Facility
|
OP
|
$6,705.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.64 |
| Max. Negotiated Rate |
$6,437.26 |
| Rate for Payer: Aetna Commercial |
$5,163.22
|
| Rate for Payer: Anthem Medicaid |
$2,306.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.27
|
| Rate for Payer: Cash Price |
$3,352.74
|
| Rate for Payer: Cigna Commercial |
$5,565.55
|
| Rate for Payer: First Health Commercial |
$6,370.21
|
| Rate for Payer: Humana Commercial |
$5,699.66
|
| Rate for Payer: Humana KY Medicaid |
$2,306.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,364.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.78
|
| Rate for Payer: PHCS Commercial |
$6,437.26
|
| Rate for Payer: United Healthcare All Payer |
$5,900.82
|
|
|
GMRS FLUTD STEM EXT 17MM*155MM
|
Facility
|
IP
|
$6,705.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.64 |
| Max. Negotiated Rate |
$6,437.26 |
| Rate for Payer: Aetna Commercial |
$5,163.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.27
|
| Rate for Payer: Cash Price |
$3,352.74
|
| Rate for Payer: Cigna Commercial |
$5,565.55
|
| Rate for Payer: First Health Commercial |
$6,370.21
|
| Rate for Payer: Humana Commercial |
$5,699.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,364.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.78
|
| Rate for Payer: PHCS Commercial |
$6,437.26
|
| Rate for Payer: United Healthcare All Payer |
$5,900.82
|
|
|
GMRS FLUTD STEM EXT 17MM*155MM
|
Facility
|
OP
|
$6,705.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.64 |
| Max. Negotiated Rate |
$6,437.26 |
| Rate for Payer: Aetna Commercial |
$5,163.22
|
| Rate for Payer: Anthem Medicaid |
$2,306.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.27
|
| Rate for Payer: Cash Price |
$3,352.74
|
| Rate for Payer: Cigna Commercial |
$5,565.55
|
| Rate for Payer: First Health Commercial |
$6,370.21
|
| Rate for Payer: Humana Commercial |
$5,699.66
|
| Rate for Payer: Humana KY Medicaid |
$2,306.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,364.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.78
|
| Rate for Payer: PHCS Commercial |
$6,437.26
|
| Rate for Payer: United Healthcare All Payer |
$5,900.82
|
|
|
GMRS FLUTD STEM EXT 18MM*155MM
|
Facility
|
OP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem Medicaid |
$1,717.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Humana KY Medicaid |
$1,717.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,734.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,751.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
|
GMRS FLUTD STEM EXT 18MM*155MM
|
Facility
|
IP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
