|
ECHELON PP HA SZ 11 190MM
|
Facility
|
IP
|
$29,350.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,815.51 |
| Max. Negotiated Rate |
$28,176.08 |
| Rate for Payer: Aetna Commercial |
$22,599.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,893.06
|
| Rate for Payer: Cash Price |
$14,675.04
|
| Rate for Payer: Cigna Commercial |
$24,360.57
|
| Rate for Payer: First Health Commercial |
$27,882.58
|
| Rate for Payer: Humana Commercial |
$24,947.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,067.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,660.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,805.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,828.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,012.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,870.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,098.52
|
| Rate for Payer: PHCS Commercial |
$28,176.08
|
| Rate for Payer: United Healthcare All Payer |
$25,828.07
|
|
|
ECHELON PP HA SZ 11 190MM
|
Facility
|
OP
|
$29,350.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,815.51 |
| Max. Negotiated Rate |
$28,176.08 |
| Rate for Payer: Aetna Commercial |
$22,599.56
|
| Rate for Payer: Anthem Medicaid |
$10,093.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,893.06
|
| Rate for Payer: Cash Price |
$14,675.04
|
| Rate for Payer: Cigna Commercial |
$24,360.57
|
| Rate for Payer: First Health Commercial |
$27,882.58
|
| Rate for Payer: Humana Commercial |
$24,947.57
|
| Rate for Payer: Humana KY Medicaid |
$10,093.49
|
| Rate for Payer: Kentucky WC Medicaid |
$10,196.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,067.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,660.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,805.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,296.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,828.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,012.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,870.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,098.52
|
| Rate for Payer: PHCS Commercial |
$28,176.08
|
| Rate for Payer: United Healthcare All Payer |
$25,828.07
|
|
|
ECHELON PP HA SZ 12 190MM
|
Facility
|
IP
|
$29,350.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,815.51 |
| Max. Negotiated Rate |
$28,176.08 |
| Rate for Payer: Aetna Commercial |
$22,599.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,893.06
|
| Rate for Payer: Cash Price |
$14,675.04
|
| Rate for Payer: Cigna Commercial |
$24,360.57
|
| Rate for Payer: First Health Commercial |
$27,882.58
|
| Rate for Payer: Humana Commercial |
$24,947.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,067.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,660.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,805.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,828.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,012.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,870.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,098.52
|
| Rate for Payer: PHCS Commercial |
$28,176.08
|
| Rate for Payer: United Healthcare All Payer |
$25,828.07
|
|
|
ECHELON PP HA SZ 12 190MM
|
Facility
|
OP
|
$29,350.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,815.51 |
| Max. Negotiated Rate |
$28,176.08 |
| Rate for Payer: Aetna Commercial |
$22,599.56
|
| Rate for Payer: Anthem Medicaid |
$10,093.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,893.06
|
| Rate for Payer: Cash Price |
$14,675.04
|
| Rate for Payer: Cigna Commercial |
$24,360.57
|
| Rate for Payer: First Health Commercial |
$27,882.58
|
| Rate for Payer: Humana Commercial |
$24,947.57
|
| Rate for Payer: Humana KY Medicaid |
$10,093.49
|
| Rate for Payer: Kentucky WC Medicaid |
$10,196.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,067.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,660.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,805.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,296.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,828.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,012.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,870.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,098.52
|
| Rate for Payer: PHCS Commercial |
$28,176.08
|
| Rate for Payer: United Healthcare All Payer |
$25,828.07
|
|
|
ECHELON PP HA SZ 13 190MM
|
Facility
|
IP
|
$29,350.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,815.51 |
| Max. Negotiated Rate |
$28,176.08 |
| Rate for Payer: Aetna Commercial |
$22,599.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,893.06
|
| Rate for Payer: Cash Price |
$14,675.04
|
| Rate for Payer: Cigna Commercial |
$24,360.57
|
| Rate for Payer: First Health Commercial |
$27,882.58
|
| Rate for Payer: Humana Commercial |
$24,947.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,067.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,660.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,805.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,828.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,012.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,870.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,098.52
|
| Rate for Payer: PHCS Commercial |
$28,176.08
|
| Rate for Payer: United Healthcare All Payer |
$25,828.07
|
|
|
ECHELON PP HA SZ 13 190MM
|
Facility
|
OP
|
$29,350.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,815.51 |
| Max. Negotiated Rate |
$28,176.08 |
| Rate for Payer: Aetna Commercial |
$22,599.56
|
| Rate for Payer: Anthem Medicaid |
$10,093.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,893.06
|
| Rate for Payer: Cash Price |
$14,675.04
|
| Rate for Payer: Cigna Commercial |
$24,360.57
|
| Rate for Payer: First Health Commercial |
$27,882.58
|
| Rate for Payer: Humana Commercial |
$24,947.57
|
| Rate for Payer: Humana KY Medicaid |
$10,093.49
|
| Rate for Payer: Kentucky WC Medicaid |
$10,196.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,067.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,660.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,805.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,296.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,828.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,012.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,870.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,098.52
|
| Rate for Payer: PHCS Commercial |
$28,176.08
|
| Rate for Payer: United Healthcare All Payer |
$25,828.07
|
|
|
ECHELON PP HA SZ 14 190MM
|
Facility
|
IP
|
$29,350.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,815.51 |
| Max. Negotiated Rate |
$28,176.08 |
| Rate for Payer: Aetna Commercial |
$22,599.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,893.06
|
| Rate for Payer: Cash Price |
$14,675.04
|
| Rate for Payer: Cigna Commercial |
$24,360.57
|
| Rate for Payer: First Health Commercial |
$27,882.58
|
| Rate for Payer: Humana Commercial |
$24,947.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,067.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,660.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,805.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,828.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,012.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,870.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,098.52
|
| Rate for Payer: PHCS Commercial |
$28,176.08
|
| Rate for Payer: United Healthcare All Payer |
$25,828.07
|
|
|
ECHELON PP HA SZ 14 190MM
|
Facility
|
OP
|
$29,350.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,815.51 |
| Max. Negotiated Rate |
$28,176.08 |
| Rate for Payer: Aetna Commercial |
$22,599.56
|
| Rate for Payer: Anthem Medicaid |
$10,093.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,893.06
|
| Rate for Payer: Cash Price |
$14,675.04
|
| Rate for Payer: Cigna Commercial |
$24,360.57
|
| Rate for Payer: First Health Commercial |
$27,882.58
|
| Rate for Payer: Humana Commercial |
$24,947.57
|
| Rate for Payer: Humana KY Medicaid |
$10,093.49
|
| Rate for Payer: Kentucky WC Medicaid |
$10,196.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,067.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,660.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,805.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,296.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,828.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,012.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,870.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,098.52
|
| Rate for Payer: PHCS Commercial |
$28,176.08
|
| Rate for Payer: United Healthcare All Payer |
$25,828.07
|
|
|
ECHELON PP HA SZ 15 190MM
|
Facility
|
OP
|
$29,350.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,815.51 |
| Max. Negotiated Rate |
$28,176.08 |
| Rate for Payer: Aetna Commercial |
$22,599.56
|
| Rate for Payer: Anthem Medicaid |
$10,093.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,893.06
|
| Rate for Payer: Cash Price |
$14,675.04
|
| Rate for Payer: Cigna Commercial |
$24,360.57
|
| Rate for Payer: First Health Commercial |
$27,882.58
|
| Rate for Payer: Humana Commercial |
$24,947.57
|
| Rate for Payer: Humana KY Medicaid |
$10,093.49
|
| Rate for Payer: Kentucky WC Medicaid |
$10,196.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,067.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,660.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,805.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,296.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,828.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,012.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,870.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,098.52
|
| Rate for Payer: PHCS Commercial |
$28,176.08
|
| Rate for Payer: United Healthcare All Payer |
$25,828.07
|
|
|
ECHELON PP HA SZ 15 190MM
|
Facility
|
IP
|
$29,350.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,815.51 |
| Max. Negotiated Rate |
$28,176.08 |
| Rate for Payer: Aetna Commercial |
$22,599.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,893.06
|
| Rate for Payer: Cash Price |
$14,675.04
|
| Rate for Payer: Cigna Commercial |
$24,360.57
|
| Rate for Payer: First Health Commercial |
$27,882.58
|
| Rate for Payer: Humana Commercial |
$24,947.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,067.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,660.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,805.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,828.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,012.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,870.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,098.52
|
| Rate for Payer: PHCS Commercial |
$28,176.08
|
| Rate for Payer: United Healthcare All Payer |
$25,828.07
|
|
|
ECHELON PP HA SZ 16 190MM
|
Facility
|
OP
|
$29,350.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,815.51 |
| Max. Negotiated Rate |
$28,176.08 |
| Rate for Payer: Aetna Commercial |
$22,599.56
|
| Rate for Payer: Anthem Medicaid |
$10,093.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,893.06
|
| Rate for Payer: Cash Price |
$14,675.04
|
| Rate for Payer: Cigna Commercial |
$24,360.57
|
| Rate for Payer: First Health Commercial |
$27,882.58
|
| Rate for Payer: Humana Commercial |
$24,947.57
|
| Rate for Payer: Humana KY Medicaid |
$10,093.49
|
| Rate for Payer: Kentucky WC Medicaid |
$10,196.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,067.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,660.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,805.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,296.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,828.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,012.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,870.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,098.52
|
| Rate for Payer: PHCS Commercial |
$28,176.08
|
| Rate for Payer: United Healthcare All Payer |
$25,828.07
|
|
|
ECHELON PP HA SZ 16 190MM
|
Facility
|
IP
|
$29,350.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,815.51 |
| Max. Negotiated Rate |
$28,176.08 |
| Rate for Payer: Aetna Commercial |
$22,599.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,893.06
|
| Rate for Payer: Cash Price |
$14,675.04
|
| Rate for Payer: Cigna Commercial |
$24,360.57
|
| Rate for Payer: First Health Commercial |
$27,882.58
|
| Rate for Payer: Humana Commercial |
$24,947.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,067.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,660.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,805.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,828.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,012.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,870.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,098.52
|
| Rate for Payer: PHCS Commercial |
$28,176.08
|
| Rate for Payer: United Healthcare All Payer |
$25,828.07
|
|
|
ECHELON PP HA SZ 17 190MM
|
Facility
|
IP
|
$29,350.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,815.51 |
| Max. Negotiated Rate |
$28,176.08 |
| Rate for Payer: Aetna Commercial |
$22,599.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,893.06
|
| Rate for Payer: Cash Price |
$14,675.04
|
| Rate for Payer: Cigna Commercial |
$24,360.57
|
| Rate for Payer: First Health Commercial |
$27,882.58
|
| Rate for Payer: Humana Commercial |
$24,947.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,067.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,660.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,805.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,828.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,012.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,870.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,098.52
|
| Rate for Payer: PHCS Commercial |
$28,176.08
|
| Rate for Payer: United Healthcare All Payer |
$25,828.07
|
|
|
ECHELON PP HA SZ 17 190MM
|
Facility
|
OP
|
$29,350.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,815.51 |
| Max. Negotiated Rate |
$28,176.08 |
| Rate for Payer: Aetna Commercial |
$22,599.56
|
| Rate for Payer: Anthem Medicaid |
$10,093.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,893.06
|
| Rate for Payer: Cash Price |
$14,675.04
|
| Rate for Payer: Cigna Commercial |
$24,360.57
|
| Rate for Payer: First Health Commercial |
$27,882.58
|
| Rate for Payer: Humana Commercial |
$24,947.57
|
| Rate for Payer: Humana KY Medicaid |
$10,093.49
|
| Rate for Payer: Kentucky WC Medicaid |
$10,196.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,067.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,660.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,805.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,296.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,828.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,012.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,870.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,098.52
|
| Rate for Payer: PHCS Commercial |
$28,176.08
|
| Rate for Payer: United Healthcare All Payer |
$25,828.07
|
|
|
ECHELON PP HA SZ 18 190MM
|
Facility
|
IP
|
$29,350.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,815.51 |
| Max. Negotiated Rate |
$28,176.08 |
| Rate for Payer: Aetna Commercial |
$22,599.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,893.06
|
| Rate for Payer: Cash Price |
$14,675.04
|
| Rate for Payer: Cigna Commercial |
$24,360.57
|
| Rate for Payer: First Health Commercial |
$27,882.58
|
| Rate for Payer: Humana Commercial |
$24,947.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,067.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,660.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,805.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,828.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,012.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,870.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,098.52
|
| Rate for Payer: PHCS Commercial |
$28,176.08
|
| Rate for Payer: United Healthcare All Payer |
$25,828.07
|
|
|
ECHELON PP HA SZ 18 190MM
|
Facility
|
OP
|
$29,350.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,815.51 |
| Max. Negotiated Rate |
$28,176.08 |
| Rate for Payer: Aetna Commercial |
$22,599.56
|
| Rate for Payer: Anthem Medicaid |
$10,093.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,893.06
|
| Rate for Payer: Cash Price |
$14,675.04
|
| Rate for Payer: Cigna Commercial |
$24,360.57
|
| Rate for Payer: First Health Commercial |
$27,882.58
|
| Rate for Payer: Humana Commercial |
$24,947.57
|
| Rate for Payer: Humana KY Medicaid |
$10,093.49
|
| Rate for Payer: Kentucky WC Medicaid |
$10,196.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,067.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,660.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,805.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,296.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,828.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,012.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,870.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,098.52
|
| Rate for Payer: PHCS Commercial |
$28,176.08
|
| Rate for Payer: United Healthcare All Payer |
$25,828.07
|
|
|
ECHELON PP HA SZ 19 190MM
|
Facility
|
OP
|
$29,350.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,815.51 |
| Max. Negotiated Rate |
$28,176.08 |
| Rate for Payer: Aetna Commercial |
$22,599.56
|
| Rate for Payer: Anthem Medicaid |
$10,093.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,893.06
|
| Rate for Payer: Cash Price |
$14,675.04
|
| Rate for Payer: Cigna Commercial |
$24,360.57
|
| Rate for Payer: First Health Commercial |
$27,882.58
|
| Rate for Payer: Humana Commercial |
$24,947.57
|
| Rate for Payer: Humana KY Medicaid |
$10,093.49
|
| Rate for Payer: Kentucky WC Medicaid |
$10,196.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,067.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,660.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,805.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,296.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,828.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,012.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,870.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,098.52
|
| Rate for Payer: PHCS Commercial |
$28,176.08
|
| Rate for Payer: United Healthcare All Payer |
$25,828.07
|
|
|
ECHELON PP HA SZ 19 190MM
|
Facility
|
IP
|
$29,350.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,815.51 |
| Max. Negotiated Rate |
$28,176.08 |
| Rate for Payer: Aetna Commercial |
$22,599.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,893.06
|
| Rate for Payer: Cash Price |
$14,675.04
|
| Rate for Payer: Cigna Commercial |
$24,360.57
|
| Rate for Payer: First Health Commercial |
$27,882.58
|
| Rate for Payer: Humana Commercial |
$24,947.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,067.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,660.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,805.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,828.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,012.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,870.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,098.52
|
| Rate for Payer: PHCS Commercial |
$28,176.08
|
| Rate for Payer: United Healthcare All Payer |
$25,828.07
|
|
|
ECHELON PP HA SZ 20 190MM
|
Facility
|
IP
|
$29,350.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,815.51 |
| Max. Negotiated Rate |
$28,176.08 |
| Rate for Payer: Aetna Commercial |
$22,599.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,893.06
|
| Rate for Payer: Cash Price |
$14,675.04
|
| Rate for Payer: Cigna Commercial |
$24,360.57
|
| Rate for Payer: First Health Commercial |
$27,882.58
|
| Rate for Payer: Humana Commercial |
$24,947.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,067.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,660.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,805.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,828.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,012.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,870.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,098.52
|
| Rate for Payer: PHCS Commercial |
$28,176.08
|
| Rate for Payer: United Healthcare All Payer |
$25,828.07
|
|
|
ECHELON PP HA SZ 20 190MM
|
Facility
|
OP
|
$29,350.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,815.51 |
| Max. Negotiated Rate |
$28,176.08 |
| Rate for Payer: Aetna Commercial |
$22,599.56
|
| Rate for Payer: Anthem Medicaid |
$10,093.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,893.06
|
| Rate for Payer: Cash Price |
$14,675.04
|
| Rate for Payer: Cigna Commercial |
$24,360.57
|
| Rate for Payer: First Health Commercial |
$27,882.58
|
| Rate for Payer: Humana Commercial |
$24,947.57
|
| Rate for Payer: Humana KY Medicaid |
$10,093.49
|
| Rate for Payer: Kentucky WC Medicaid |
$10,196.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,067.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,660.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,805.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,296.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,828.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,012.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,870.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,815.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,098.52
|
| Rate for Payer: PHCS Commercial |
$28,176.08
|
| Rate for Payer: United Healthcare All Payer |
$25,828.07
|
|
|
ECHELON THIN SHAFT REAMER 23MM
|
Facility
|
IP
|
$4,463.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$580.32 |
| Max. Negotiated Rate |
$4,285.42 |
| Rate for Payer: Aetna Commercial |
$3,437.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.90
|
| Rate for Payer: Cash Price |
$2,231.99
|
| Rate for Payer: Cigna Commercial |
$3,705.10
|
| Rate for Payer: First Health Commercial |
$4,240.78
|
| Rate for Payer: Humana Commercial |
$3,794.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,660.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,294.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,339.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,928.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$892.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,383.83
|
| Rate for Payer: PHCS Commercial |
$4,285.42
|
| Rate for Payer: United Healthcare All Payer |
$3,928.30
|
|
|
ECHELON THIN SHAFT REAMER 23MM
|
Facility
|
OP
|
$4,463.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$580.32 |
| Max. Negotiated Rate |
$4,285.42 |
| Rate for Payer: Aetna Commercial |
$3,437.26
|
| Rate for Payer: Anthem Medicaid |
$1,535.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.90
|
| Rate for Payer: Cash Price |
$2,231.99
|
| Rate for Payer: Cigna Commercial |
$3,705.10
|
| Rate for Payer: First Health Commercial |
$4,240.78
|
| Rate for Payer: Humana Commercial |
$3,794.38
|
| Rate for Payer: Humana KY Medicaid |
$1,535.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,550.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,660.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,294.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,339.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,565.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,928.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$892.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,383.83
|
| Rate for Payer: PHCS Commercial |
$4,285.42
|
| Rate for Payer: United Healthcare All Payer |
$3,928.30
|
|
|
ECHELON THIN SHAFT REAMER 24MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
ECHELON THIN SHAFT REAMER 24MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
ECHELON THN SHFT REAMER 22.5MM
|
Facility
|
IP
|
$4,463.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$580.32 |
| Max. Negotiated Rate |
$4,285.42 |
| Rate for Payer: Aetna Commercial |
$3,437.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.90
|
| Rate for Payer: Cash Price |
$2,231.99
|
| Rate for Payer: Cigna Commercial |
$3,705.10
|
| Rate for Payer: First Health Commercial |
$4,240.78
|
| Rate for Payer: Humana Commercial |
$3,794.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,660.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,294.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,339.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,928.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$892.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,383.83
|
| Rate for Payer: PHCS Commercial |
$4,285.42
|
| Rate for Payer: United Healthcare All Payer |
$3,928.30
|
|
