|
ECH CEM 15MM CAL SZ 12 225MM
|
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 225MM
|
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
|
|
|
ECH CEM 15MM CAL SZ 14 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 14 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
|
|
|
ECH CEM 15MM CAL SZ 14 225MM
|
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
|
|
|
ECH CEM 15MM CAL SZ 14 225MM
|
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 16 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 16 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
|
|
|
ECH CEM 15MM CAL SZ 16 225MM
|
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 16 225MM
|
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
|
|
|
ECH CEM 30MM 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 30MM 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
|
|
|
ECH CEM 30MM CAL SZ 12 225MM
|
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 30MM CAL SZ 12 225MM
|
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
|
|
|
ECH CEM 30MM CAL SZ 14 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
|
|
|
ECH CEM 30MM CAL SZ 14 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 30MM CAL SZ 14 225MM
|
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
|
|
|
ECH CEM 30MM CAL SZ 14 225MM
|
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 30MM CAL SZ 16 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
|
|
|
ECH CEM 30MM CAL SZ 16 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 30MM CAL SZ 16 225MM
|
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
|
|
|
ECH CEM 30MM CAL SZ 16 225MM
|
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 FEM CMP BOW SZ12 L 300
|
Facility
|
OP
|
$29,616.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,850.13 |
| Max. Negotiated Rate |
$28,431.70 |
| Rate for Payer: Aetna Commercial |
$22,804.59
|
| Rate for Payer: Anthem Medicaid |
$10,185.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,100.75
|
| Rate for Payer: Cash Price |
$14,808.17
|
| Rate for Payer: Cigna Commercial |
$24,581.57
|
| Rate for Payer: First Health Commercial |
$28,135.53
|
| Rate for Payer: Humana Commercial |
$25,173.90
|
| Rate for Payer: Humana KY Medicaid |
$10,185.06
|
| Rate for Payer: Kentucky WC Medicaid |
$10,288.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,285.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,856.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,884.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,389.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,062.39
|
| Rate for Payer: Ohio Health Group HMO |
$22,212.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,923.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,850.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,181.07
|
| Rate for Payer: PHCS Commercial |
$28,431.70
|
| Rate for Payer: United Healthcare All Payer |
$26,062.39
|
|
|
ECH CEM FEM CMP BOW SZ12 L 300
|
Facility
|
IP
|
$29,616.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,850.13 |
| Max. Negotiated Rate |
$28,431.70 |
| Rate for Payer: Aetna Commercial |
$22,804.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,100.75
|
| Rate for Payer: Cash Price |
$14,808.17
|
| Rate for Payer: Cigna Commercial |
$24,581.57
|
| Rate for Payer: First Health Commercial |
$28,135.53
|
| Rate for Payer: Humana Commercial |
$25,173.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,285.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,856.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,884.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,062.39
|
| Rate for Payer: Ohio Health Group HMO |
$22,212.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,923.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,850.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,181.07
|
| Rate for Payer: PHCS Commercial |
$28,431.70
|
| Rate for Payer: United Healthcare All Payer |
$26,062.39
|
|
|
ECH CEM FEM CMP BOW SZ12 R 300
|
Facility
|
OP
|
$29,616.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,850.13 |
| Max. Negotiated Rate |
$28,431.70 |
| Rate for Payer: Aetna Commercial |
$22,804.59
|
| Rate for Payer: Anthem Medicaid |
$10,185.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,100.75
|
| Rate for Payer: Cash Price |
$14,808.17
|
| Rate for Payer: Cigna Commercial |
$24,581.57
|
| Rate for Payer: First Health Commercial |
$28,135.53
|
| Rate for Payer: Humana Commercial |
$25,173.90
|
| Rate for Payer: Humana KY Medicaid |
$10,185.06
|
| Rate for Payer: Kentucky WC Medicaid |
$10,288.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,285.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,856.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,884.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,389.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,062.39
|
| Rate for Payer: Ohio Health Group HMO |
$22,212.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,923.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,850.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,181.07
|
| Rate for Payer: PHCS Commercial |
$28,431.70
|
| Rate for Payer: United Healthcare All Payer |
$26,062.39
|
|
