|
ECG UP TO 48 HR HOLTER MONITOR
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
HCPCS 93226
|
| Hospital Charge Code |
73000006
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$52.89 |
| Max. Negotiated Rate |
$1,076.16 |
| Rate for Payer: PHCS Commercial |
$1,076.16
|
| Rate for Payer: Aetna Commercial |
$863.17
|
| Rate for Payer: Anthem Medicaid |
$59.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$874.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$560.50
|
| Rate for Payer: Cash Price |
$560.50
|
| Rate for Payer: Cigna Commercial |
$930.43
|
| Rate for Payer: First Health Commercial |
$1,064.95
|
| Rate for Payer: Humana Commercial |
$952.85
|
| Rate for Payer: Humana KY Medicaid |
$59.68
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$60.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$919.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$827.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$60.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$986.48
|
| Rate for Payer: Ohio Health Group HMO |
$840.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.51
|
| Rate for Payer: United Healthcare All Payer |
$986.48
|
|
|
ECG W/12 LEADS - TRACING ONLY
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Anthem Medicaid |
$17.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$36.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.76
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: First Health Commercial |
$47.50
|
| Rate for Payer: Humana Commercial |
$42.50
|
| Rate for Payer: Humana KY Medicaid |
$17.20
|
| Rate for Payer: Humana Medicare Advantage |
$25.75
|
| Rate for Payer: Kentucky WC Medicaid |
$17.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.00
|
| Rate for Payer: Ohio Health Group HMO |
$37.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
|
ECG W/12 LEADS - TRACING ONLY
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: First Health Commercial |
$47.50
|
| Rate for Payer: Humana Commercial |
$42.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.00
|
| Rate for Payer: Ohio Health Group HMO |
$37.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
|
ECH 190MM+15 STR SZ 11 CALCAR
|
Facility
|
OP
|
$33,341.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,334.35 |
| Max. Negotiated Rate |
$32,007.53 |
| Rate for Payer: Aetna Commercial |
$25,672.71
|
| Rate for Payer: Anthem Medicaid |
$11,466.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,006.12
|
| Rate for Payer: Cash Price |
$16,670.59
|
| Rate for Payer: Cigna Commercial |
$27,673.18
|
| Rate for Payer: First Health Commercial |
$31,674.12
|
| Rate for Payer: Humana Commercial |
$28,340.00
|
| Rate for Payer: Humana KY Medicaid |
$11,466.03
|
| Rate for Payer: Kentucky WC Medicaid |
$11,582.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,339.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,605.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,002.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,696.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$25,005.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,668.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,334.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,335.77
|
| Rate for Payer: PHCS Commercial |
$32,007.53
|
| Rate for Payer: United Healthcare All Payer |
$29,340.24
|
|
|
ECH 190MM+15 STR SZ 11 CALCAR
|
Facility
|
IP
|
$33,341.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,334.35 |
| Max. Negotiated Rate |
$32,007.53 |
| Rate for Payer: Aetna Commercial |
$25,672.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,006.12
|
| Rate for Payer: Cash Price |
$16,670.59
|
| Rate for Payer: Cigna Commercial |
$27,673.18
|
| Rate for Payer: First Health Commercial |
$31,674.12
|
| Rate for Payer: Humana Commercial |
$28,340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,339.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,605.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,002.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$25,005.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,668.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,334.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,335.77
|
| Rate for Payer: PHCS Commercial |
$32,007.53
|
| Rate for Payer: United Healthcare All Payer |
$29,340.24
|
|
|
ECH 190MM+15 STR SZ 12 CALCAR
|
Facility
|
OP
|
$33,341.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,334.35 |
| Max. Negotiated Rate |
$32,007.53 |
| Rate for Payer: Aetna Commercial |
$25,672.71
|
| Rate for Payer: Anthem Medicaid |
$11,466.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,006.12
|
| Rate for Payer: Cash Price |
$16,670.59
|
| Rate for Payer: Cigna Commercial |
$27,673.18
|
| Rate for Payer: First Health Commercial |
$31,674.12
|
| Rate for Payer: Humana Commercial |
$28,340.00
|
| Rate for Payer: Humana KY Medicaid |
$11,466.03
|
| Rate for Payer: Kentucky WC Medicaid |
$11,582.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,339.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,605.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,002.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,696.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$25,005.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,668.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,334.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,335.77
|
| Rate for Payer: PHCS Commercial |
$32,007.53
|
| Rate for Payer: United Healthcare All Payer |
$29,340.24
|
|
|
ECH 190MM+15 STR SZ 12 CALCAR
|
Facility
|
IP
|
$33,341.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,334.35 |
| Max. Negotiated Rate |
$32,007.53 |
| Rate for Payer: Aetna Commercial |
$25,672.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,006.12
|
| Rate for Payer: Cash Price |
$16,670.59
|
| Rate for Payer: Cigna Commercial |
$27,673.18
|
| Rate for Payer: First Health Commercial |
$31,674.12
|
| Rate for Payer: Humana Commercial |
$28,340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,339.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,605.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,002.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$25,005.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,668.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,334.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,335.77
|
| Rate for Payer: PHCS Commercial |
$32,007.53
|
| Rate for Payer: United Healthcare All Payer |
$29,340.24
|
|
|
ECH 190MM STD SZ 20 COLLAR
|
Facility
|
IP
|
$36,200.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,706.01 |
| Max. Negotiated Rate |
$34,752.04 |
| Rate for Payer: Aetna Commercial |
$27,874.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,236.03
|
| Rate for Payer: Cash Price |
$18,100.02
|
| Rate for Payer: Cigna Commercial |
$30,046.03
|
| Rate for Payer: First Health Commercial |
$34,390.04
|
| Rate for Payer: Humana Commercial |
$30,770.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,684.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,715.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,860.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,856.04
|
| Rate for Payer: Ohio Health Group HMO |
$27,150.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,240.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,706.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,222.01
|
| Rate for Payer: PHCS Commercial |
$34,752.04
|
| Rate for Payer: United Healthcare All Payer |
$31,856.04
|
|
|
ECH 190MM STD SZ 20 COLLAR
|
Facility
|
OP
|
$36,200.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,706.01 |
| Max. Negotiated Rate |
$34,752.04 |
| Rate for Payer: Aetna Commercial |
$27,874.03
|
| Rate for Payer: Anthem Medicaid |
$12,449.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,236.03
|
| Rate for Payer: Cash Price |
$18,100.02
|
| Rate for Payer: Cigna Commercial |
$30,046.03
|
| Rate for Payer: First Health Commercial |
$34,390.04
|
| Rate for Payer: Humana Commercial |
$30,770.03
|
| Rate for Payer: Humana KY Medicaid |
$12,449.19
|
| Rate for Payer: Kentucky WC Medicaid |
$12,575.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,684.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,715.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,860.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,698.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,856.04
|
| Rate for Payer: Ohio Health Group HMO |
$27,150.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,240.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,706.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,222.01
|
| Rate for Payer: PHCS Commercial |
$34,752.04
|
| Rate for Payer: United Healthcare All Payer |
$31,856.04
|
|
|
ECH 190MM STR SZ 13 COLLAR
|
Facility
|
IP
|
$33,341.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,334.35 |
| Max. Negotiated Rate |
$32,007.53 |
| Rate for Payer: Aetna Commercial |
$25,672.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,006.12
|
| Rate for Payer: Cash Price |
$16,670.59
|
| Rate for Payer: Cigna Commercial |
$27,673.18
|
| Rate for Payer: First Health Commercial |
$31,674.12
|
| Rate for Payer: Humana Commercial |
$28,340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,339.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,605.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,002.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$25,005.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,668.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,334.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,335.77
|
| Rate for Payer: PHCS Commercial |
$32,007.53
|
| Rate for Payer: United Healthcare All Payer |
$29,340.24
|
|
|
ECH 190MM STR SZ 13 COLLAR
|
Facility
|
OP
|
$33,341.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,334.35 |
| Max. Negotiated Rate |
$32,007.53 |
| Rate for Payer: Aetna Commercial |
$25,672.71
|
| Rate for Payer: Anthem Medicaid |
$11,466.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,006.12
|
| Rate for Payer: Cash Price |
$16,670.59
|
| Rate for Payer: Cigna Commercial |
$27,673.18
|
| Rate for Payer: First Health Commercial |
$31,674.12
|
| Rate for Payer: Humana Commercial |
$28,340.00
|
| Rate for Payer: Humana KY Medicaid |
$11,466.03
|
| Rate for Payer: Kentucky WC Medicaid |
$11,582.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,339.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,605.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,002.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,696.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$25,005.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,668.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,334.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,335.77
|
| Rate for Payer: PHCS Commercial |
$32,007.53
|
| Rate for Payer: United Healthcare All Payer |
$29,340.24
|
|
|
ECH 190MM STR SZ 14 COLLAR
|
Facility
|
IP
|
$33,341.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,334.35 |
| Max. Negotiated Rate |
$32,007.53 |
| Rate for Payer: Aetna Commercial |
$25,672.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,006.12
|
| Rate for Payer: Cash Price |
$16,670.59
|
| Rate for Payer: Cigna Commercial |
$27,673.18
|
| Rate for Payer: First Health Commercial |
$31,674.12
|
| Rate for Payer: Humana Commercial |
$28,340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,339.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,605.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,002.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$25,005.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,668.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,334.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,335.77
|
| Rate for Payer: PHCS Commercial |
$32,007.53
|
| Rate for Payer: United Healthcare All Payer |
$29,340.24
|
|
|
ECH 190MM STR SZ 14 COLLAR
|
Facility
|
OP
|
$33,341.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,334.35 |
| Max. Negotiated Rate |
$32,007.53 |
| Rate for Payer: Aetna Commercial |
$25,672.71
|
| Rate for Payer: Anthem Medicaid |
$11,466.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,006.12
|
| Rate for Payer: Cash Price |
$16,670.59
|
| Rate for Payer: Cigna Commercial |
$27,673.18
|
| Rate for Payer: First Health Commercial |
$31,674.12
|
| Rate for Payer: Humana Commercial |
$28,340.00
|
| Rate for Payer: Humana KY Medicaid |
$11,466.03
|
| Rate for Payer: Kentucky WC Medicaid |
$11,582.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,339.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,605.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,002.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,696.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$25,005.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,668.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,334.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,335.77
|
| Rate for Payer: PHCS Commercial |
$32,007.53
|
| Rate for Payer: United Healthcare All Payer |
$29,340.24
|
|
|
ECH 190MM STR SZ 15 COLLAR
|
Facility
|
OP
|
$33,341.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,334.35 |
| Max. Negotiated Rate |
$32,007.53 |
| Rate for Payer: Aetna Commercial |
$25,672.71
|
| Rate for Payer: Anthem Medicaid |
$11,466.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,006.12
|
| Rate for Payer: Cash Price |
$16,670.59
|
| Rate for Payer: Cigna Commercial |
$27,673.18
|
| Rate for Payer: First Health Commercial |
$31,674.12
|
| Rate for Payer: Humana Commercial |
$28,340.00
|
| Rate for Payer: Humana KY Medicaid |
$11,466.03
|
| Rate for Payer: Kentucky WC Medicaid |
$11,582.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,339.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,605.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,002.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,696.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$25,005.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,668.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,334.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,335.77
|
| Rate for Payer: PHCS Commercial |
$32,007.53
|
| Rate for Payer: United Healthcare All Payer |
$29,340.24
|
|
|
ECH 190MM STR SZ 15 COLLAR
|
Facility
|
IP
|
$33,341.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,334.35 |
| Max. Negotiated Rate |
$32,007.53 |
| Rate for Payer: Aetna Commercial |
$25,672.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,006.12
|
| Rate for Payer: Cash Price |
$16,670.59
|
| Rate for Payer: Cigna Commercial |
$27,673.18
|
| Rate for Payer: First Health Commercial |
$31,674.12
|
| Rate for Payer: Humana Commercial |
$28,340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,339.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,605.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,002.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$25,005.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,668.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,334.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,335.77
|
| Rate for Payer: PHCS Commercial |
$32,007.53
|
| Rate for Payer: United Healthcare All Payer |
$29,340.24
|
|
|
ECH 190MM STR SZ 16 COLLAR
|
Facility
|
OP
|
$33,341.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,334.35 |
| Max. Negotiated Rate |
$32,007.53 |
| Rate for Payer: Aetna Commercial |
$25,672.71
|
| Rate for Payer: Anthem Medicaid |
$11,466.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,006.12
|
| Rate for Payer: Cash Price |
$16,670.59
|
| Rate for Payer: Cigna Commercial |
$27,673.18
|
| Rate for Payer: First Health Commercial |
$31,674.12
|
| Rate for Payer: Humana Commercial |
$28,340.00
|
| Rate for Payer: Humana KY Medicaid |
$11,466.03
|
| Rate for Payer: Kentucky WC Medicaid |
$11,582.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,339.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,605.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,002.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,696.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$25,005.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,668.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,334.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,335.77
|
| Rate for Payer: PHCS Commercial |
$32,007.53
|
| Rate for Payer: United Healthcare All Payer |
$29,340.24
|
|
|
ECH 190MM STR SZ 16 COLLAR
|
Facility
|
IP
|
$33,341.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,334.35 |
| Max. Negotiated Rate |
$32,007.53 |
| Rate for Payer: Aetna Commercial |
$25,672.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,006.12
|
| Rate for Payer: Cash Price |
$16,670.59
|
| Rate for Payer: Cigna Commercial |
$27,673.18
|
| Rate for Payer: First Health Commercial |
$31,674.12
|
| Rate for Payer: Humana Commercial |
$28,340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,339.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,605.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,002.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$25,005.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,668.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,334.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,335.77
|
| Rate for Payer: PHCS Commercial |
$32,007.53
|
| Rate for Payer: United Healthcare All Payer |
$29,340.24
|
|
|
ECH 190MM STR SZ 17 COLLAR
|
Facility
|
IP
|
$33,341.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,334.35 |
| Max. Negotiated Rate |
$32,007.53 |
| Rate for Payer: Aetna Commercial |
$25,672.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,006.12
|
| Rate for Payer: Cash Price |
$16,670.59
|
| Rate for Payer: Cigna Commercial |
$27,673.18
|
| Rate for Payer: First Health Commercial |
$31,674.12
|
| Rate for Payer: Humana Commercial |
$28,340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,339.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,605.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,002.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$25,005.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,668.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,334.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,335.77
|
| Rate for Payer: PHCS Commercial |
$32,007.53
|
| Rate for Payer: United Healthcare All Payer |
$29,340.24
|
|
|
ECH 190MM STR SZ 17 COLLAR
|
Facility
|
OP
|
$33,341.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,334.35 |
| Max. Negotiated Rate |
$32,007.53 |
| Rate for Payer: Aetna Commercial |
$25,672.71
|
| Rate for Payer: Anthem Medicaid |
$11,466.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,006.12
|
| Rate for Payer: Cash Price |
$16,670.59
|
| Rate for Payer: Cigna Commercial |
$27,673.18
|
| Rate for Payer: First Health Commercial |
$31,674.12
|
| Rate for Payer: Humana Commercial |
$28,340.00
|
| Rate for Payer: Humana KY Medicaid |
$11,466.03
|
| Rate for Payer: Kentucky WC Medicaid |
$11,582.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,339.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,605.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,002.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,696.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$25,005.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,668.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,334.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,335.77
|
| Rate for Payer: PHCS Commercial |
$32,007.53
|
| Rate for Payer: United Healthcare All Payer |
$29,340.24
|
|
|
ECH 190MM STR SZ 18 COLLAR
|
Facility
|
IP
|
$33,341.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,334.35 |
| Max. Negotiated Rate |
$32,007.53 |
| Rate for Payer: Aetna Commercial |
$25,672.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,006.12
|
| Rate for Payer: Cash Price |
$16,670.59
|
| Rate for Payer: Cigna Commercial |
$27,673.18
|
| Rate for Payer: First Health Commercial |
$31,674.12
|
| Rate for Payer: Humana Commercial |
$28,340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,339.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,605.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,002.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$25,005.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,668.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,334.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,335.77
|
| Rate for Payer: PHCS Commercial |
$32,007.53
|
| Rate for Payer: United Healthcare All Payer |
$29,340.24
|
|
|
ECH 190MM STR SZ 18 COLLAR
|
Facility
|
OP
|
$33,341.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,334.35 |
| Max. Negotiated Rate |
$32,007.53 |
| Rate for Payer: Aetna Commercial |
$25,672.71
|
| Rate for Payer: Anthem Medicaid |
$11,466.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,006.12
|
| Rate for Payer: Cash Price |
$16,670.59
|
| Rate for Payer: Cigna Commercial |
$27,673.18
|
| Rate for Payer: First Health Commercial |
$31,674.12
|
| Rate for Payer: Humana Commercial |
$28,340.00
|
| Rate for Payer: Humana KY Medicaid |
$11,466.03
|
| Rate for Payer: Kentucky WC Medicaid |
$11,582.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,339.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,605.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,002.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,696.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$25,005.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,668.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,334.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,335.77
|
| Rate for Payer: PHCS Commercial |
$32,007.53
|
| Rate for Payer: United Healthcare All Payer |
$29,340.24
|
|
|
ECH 190MM STR SZ 19 COLLAR
|
Facility
|
IP
|
$36,200.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,706.01 |
| Max. Negotiated Rate |
$34,752.04 |
| Rate for Payer: Aetna Commercial |
$27,874.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,236.03
|
| Rate for Payer: Cash Price |
$18,100.02
|
| Rate for Payer: Cigna Commercial |
$30,046.03
|
| Rate for Payer: First Health Commercial |
$34,390.04
|
| Rate for Payer: Humana Commercial |
$30,770.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,684.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,715.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,860.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,856.04
|
| Rate for Payer: Ohio Health Group HMO |
$27,150.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,240.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,706.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,222.01
|
| Rate for Payer: PHCS Commercial |
$34,752.04
|
| Rate for Payer: United Healthcare All Payer |
$31,856.04
|
|
|
ECH 190MM STR SZ 19 COLLAR
|
Facility
|
OP
|
$36,200.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,706.01 |
| Max. Negotiated Rate |
$34,752.04 |
| Rate for Payer: Aetna Commercial |
$27,874.03
|
| Rate for Payer: Anthem Medicaid |
$12,449.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,236.03
|
| Rate for Payer: Cash Price |
$18,100.02
|
| Rate for Payer: Cigna Commercial |
$30,046.03
|
| Rate for Payer: First Health Commercial |
$34,390.04
|
| Rate for Payer: Humana Commercial |
$30,770.03
|
| Rate for Payer: Humana KY Medicaid |
$12,449.19
|
| Rate for Payer: Kentucky WC Medicaid |
$12,575.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,684.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,715.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,860.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,698.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,856.04
|
| Rate for Payer: Ohio Health Group HMO |
$27,150.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,240.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,706.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,222.01
|
| Rate for Payer: PHCS Commercial |
$34,752.04
|
| Rate for Payer: United Healthcare All Payer |
$31,856.04
|
|
|
ECH CEM 15MM CAL SZ 12 175MM
|
Facility
|
OP
|
$26,892.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,496.08 |
| Max. Negotiated Rate |
$25,817.18 |
| Rate for Payer: Aetna Commercial |
$20,707.53
|
| Rate for Payer: Anthem Medicaid |
$9,248.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,976.46
|
| Rate for Payer: Cash Price |
$13,446.45
|
| Rate for Payer: Cigna Commercial |
$22,321.11
|
| Rate for Payer: First Health Commercial |
$25,548.26
|
| Rate for Payer: Humana Commercial |
$22,858.96
|
| Rate for Payer: Humana KY Medicaid |
$9,248.47
|
| Rate for Payer: Kentucky WC Medicaid |
$9,342.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,052.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,846.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,067.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,434.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,665.75
|
| Rate for Payer: Ohio Health Group HMO |
$20,169.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,378.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,496.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,336.80
|
| Rate for Payer: PHCS Commercial |
$25,817.18
|
| Rate for Payer: United Healthcare All Payer |
$23,665.75
|
|
|
ECH CEM 15MM CAL SZ 12 175MM
|
Facility
|
IP
|
$26,892.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,496.08 |
| Max. Negotiated Rate |
$25,817.18 |
| Rate for Payer: Aetna Commercial |
$20,707.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,976.46
|
| Rate for Payer: Cash Price |
$13,446.45
|
| Rate for Payer: Cigna Commercial |
$22,321.11
|
| Rate for Payer: First Health Commercial |
$25,548.26
|
| Rate for Payer: Humana Commercial |
$22,858.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,052.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,846.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,067.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,665.75
|
| Rate for Payer: Ohio Health Group HMO |
$20,169.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,378.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,496.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,336.80
|
| Rate for Payer: PHCS Commercial |
$25,817.18
|
| Rate for Payer: United Healthcare All Payer |
$23,665.75
|
|
